Improving operational efficiency in Acute NHS providers Chair & - - PowerPoint PPT Presentation

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DH – Leading the nation’s health and care

Improving operational efficiency in Acute NHS providers

Chair & Chief Executive Network 8th December 2015

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Adjusted Treatment Cost

Vision is to enable trusts to have a dashboard of real-time indicators they can use to keep a relentless focus on their costs

• Health systems all over the world,

be they ‘for profit’ or ‘not for profit’, have adopted a common set of metrics to monitor and improve the performance of their individual hospitals (hospitals in the US have been operating such metrics for 50 years)

• By examining methodologies

around the world, we have now developed a metric for NHS providers - the ‘Adjusted Treatment Cost’ (ATC)

• Accept it wont be perfect from

day one but will develop over time

• The most important thing is how

the metric is used…………. ATC Ideal

Apply to real-time variable cost data:

• Workforce
• Drugs
• Clinical supplies

Enabling trusts to monitor daily/ weekly/monthly/ yearly and compare with peers

Meantime

1.Accounts data (annual snapshot) 2.Reference cost data 3.Any other national data we can get our hands on e.g.

• Workforce ESR data
• Pharmacy systems
• ERIC Estates data
• Procurement systems

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We worked iteratively with the cohort of 32 trusts to examine productivity on the ground in detail

Initially we focused on the areas of high expenditure:

• Workforce
• Pharmacy
• Pathology
• Radiology
• Estates & Facilities Management
• Procurement (non-pay expenses)

Application of ATC revealed significant variation between trusts and a potential £5bn savings opportunity……

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For example in workforce…..

Wide variation in workforce management practices:

• Long term training / workforce planning
• Productive time / contact time
• Skill mix
• Rotas

National Averages Trust A Trust B 52 weeks x 37.5 hours 1950 hours 1950 hours 1950 hours Annual Leave 300 hours 298 hours 302 hours Maternity 68.25 hours 57 hours 95.5 hours Sickness 68.25 hours 48.5 hours 70 hours Training 48.75 hours 30 hours 32 hours Assumed Availability 1465 hours 1517 hours 1451 hours

Required vs Actual Nursing Hours Per Patient Day

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For example in doctor productivity, inputs and outcomes

Example: Trauma and orthopaedics data for six anonymised trusts

Data indicates significant differences between trusts

• n output/activity per Doctor

But we need to balance this analysis with other ‘quality patient-based measures’, for example:

• Average length of stay
• Procedure cancellations
• Delayed transfers of care
• Revision rates
• Annual number of procedures undertaken by surgeons
• Infection rates
• Use of technology (e.g. fixation methods i.e. cemented vs un-cemented technology, and 10A evidence rated products)

We are now collecting data on these to combine with productivity measures so we can model what good looks like

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All non-specialist acute trusts have now received a pack setting out their estimated efficiency opportunity

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Definition of a Delayed Transfer A SitRep delayed transfer of care from acute

• r non-acute (including community and mental

health) care occurs when a patient is ready to depart from such care and is still occupying a bed. A patient is ready for transfer when:

• a. A clinical decision has been made that

patient is ready for transfer AND

• b. A multi-disciplinary team decision has been

made that patient is ready for transfer AND

• c. The patient is safe to discharge/transfer.

Several trusts have highlighted the problem of lost income from cancelled operations due to a lack of beds

Question: How many beds are blocked by patients who are medically fit to go elsewhere on any one day? If those beds could be released what would you do with them (e.g. fill them with income or take them out?

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Trust boards need the tools to do the job………… The Model Hospital and Dashboards

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Executive level dashboard (draft example)

Nursing Hours per Patient Day

Patients People Money

Current month National average National leader Peer benchmark 1 month trend

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Developing the metrics example: NHPPD

• Changing nature of healthcare needs a unit
• f measurement that is simple and flexible
• NHPPD is a simple calculation by which we

can match hours needed to hours available

• Required NHPPD are adjusted for acuity

and dependency (e.g. ward type)

• Allows management to make decisions i.e.

the cost consequences of overstaffing and understaffing are visible and can be acted upon

• Allows assessment of utilisation of nursing

resources on a daily, weekly, monthly basis

• NHPPD has become a common unit of

measurement all over the world

Testing throughout September, October and December 2015, including:

• 1 month daily data collection across Carter Trusts plus a

number of FTs (36 Trusts in total)

• 1 month data collection using the Safer Nursing Care Tool

to understand the impact of acuity and dependency (7 Trusts in total)

• ‘Deep dive’ with 5 Trusts, undertaken on a daily basis using

a acuity and dependency tool to capture data ‘real time’

• 3 month data review of UNIFY and HES data to establish if

data can provide a NHPPD measure and compare to the 1 month daily data collection These data collection methods mapped against international benchmarks will provide the information to set the ‘NHPPD Next steps

• Identify most appropriate way of collecting, analysing and

presenting NHPPD data

• Develop model hospital dashboards and tools
• Ensure NHPPD stands alongside other indicators of staffing

sufficiency and quality

• Consider application of NHPPD principles to other staff

groups such as AHPs

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We intend to provide trusts with data through 3 different lenses

Which is why we have been gathering data by specialty, by workforce, by function (e.g. pathology, pharmacy, procurement)

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We are working closely with our partners including the

• rganisations that will take this work forward

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Next steps

• Final report in January 2016
• Three areas of focus:

– Tightening the grip – Collaboration/sharing – Delayed transfers

• Potential mandatory reporting
• NHPPD
• Procurement
• NED training
• Support infrastructure
• Transition to NHS Improvement
• Transparency and CQC in Autumn 2016