Case Studies & References by Areas of Work

The Outpatient Departments (OPD) is one of the largest areas within a hospital and can service thousands of patients a day depending on the size of the Trust and is a major generator of revenue with high overheads. Although the specialties may differ the productivity issues that occur are usually very similar and may include under-utilised slots, unnecessary additional spend or out of date clinic templates.

Meridian works with Trusts to ensure that Outpatient Departments are fully utilised in line with the demand of each specialty and installs robust reporting systems that delivers actionable information to managers enabling better decision making in resource allocation and approving additional capacity.

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The challenges and obstacles that are seen across inpatients units tend to be similar across the country, in that patients are routinely being kept on the wards beyond the point at which they are clinically ready. These are down to operational barriers that prevent discharge. The most commonly occurring are: Failure to find appropriate accommodation, lack of funding for ongoing patient care, lack of engagement with the community teams and a lack of escalation when these barriers are unresolvable within the wards. This causes the need for additional private beds to be procured, costing trusts thousands of pounds every bed night, and running into the millions annually.

Meridian works with the trusts to ensure that these operational tasks are focused on from day one, to ensure they have been resolved long before the patient is clinically ready for discharge. Ensuring daily allocation and review of these tasks ensure that they either get completed or can be escalated when everything has been done in the power of the wards. Developing an effective and clear escalation process alongside this ensures that senior management step in when they are required, at the earliest opportunity. Ensuring patients are in the beds when they need it, and discharged when they don’t, means patients aren’t routinely sent to out of area and private beds around the country, and that when a patient needs a bed, one is available. There is also a significant cost reduction as a result.

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Community Services are increasingly important to the health and social care economy, both in terms of improved access to care for patients and service users and providing additional funding/revenue streams for Trusts. Staff and managers deployed in the community are often working autonomously and are unaware of specific targets in terms of contacts per day, let alone commissioned contractual targets.

Meridian works with Trusts and Local Authorities to install robust management controls thus ensuring that all staff achieve their targeted activity daily/weekly/monthly. Working with the executive down through the management hierarchy, to set fair and transparent expectations of a day’s work. Teams are right-sized through demand and capacity analysis then modelled to optimise quality patient care within cost-effective, productive resource utilisation. A single streamlined information reporting suite provides every level of the organisation with the correct data to inform management decision making and demonstrate measurable improvement.

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Meridian primarily works within the Clinical teams within Trusts, however Corporate Services carry a lot of the same issues we see within clinical settings. This includes ensuring the correct management structures are in place to correctly deliver their services, inclusive of reviewing management spans and portfolio size and intrinsic difficulties with holding several types of services. Having efficient corporate services ensures decision making is more concise and manages overall management cost as they can account for a lot of an overall budget.

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The growing demand for Mental Health Services in the community has presented a number of challenges for Trusts. The complexity of the demand requires a high degree of co-ordination and planning to ensure that treatment is delivered during the pathway journeys in a way that optimises the available resources and skills of the different mental health professionals involved at the right time and with the required amount of support. Community Heath Teams have worked successfully with Meridian to reduce operational constraints such as managing the physical facilities to book and run clinics, to maximise the face to face contact time with patients, ensure that caseloads are fairly and equitably balanced and that capacity and the skills available are used to deliver defined service standards. This reduces waiting lists and supports the delivery of standardised treatment to vulnerable groups.

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Emergency departments are the front-line service for unplanned care and work within the most highly publicised targets in the NHS. They are consistently challenged with matching their patient throughput and being able to accurate schedule staff around the peak periods within the department. As the front line for the Trust, having a productive service treatment process is critical to success further down the line.

Meridian works with Trusts to ensure that the right amount of staff, made up of the correct skill mix to meet the expected throughput of patients are scheduled in and shifts are being according to best meet the needs of the service. Once you have the department running correctly, then you must ensure that moving patients more efficiently through ED, where are the potential knock on effects within the Trust as patients aren’t being held for as long. Also, expectations can be produced against all patient pathways to ensure there is an expected deliverable against each patient coming to the department.

 

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The issues with bed management teams (BMT) tends to be the same across the country: Time wasted on inappropriate admissions, an absence of clarity on the availability of beds within the wards they oversee, and a lack of follow up on the patients in private beds elsewhere in the country. This leads to patients in private beds being admitted longer than necessary, patients being sent out of area when there are available beds within the trust, and time being spent doing a triage function that should have been completed prior to reaching the bed management team.

Meridian will work with all elements in the chain (Typically the BMT, Inpatients wards and Crisis teams) to ensure that there is an effective gatekeeping procedure in place, to prevent inappropriate admissions. This will free up time for the BMT to focus on those currently out of area, to repatriate much earlier, and also to spend time on the wards and get a much better picture of what is happening on the wards. This allows them to have a clearer idea of upcoming discharges, which can be planned around the waiting lists for admission, and prevent private bed usage.

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Including scanning and subsequent reporting of scans, Radiology is one of the primary diagnostic areas within the hospital environment and covers A&E, Inpatients, Outpatients and Theatres. In scanning, problems can include a lack of utilisation of the machines where as in reporting; a lack of capacity to report on theses scans, both of which are the result of a lack of control systems in place to identify and remedy operational issues.

Meridian works with Trusts to ensure that there is robust performance report is in place to highlight available capacity and the productivity of its workforce. Once in place these reports alongside appropriate management actions will increase the productivity of reporting and machines leading to productivity improvements and a reduction in any potential additional spend.

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We see a lot of the same issues across the country in Administration departments: No expectations, under-bookings and late changes, amongst others. The work focuses on ensuring there is the right amount of staff working in the right areas to meet the needs of the Trust. The output from the work completed within most Administration drives a huge amount of the potential income for the Trust, as they are responsible for ensuring all available capacity is booked, with the best potential for those patients to attend their respective appointments.

Meridian works with Administration departments to ensure they are correctly set up to book all available slots. This is inclusive of setting fair and equitable expectations within the department, for areas such as bookings, referral processing and phone calls attended to. Having effective admin processes ensures the patient experiences a good process prior to their appointment taking place and starts the patient journey on a positive footing.

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Productivity is as pertinent in non-clinical services as in others. Meridian focus on forecasting, planning and allocating work to the most appropriate persons. In Portering, capacity and demand work is crucial along with understanding the balance of workflow; this service plays such an integral role on the efficient running of many clinical departments and hence should be afforded similar attention. Our focus is on making sure that we have the right resources available at the right times and ensuring that supporting services do just that…
Catering is another service where the origins of productivity can come to the fore. From menu design to portion control, we have seen real improvements within Catering services reducing the cost per portion and ensuring that levels of quality remain at the highest levels every hour of every day.

References

Pharmacy is a broad and complex clinical speciality that is frequently overlooked in the world of productivity consultancy. From enhanced clinical services in Community Pharmacies, optimised team efficiencies in acute hospital and primary care settings to deliver best care for patients or the delivery of cost improvement plans through improved procurement of medicines, productive pharmacy has a crucial role within our healthcare economy.

Here at Meridian, we tackle pharmacy innovatively. We have increased profitability in Community Pharmacies by working with the Board and senior managers to strengthen management control systems. Meridian has also delivered cash releasing savings by accelerating compliance with national procurement guidelines for high cost/high volume medicines. We reconfigured skill mix and staffing rosters in the acute setting to ensure the right resource is in the right place at the right time providing services at the right quantity, quality and cost.

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Pathology testing is vital to most areas of healthcare, providing insights into how to manage a patient’s condition, either by confirming a diagnosis, managing medication or monitoring the progression of a condition. NHS Improvement have identified potential efficiencies circa £200m/p.a. through consolidation of pathology services across NHS England.

Meridian works with Trusts to centralise vital pathology services, reaping economies of scale for equipment and pooling of management, clinical and technical expertise across sub-specialities. Developing management information systems that provide live data on inputs and outputs created a flexible and dynamic service. Capacity and demand analysis informed robust crewing guides and efficient staff rostering to eliminate unwarranted overtime and on-call duties to deliver cash savings.

 

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