Kent, Surrey and Sussex HFMA The Difference a Day Makes: Working Day One Reporting
& Model Hospital - A NEW Mo Farah moment for
Bolton FT ……. Continuous improvement
Andrew Chilton, Associate Director of Finance James Coleman, Finance Business Partner - Acute Adult Division
Running Order
Part 1 – Introduction to Bolton and Why Working Day One
Part 2 – Delivering Working Day One
Part 3 – The Difference a Day Makes
Questions
Part 4 – Introduction to Model Hospital
Part 5 – Building the model
Part 6 – Using the model
Questions
“To be the best NHS Finance, Information
and Procurement Service delivering value
to enable excellent patient care”
Working Day One Reporting
WD1
Day 6
Day 30 Day 1
Day 15
WD1
Day 6
Day 30 Day 1
Day 15
WD1
Day 6
Day 30 Day 1
Day 15
WD1
Day 6
Day 30 Day 1
Day 15
But the worst part was……
Exercise
• What would be the barriers both in your department and Trust to achieving working day 1 reporting?
Financial information is often out of date by the time it
is reported to senior managers and budget holders.
Our September results and budget statements were issued by 5:00pm on Monday 3rd October.
Why do we have budget statements?
Framing the Challenge
Is a budget statement – A detailed bank reconciliation?
Moving Keith
Is a budget statement – A call to action?
How we approached WD1
• Planning end-to-end
• Practical workshops
• Clear communications
The Key to Success
Discipline
Communication
Supportive
Materiality
Empowerment
Hard-work Together
Month Finishes
Working Day 1 Board Meeting
Meetings with
Divisional Directors of Operations
Paper to Execs Budget Statements
Issued
Actions • …………………………… • …………………………… • ……………………………
30th October WD-1
2nd November 3nd November WD2 26th November 13th November WD10
Actions • …………………………… • …………………………… • ……………………………
We can now deliver actions within days rather than months; delivering value to enable the delivery of excellent patient care.
What difference has it made?
Enjoy the Success
Further info is available through a Webinar on
https://www.brighttalk.com/webcast/7323/206555
Model hospital - A NEW Mo Farah moment
for Bolton FT ……. Continuous improvement
Bolton NHS Foundation Trust – Model Hospital
The Bolton Model Hospital timeline 8 week plan
▪ Introduce to specialty leads to ensure understanding of the process
▪ Schedule meetings – and share timeline of process. Hold initial meetings with divisional management leads
▪ Identify roles and responsibilities
4 weeks
0 1
Finance phase – building the model
2
5 weeks
3
Discuss challenges, opportunities and options
6 weeks
4 5
Agree on preliminary recommendations
8 weeks
Send initial data requests and introduce Programme
Specialty review outputs from model
Divisional management agree preliminary recommendations
7 weeks
▪Map the high level pathway
▪Gather information relating to the pathway
▪Agree specialty related improvement questions
▪Build model to validate opportunities
▪Prepare specialty summary paper
▪Meeting to review information gathered and improvement opportunities with divisional management team
▪Review meeting with specialty teams;
▪Clinical lead
▪Business lead
▪ Lead nurses
▪HOD
Goals:
▪Agreement on challenges and opportunities for the specialty based on model
▪ List of possible options to address each challenge or opportunity
▪Clear view of next steps
▪Develop plans
▪Develop QIAs
Goals:
▪Plans written
▪QIA completed
▪Consensus on strategic recommendations that the specialty
▪Clear view of next steps and how progress against plan will be monitored
▪Meet with Divisional management team to present progress
Weekly catch up with finance BI/PMO
Background work Weekly specialty lead team
meetings (and background work) Specialty team
meeting
Weekly specialty lead team meetings
Specialty team meeting Se
ttin
gs
Ste
ps Update ICIP
tracker
▪ Follow-up delivery plans
Bolton Model Hospital
Task
• Map out simple Pathway for Elective Urology patient
• Time – 5 minutes
1. Map the Pathway – How is value created and delivered?
Only at a high level
2. Gather existing information
Task
• What improvement ideas do you have?
4. Identify improvement opportunities – Pull the team through the process
Improvement opportunities Value
Outpatients
1 If respiratory increases the number of patients seen in outpatients by 5%
£47,000
2
If respiratory reduce DNA rates to Trust target £36,000
3
If the new to follow up rate is improved by 20% £144,000
4
If admin and clerical costs are reduced by 10%* £13,000
Diagnostics
6
If the specialty has not undergone a review of drug usage in the last 2 years, drug expenditure could be reduced by 10%*
£61,000
7 If the specialty has not undergone a review of investigation and diagnostics in the last 2 years, expenditure could be reduced by 10%*
£32,000
Inpatients
8
If length of stay is reduced by 1.5 days £579,000
9 If you reduce nursing sickness to Trust target – agency spend can be reduced
£5,000
10 If respiratory wards eliminate unqualified nursing agency spend £22,000
11 If you reduce nursing agency spend by 50% £11,000
12 If you reduce medical agency spend by 50% £10,000
Total savings opportunity: £960,000
Deliver
Improvement Opportunities
Improvement Opportunities - Outpatients Value Proposed Value
3 If the new to follow up rate is improved by 20% £144,000 £144,000
To establish new to follow up ratio data per clinic and present this to all clinicians and discuss our ideas for change. Proposals • Change clinical correspondence letter template to include a clear plan at end of consultation to identify reason
for follow up and FU appointment is focused. • Develop a discharge leaflet with advice on instructions of what to do if condition changes to give confidence to
patients • To complete a snapshot audit, initially in COPD clinic, re follow up ratio and purpose of appointment and
develop action plan to address concerns. • Share and educate regarding the access policy with all clinical staff undertaking clinics
Improvement Opportunities Improvement Opportunities - Diagnostics Value Proposed value
6 If the speciality has not undergone a review of drug usage in the last 2years, drug expenditure could be reduced by 10%*(if reviewed in 12 months opportunities
should be 5%)
£61,000 Estimate- £30,000
The service has already made some savings last year with medications. Proposals • To ensure all prescribers only prescribe a max of 4 weeks of medication for out patients. Put posters up in the department
to advise patients & design a leaflet for patients that will be distributed with meds. • To stop repeat prescribing for meds that should be supplied by the GP where safe to do so. • To display a trajectory of savings in prescribing for named drugs within respiratory department. – visual management • Use alternative cheaper products - posters of items and costs to be available in each clinic room and wards. • Identify top 10 costs of prescribing in Thoracic, to track impact and ensure this is visible in the department. • Review prescribing against best practice guidelines
Improvement Opportunities Improvement Opportunities – In patients Value Proposed values
8 If length of stay is reduced by 1.5 days £579,000 Estimate - £475,000
• To ensure safeguard and enhanced staffing is completed correctly and timely • Ensure PDD’s are entered onto the board above the beds so it can be shared with patients and their families. • Utilising e-roster to ensure adequate nursing staffing so nurse can attend ward rounds consistently • Limited cover from junior medical staff - start process of looking into fair distribution of medical juniors • No cover for juniors when on training, shortage of medical cover - business case for middle grade. • Ensure ward clerks are updating the ward patients on LE2.2 to be under the correct speciality to ensure coding is
correct and a system is in place for when ward clerks are absent • To review ward clerk hours of work and cover arrangements • Audit in-patients with a primary diagnosis of COPD to see if there are more patients that can be discharged earlier
with BART if BART had increased capacity.
Improvement Opportunities Improvement Opportunities – In patients Value Proposed values
8 If length of stay is reduced by 1.5 days
£579,000 Estimate - £475,000
• We can increase use of day case in PIU or new pleural room on D4 eg CT guided biopsy, pleural effusion taps and drains, Bronchoscopy (currently done as in-patients if no capacity on M/F lists, IV antibiotics (1 dose and discharge to home IV). The middle grade post will greatly help deliver this consistently
• To monitor implementation of delaying prescribing of inhalers and requesting patients bring these in from home • Address barriers to discharging patients home once medically fit. Division to review the discharge team in order to
coordinate discharge. • Ward staff busy first thing with IV antibiotics/nebs/NIV that limited time available for discharge moves. To review
time this is done and move to night staff • Lack of juniors doctors at weekend can delay weekend discharges. To ensure advanced planning for this.
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