An acute hospital in the Midlands experienced a rapid decline of over 15 percentage points in 4-hour performance over a 6-month period, as well as an increase in stranded and super-stranded patients.
A principal driver of this deterioration was ineffective ways of working creating friction within and between teams, contributing to low staff morale. However, hospital leadership also wanted to understand the challenges in more detail.
4-hour performance dropped by over 15 percentage points over a 6-month period
Undertook a comprehensive diagnostic to create One Version of the Truth (OVT) and determine focus areas for transformation
Established new planning processes including introducing three site management meetings per day to identify discharges by ward and generate daily forecast of bed supply
Revised ways of working on hospital wards following NHS policy and guidelines (e.g., SAFER). Developed new hospital policy including: Multi-Disciplinary Team engagement on twice daily board rounds, and ward-specific daily discharge targets
Worked with health and community teams to streamline processes for the efficient transfer of care from the hospital to the community.
Performance increased to 86%, close to the national average, despite increasing attendances
Reduced in-patient average length of stay, especially within the super-stranded patient cohort (length of stay >21 days)
Non-elective discharges increased 13%. This was driven by an 18% increase in medical non-elective discharges