Improving emergency care, Midlands 2019

Northampton General Hospital


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
percentage points

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

  • Qualitative: Listening events, 1:1 discussion, targeted interviews
  • Quantitively: Analysis e.g., of inpatient data

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.


4-hour performance

Performance increased to 86%, close to the national average, despite increasing attendances

Length of stay
patients over 21 days

Reduced in-patient average length of stay, especially within the super-stranded patient cohort (length of stay >21 days)

Patient flow
non-elective discharges
medical non-elective discharges

Non-elective discharges increased 13%. This was driven by an 18% increase in medical non-elective discharges

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