Increased 4-hour ED performance to 86%, close to the national average, despite increasing attendances
Decrease in inpatient average length of stay for patients staying over 21 days
Increase in discharge rate, improving patient flow through the hospital
Over a six-month period, the acute hospital saw a decline of more than 15 percentage points in 4-hour performance, alongside a significant increase in the number of ‘stranded’ and ‘super-stranded’ patients (those staying over 7 and 21 days), highlighting deteriorating patient flow across the hospital. A principal driver of this deterioration was ineffective ways of working creating friction within and between teams, contributing to low staff morale. Hospital leadership wanted to understand the challenges in more detail.
TN was commissioned to creating a robust diagnostic of hospital performance, highlighting areas of opportunity to reverse the negative trend. Building on this diagnostic, the hospital further commissioned TN to develop and implement new ways of working to drive performance improvement.
- Conducting a comprehensive diagnostic: Created one version of the truth to determine focus areas for transformation from qualitative listening events, downloading discussions and targeted interviews as well as quantitative analysis of ED and inpatient data
- Establishing new planning processes: Introduced three site management meetings per day to identify discharges by ward and generate daily forecast of bed supply
- Revising hospital ways of working: Adapted hospital ward practices to follow NHS policy and guidelines (e.g., SAFER) by developing policies including twice daily MDT board rounds, and ward-specific daily discharge targets
- Streamlining discharge processes: Worked with health and community teams to efficiently transfer patients from hospital to community care
