Length of Stay Review

• 16% reduction in average length of stay
• 26% hour reduction in medical average length of stay
• Ambulance waiting times reduced by 44%
• 14% reduction in long waits in outpatients
• Operating theatre utilisation increased by 24% to 74%
• New standardised operating procedures designed and all staff trained
• Improved visualisation in the form of dashboards that are fed by the EDIS system
• New process for generating, reviewing, prioritising & implementing new ideas
• Improvement sheets on display showing individual benefits from ideas implemented
• Start of a ‘Continuous Improvement’ mindset within the Trust

We worked with one of the biggest NHS Trusts in the country, covering two sites with over 2,000 beds, 12,000 staff and 96 wards.

Phase One: Diagnostic – Identify Opportunities

Working with the trust, we established a project team to identify opportunities, track all activities and understand the benefits of proposed changes. Training was provided to the internal team on Lean and improvement methodologies with a focus on knowledge transfer to ensure project sustainability. Then as a team all patient categories and processes impacting on length of stay were reviewed and priorities established and agreed with clinical staff and executive sponsors.

Phase Two: Change Trials – Confirm benefits and concepts of change

Starting with a gap ‘state of readiness’ analysis, we introduced project teams with each project being assigned a project champion (department) a project lead (service improvement support) and team members made up of different levels of support. Using a PDSA cycle, trials of improvement activities were run. Taking place during the normal working day, robust planning and control was required to mitigate potential issues. Data was captured analysed to review results against agreed measures.

Phase Three: Rollout and implementation – realise benefits and ensure sustainability

New MDT service with the appropriate decision maker closer to the front door (minors), which reduced inappropriate tests, reduced patient Length Of Stay (LOS) and increased the value added time for the patient, whilst a new streaming process to incorporate new protocols, utilise skill mix and support for staff (all) which resulted in, improving standardisation, reducing patient waiting time and reducing stress levels for staff through better support.