In February 2015, BDCFT commissioned a productivity analysis of the Adult Mental Health Acute Inpatient Wards and embarked upon a 19 week transformation programme to improve the flow of patients through the service, decrease the Average Length of Stay and reduce Out Of Area placements.
Wards based both at Lynfield Mount Hospital and Airedale Centre for Mental Health provide a safe environment to assess and treat people with acute mental health needs, until they are well enough to return home. In addition to nursing and medical care, each ward has a comprehensive programme of occupational and psychological therapy to support people in their recovery.
In February 2015, BDCFT commissioned a productivity analysis of the Adult Mental Health Acute Inpatient Wards and embarked upon a 19 week transformation programme to improve the flow of patients through the service, decrease the Average Length of Stay and reduce Out Of Area placements.
The inpatient teams fully embraced this and took direct ownership. The commitment, enthusiasm and drive of these teams to improve quality of care and treatment by working in a productive, efficient way has had a dramatic effect on how the wards operate, and the total patient experience.
Historically the wards have had over 100% occupancy of our acute beds and, as a result, averaged around 6 people placed out of area per day. With an annual OOA spend of £1.8m. With productivity experts the teams have worked together to introduce revised processes to inpatient areas that have significantly reduced occupancy and it has been 12 months since a patient was admitted to an out of area bed.
The In-patient teams through a workshop approach outlined in an open and professional way the systems and process that were not working and causing barriers to care and flow on the ward, the wards invited productivity experts into the ward environments to enable their daily work and procedures to be monitored in a transparent way. This allowed the teams to analyse how efficiently they work across all the wards which started to shape new systems eliminate duplication and streamline working and provide value for money care and treatment.
The new processes and controls have been developed to maximise the potential in these areas of control and improve overall efficiency on the ward. The objective of the system and management techniques is to control and improve service delivery of the Adult Acute Inpatient Wards, manage the length of stay of patients on the wards, ensure they are being discharged in a timely manner and to improve the flow of patients through the service, thus freeing up bed capacity for emergency admissions to avoid Out Of Area placements.
The ward staff have developed these processes, changing practice within hand overs, ward rounds and staff meetings. One key development the staff have implemented is a ‘10 point’ discharge tracker. At the first clinical review after admission all patients are set a target discharge date. Variance against this date is then monitored within nursing handovers and tasks allocated to prevent any delay. The 10 points required to enable discharge includes mental state, accommodation, mental health act, finances. Each of these is RAG rated to focus task management.
The primary objective has been achieved through the ward staff owning and developing these systems and applying them on a consistent basis. Through this diligent approach they have achieved a more efficient value for money way of working by improving overall productivity and introducing effective discharge planning & reviewing. Only acutely unwell patients are being treated on the wards and the patients not in crisis anymore are transferred to an environment more appropriate in their situation.
Throughout this project full engagement with Service Users around the development of the discharge tracker tool. Staff’s feedback was constantly sought through workshops and daily system change experiences.
From an Information and Technology perspective early engagement around IT devices to have enabled a bigger impact immediately around instant communication and tracking through smart boards would have been helpful.
A change in culture around the way Consultant Psychiatrists and nursing staff operate was the biggest challenge, changing systems and processes within a ward environment takes a high degree of clinical leadership and teams operating together with a collective vision and objectives, staff on a daily basis had their practice observed.
Through visible leadership across all the wards was a key to overcome the challenges, very early success enabled staff and service users see the benefits of this new way of working to enable a positive flow, as well as a constant approach was adopted and close working with the teams
The new systems and controls are part of the wards systems and controls, that are monitored on a daily basis through daily discharge meetings and handovers, a weekly dashboard is in place that reports to executive team around, admissions, discharges, lengths of stay so early escalation is in place if required. On a monthly basis it’s part of Quality and Safety meetings and reported to committees within the organisation. The ward staff are in completely owning this and are working together with consultants to ensure patient experience is paramount and from the day of admission service users are part of working to their discharge date and clear communication around any potential barriers are addressed early to ensure delays are eliminated.
The benefits and outcomes have been varied and many are intangible, relating to behaviour, changes in culture across the wards around assessment and treatment and renewed and refreshed staff perceptions. However, if the real-time results of the project were to be quantified, they would speak for themselves
Over 12 months without an OOA treatment, the longest period without an OOA since information about OOA began to be collated in 2012. This followed an average of 62 bed nights per week before the project commenced, with a saving of 1.8 million
All people requiring acute care have been treated locally; The lowest recorded bed occupancy (with leave) in the last five financial years; Introduction of discharge planning from the point of admission; Robust review process of patients on the wards; Staff working together, strong relationships and partnerships formed outside of the ward environment with primary care, Local Authority and housing providers, IHTT and CMHT to enhance care and treatment and safe discharge; Clear vision and objectives that all staff are proud to work to around efficient care that is value for money.
We have had a number of Trusts visit and have shared a wealth of information including the tools we are using, we have taken the time to meet and discuss how we have taken this approach the benefits and outcomes.
We have had a Minister’s visit, NHS England, and national mental health leads, we have presented recently at the Department of Health around our turnaround on Delayed Transfers of Care and how we have achieved this. We are part of DoH policy development of reducing OOA placements and advising around how this can be achieved.
