Background:
A large territorial Health Trust in Scotland, serving a diverse mix of urban, rural, and island communities, was facing growing operational and financial pressures. With over 150 community-based teams, increasing patient demand, and persistent staffing vacancies, there was an urgent need to improve how workforce capacity aligned with real-world service demand.
The Trust partnered with Meridian Productivity to assess and enhance its use of clinical time—aiming to deliver more patient care, reduce unwarranted variation, and avoid unnecessary cost, all without increasing headcount.
Analysis:
Meridian undertook a detailed diagnostic across community services, engaging executive leaders, service managers, and frontline staff. The review included live observational studies, performance data analysis, and feedback from across the system.
The diagnostic uncovered five key challenges:
Uneven workloads across teams with similar remits
Historic rostering models hiding underused clinical time
Limited visibility over patient-facing activity
Inconsistent use of workforce planning tools
Lack of real-time data to support operational decisions
Without a standardised system of oversight and control, service leaders found it difficult to respond dynamically to pressure, leading to inefficiencies and delays in care.
Implementation:
Over a focused 12-week period, Meridian introduced a tailored Management Control System (MCS) designed to deliver transparency, accountability, and consistency across all 150 teams.
Key interventions included:
Fair Day’s Work Allocation Tool to equitably distribute workload based on agreed planning norms
Weekly TWNW (This Week/Next Week) meetings and dashboards to monitor utilisation and variance
Weekly Operating Reports tracking workforce deployment, patient contact time, and areas of non-compliance
Role-specific planning templates by service and region
Training for team leaders on interpreting data, managing variance, and forecasting demand
Reinforced governance structures to embed change and track progress across the system
The programme also enhanced integration between community, inpatient, and diagnostic services—improving whole-system coordination.
Results:
The outcomes were both significant and sustainable:
£8.27 million in annualised financial opportunities identified
16.6:1 return on investment, achieved by optimising use of current staff and systems
Marked increase in patient-facing time, reducing delays and improving service access
System-wide visibility of workforce deployment, enabling dynamic response to changing demand
Cultural shift towards accountability and proactive planning, embedded through tools and governance
Conclusion
This Scottish Health Trust demonstrated that even across a complex, geographically dispersed system, it is possible to deliver measurable gains in efficiency, performance, and patient care—without new investment.
By focusing on workforce alignment, operational control, and cross-team collaboration, the Trust created a robust foundation for long-term improvement in community healthcare delivery.
