Service: Process Modelling & Design

Case Study

Reduction of ICB Waiting List through Pooling of Resources

Home Performance Improvement Process Modelling & Design
Published Read Time 2 minutes

Akeso were engaged to work closely with the Clinical and Operational teams from the 9 hospitals who deliver Endoscopy Services in the ICB to model a shared waiting list for Endoscopy and identify opportunities to pool resources across neighbouring hospitals across the region to treat patients more quickly and reduce the waiting list.

INSIGHT

The demand for Endoscopy Diagnostics is increasing year-on-year driven by increases in Gastroenterology and Colorectal Surgery. As of April-24, the NHS waiting list for Gastroenterology-related Diagnostics stood at almost 170k nationally.

From an ICB perspective, pooling of resources across a regional Health system can be a key means to addressing the growing waiting list for a given clinical service, particularly for day case / walk in activity such as Endoscopy. It also maximises utilisation of existing resources. Our work with Health providers across the NHS suggests that capacity increases of over 20% can be achieved through pooling of waiting lists and associated resources.

To be successful however, there are a number steps that must be taken beyond the simple aggregation of the waiting list across a group of providers including: (1) building a detailed understanding the cohort of patients awaiting diagnostics / treatment, (2) understanding potential challenges and barriers to patients accessing and receiving care at an alternative provider and (3) developing strategies and plans for how these can be overcome.

ACTION

  • Akeso conducted a full service ‘as-is’ review, presented through data collation, validation and analysis, which provided a network wide view of current service, including waiting lists, capacity, activity, and workforce;
  • Scenario modelling was then performed utilising the current network status and changeable inputs and outputs allowing for simulation testing to understand the potentials of service optimisation, in terms of absolute waiting list reduction, additional income and costs;
  • A series of business cases were then developed exploring specific options available to individual Trusts as well as the network as a whole. This incorporates options to clear the current backlogs / waiting lists, as well as how to future proof the service in accordance with demand predictions;
  • A final interactive dashboard tool was developed to be used for short-medium term service planning, providing real-time service and workforce optimisation based on Trust needs.

RESULTS

We found that the ICB in question could realise a capacity increase of 20% through the pooling of waiting lists and resources. We also proposed and developed a series of recommendations, on supply and demand side, to help them address potential barriers to patients accessing available with alternative providers in the region.

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Adam Thwaites

Director
Case Study

£1m Savings Delivered for ICS Procurement Collaborative

Home Performance Improvement Process Modelling & Design
Published Read Time 2 minutes

We supported the design, development, and implementation of a collaborative procurement function across North East London, including the delivery of over £1m in savings on non-pay spend, service specific ICS category strategies, and standardised processes

INSIGHT

North East London (NEL) are one of the largest integrated care systems across England, formed of five Trusts, with a total third-party, non-pay spend over £1.2bn.

Akeso were engaged to analyse this spend and deliver £1m in cost savings efficiencies through the collaborative model, in addition to designing a new operating model for procurement services, develop collaborative category strategies, and transform singular service provisions into integrated delivery models.

ACTION

  • Akeso developed an initial opportunity assessment analysing the ICS’s total £1.2bn non-pay spend (60% non-clinical products and services; 19% clinical products and services; and 21% on drugs)
  • From this, Akeso delivered a series of collaborative opportunity recommendations, which ranged from 3rd-party spend cost reduction initiatives to yield ‘hard’ benefits, to ‘softer’ service enhancement and capability development initiatives
  • We developed an overarching governance and reporting structure to track opportunities and value delivery and designed a detailed workstream and category management structure and supported value-delivery projects including; CIPs, procurement exercises, strategy design, and business case development across clinical products and services, estates and facilities, corporate services, and IT, data, and systems

RESULTS

Across the programme we developed and implementation a new collaborative operating model, including an overarching collaborative governance structure, delivered over £1m in collaborative annual savings, developed approved service specific business cases, consistent ways of working, processes, standardised templates, and the upskilling of NEL team members

NEL team

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Chris Robson

Chris Robson

Managing Partner
Insight

Akeso’s response to the NHS Workforce Plan: Translating national targets at a local level through productivity and retention

Home Performance Improvement Process Modelling & Design
Published Read Time 2 minutes

The highly anticipated NHS Workforce Plan was released last week, with many weighing in to give their assessment. The main themes of ‘train’, ‘retain’, and ‘reform’ have generally been well received but as with all grand plans, what matters now is execution.

Akeso highlights three key areas that will be instrumental in the successful execution of the ambitious plan.

The commitment to support recruitment across a wide range of healthcare roles is commendable – with a target of an additional 300,000 clinicians by 2036/2037, including 170,000 nurses and 60,000 doctors[1]. This is based on top-down national-level modelling to steer the strategy in the right direction.

To translate these targets, it is essential that ICBs and their regional partners develop their own local service plans. These plans must be founded on locally validated capacity and demand, informed by assumptions linked to innovative, technology-enabled workforce models.

This is a long-term plan to expand workforce and will require a productivity increase of up to 2% to fund new initiatives. [2]This investment will be needed if we are to realise the ambition of “delivering care closer to home while avoiding costly admissions, achieving operational excellence, and reducing administrative burden through better technology and infrastructure.’’ [3]Therefore, it is imperative ICBs and NHS organisations can deliver achievable Financial Improvement Plans, which depend on two main factors:

  • a sustainable investment in NHS estate and equipment
  • use of technology and digital innovation (with consideration for funding availability)

Perhaps the most challenging initiative is to retain staff, starting by making the NHS an attractive place to work. In 2022, the reported level of absence due to sickness was 5.6% (well above the public sector average), which equates to 27 million days across 2022 and 74,500 full-time equivalent staff.

Unsurprisingly, morale is also declining, with nearly a third of NHS staff thinking about leaving their organisation[4]. Further research on why this is the case is urgently needed but, in the meantime, immediate solutions to retain staff must be implemented.

However, the plan does little to address the elephant(s) in the room: pay, compensation and terms and conditions. The recent strikes by doctors and nurses highlight that significant progress is needed in these areas.

Equally important is attracting and retaining non-clinical roles, particularly in medical technology, to support use of artificial intelligence, robotics and automation diagnostic solutions and treatments to deliver improved, efficient and patient-focused care.

Read the full NHS Long Term Workforce Plan 2023 on NHS England’s website.

References

[1] NHS Long Term Workforce Plan (england.nhs.uk) – page 21

[2] NHS England » Record recruitment and reform to boost patient care under first NHS Long Term Workforce Plan

[3] https://htn.co.uk/2023/06/30/train-retain-reform-nhs-englands-workforce-plan-published/

[4] https://www.nhsemployers.org/articles/nhs-staff-survey-2022-analysis-results

 

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Chris Robson

Chris Robson

Managing Partner
Insight

Delivering improvements to discharge practices

Home Performance Improvement Process Modelling & Design
Published Read Time 2 minutes

At Akeso, we are extremely saddened by the current healthcare crisis caused by the unprecedented NHS capacity constraints which is threatening the lives of so many of us this winter.

According to the latest discussions at No10, the Government’s response to this challenge is an improved discharge to medically fit patients that is enabled by solutions such as virtual wards.

Although programmes such as discharge to assess (D2A) and virtual wards are not new, we welcome the recognition that doing the same but (slightly) better is not going to solve the problem this winter, or in fact any winter going forward.

According to the NHS, there are 12,809 patients fit for discharge who are occupying beds which could be available to save lives. In an analysis by HSJ, 7,000 virtual ward beds exist, but only half of them are occupied.

So, what is causing this disconnect and why aren’t virtual wards that are in place delivering results?

We believe that the system is struggling with uptake due to the lack of mechanisms that offer a partnership platform between healthcare professionals, who must continue to care for patients uninterruptedly, and specialist partners that can facilitate discharge programmes and implement functional virtual wards.

Akeso can offer such a mechanism and work with Trusts to deliver improvements to discharge practices and implement technology enable virtual wards. We can enable this by offering:

  • Demand and capacity analysis to enable care pathway remodelling.
  • Workforce optimisation and empowerment to support discharge and remote care.
  • Project management to ensure programmes and solutions offer evidenced results.
  • Comprehensive guide and methodology which takes a Trust ‘step-by-step’ through business case, implementation, effective management and scaling of virtual wards.

A medically graded virtual ward technology which offers proven discharge results by reducing length of stay of medically fit patients.

We are here to talk and help Trusts and ICSs with a free assessment and actionable plan that can offer results right now!

Together with HSJ and Masimo we’ll be hosting a roundtable which will focus on Virtual Wards and Discharge in March. Watch this space for updates!

Insight

Discharge to Assess: Where the rubber hits the road

Home Performance Improvement Process Modelling & Design
Published Read Time 4 minutes

There are seven key steps to generating traction and improving the discharge-to-assess pathways. These are a mix of technical development in respect of discharge-to-assess (such as the establishment of agreed patient strata) and the generic challenges of change management (such as engagement, communication, and skills building). The first 3 phases (which are the planning phases) will be broadly sequential but the delivery phases can be run in parallel, as the figure below indicates:

  1. Establish a core guiding coalition: build a small group with representation from the acute, community, and social care teams who will act as the core accountable team.  This team will guide the program to ensure time and resources are well spent.
  2. Understand where you are and why, in order to build the local case for change, including:
    1. Maturity model completion:  complete the self-assessment complete the self-assessment of the Akeso discharge-to-assess maturity model to show where the current system is already fit-for-purpose and where changes need to be made
    2. Internal analysis on “no right to reside” and other key metrics (such as risk adjected length of stay, and elective and cancer waitlist variation) to give additional local relevance
  3. Define the overall model of discharge-to-assess which best suits your location, given the NHS England guidance, known exemplar case studies, and the results from the maturity assessment, including:
    1. Patient stratification: be clear on which patients fall under the category of relevant for discharge-to-assess and how/when they are highlighted
    2. Workforce models: with community and social care partners, develop a sustainable workforce model which meets local population health needs and is achievable with local resources
    3. High-level process: agree what the high-level discharge-to-assess process is which balances discharge efficacy with clinical risk
    4. Technology aspirations: be clear on where technology will help (with both current and potential future systems)
  4. Launch the program of change: take the time to engage with a broad range of stakeholders to lay out the overall aims of the discharge-to-assess program and how it contributes to the aims of the organisation, including:
    1. Vision expected outcomes, and expected timelines: establish what success looks like from an outcome perspective (for example, number of patients remaining in the acute setting with no right to reside; 7-day re-admission rate
    2. Leadership team & resource: ensure that there is sufficient resource ring-fenced to deliver and manage the work, and that senior leaders are actively supportive
    3. Govern and track effectively: embed discharge-to-assess governance within the existing board and directorate mechanisms to ensure its visibility
    4. Communicate plans and progress
      Healthcare team working
    5. Establish portfolio of work: the maturity matrix and case study examples will suggest a wide range of work to be done. It’s important that any portfolio and phasing is chosen which reflects the need and resources available, including:
      1. Pilot and refine: choose 1-2 specific patient groups or services on which to pilot the design where there is both a clear need and support for discharge-to-assess; learn from these pilots and moderate the initial designs as necessary and remember that “getting it right first time” doesn’t apply in this situation! Learning and adapting is part of the process. To aid this, you may want to instigate regular learning cycles (such as Plan-Do-Study-Act) and daily management meetings
      2. Embed and roll-out: broaden the scope of patients and services for whom discharge-to-assess is available, building on the learnings from the pilots (in 1 or 2 further phases)
      3. Business case development: when investment is necessary, put together a robust business case (using recognised approaches such as the HM Treasury 5-case model)N.B. when engaging in technology-driven change, it is very important to ensure that practices are “digital-ready” before they become digitised so take the time to improve ways of working before the technology is available. It is value destroying to embed poor current practice within a new system. Many organisations, therefore, go through two phases of transformation: pre-tech and post-tech availability
    6. Train, support and reward those involved in delivering this new way of working. The pilots will establish local standard methods and learnings. These should be documented and shared with groups involved in subsequent phases of roll-out. The pioneers who drive the change should be given the reward and profile that it deserves.
    7. Communication progress, learnings, and successes, including regular broad updates and particular highlights. Appreciation of the efforts of everyone involved could be included within monthly and annual recognition systems. 

Keeping people healthy and returning them to their usual home after a hospital spell is a key ambition for all those involved in health and social care. There is an even greater imperative to do so given the pressures on the system now (be they workforce, elective backlog or capacity constraints). Discharge-to-assess, enabled by technology is one of the ways in which we can work together to ease this problem. Many organisations are already making this work. We hope that these four articles can encourage more progress for the benefit of citizens and health and social care workers alike.

For a free Discharge-to-assess consultation, please contact us for an initial conversation with our consultants.

Insight

I’m a patient get me out of here

Home Performance Improvement Process Modelling & Design
Published Read Time 4 minutes

As the first article in this series highlighted, too many people are spending too long in an acute setting, well beyond the point of clinical need.  One in six beds in these hospitals are occupied by patients who would be much better served in their usual place of residence. 

Furthermore, with an elective backlog of almost seven million, one in eight people across England are currently waiting for operations and other types of care, and ambulance response times are at an all-time worse. Unprecedented operational challenges are anticipated for the winter period.

Therefore, it is imperative that post-discharge short-term health and care services increase in capacity, improve in quality and effectiveness, and can support system flow for both urgent and emergency care and elective recovery. Indeed, the new Prime Minister Rishi Sunak has made tackling delayed discharges a key priority and ensuring there is an available workforce in the community to deliver timely care.

To support the safe and timely discharge of patients from hospital and to ensure that people continue to receive the care and support they need after they leave, a wide range of supportive material has been produced grounded in research and practical learnings of existing Discharge to Assess (D2A) models.  The Department of Health and Social Care (DHSC), Local Government Association and the Association of Directors of Adult Social Services (ADASS) have all released guidance for organisations and local systems on implementing best practice Discharge to Assess and community support. These include:

  • Managing transfers of care – A High Impact Change model: Local Government Association (2020)
  • Hospital discharge and community support guidance: Department of Health and Social Care (2022)
  • Quick Guide: Discharge to Assess:  ADASS (2021)

The most recent guidance was outlined in July 2022 by The National Health and Social Care Discharge Taskforce. Based on their learnings from NHS and Social Care pilots, 10 best practice initiatives have been identified. 100-day discharge challenge – Improvement – NHS Transformation Directorate (england.nhs.uk).

Maturity Matrix

From the various national guidelines, alongside discussions working with a number of organisations and systems around D2A, Akeso has developed a D2A and community support maturity matrix. This helps organisations (for example, acute trusts, local authorities and ICSs) to understand what needs to be in place for D2A to work well.  There are 36 factors across 7 different domains which all need to be in place,

The 7 domains, as part of a high-level D2A operating system are set out below:

Figure 1 – D2A operating system
Figure 1 D2A operating system

Key ‘essential’ D2A priorities we recommend organisations focus on, which can be delivered in a phased approach to implementation include:

  • Short term (0-2 months) Discharge Planning: Setting up consistent processes, ensuring early multi-disciplinary engagement and planning for discharge on admission.  This is something that organisations could be progression before winter.
  • Medium/longer term (2-6+) Integrated Team Working: Potentially has the biggest impact for patients and covers 25% of D2A best practice initiatives.  Includes systems optimising workforce capacity acute, community and social care settings, for example from joint team working and a pooled workforce
  • Medium/Longer term (2-6months+): Virtual Wards:  Implementation of a tech enabled virtual ward, would require the appropriate infrastructure, funding and resources to be in place, which has shown to improve patient experience and nursing and clinical workforce productivity

As set out in the D2A operating model, D2A priorities would need to be underpinned by robust leadership and governance, and vitally, the appropriate D2A system-wide culture.

Using this framework, we have also developed a more detailed assessment matrix which allows any organisation to assess their current level of maturity against these factors. Details of what “best practice” looks like across these different factors are shown below.

D2A and Community Support leading practice

Table 1: D2A and Community Support leading practice
Table 1: D2A and Community Support leading practice (text in blue represents the 10 best-practice D2A initiatives identified by the Health and Social Care Taskforce).

We recommend that, as an organisation continues to develop its D2A capability, it uses this D2A maturity matrix to inform the programme of work that is required.  To request Akeso’s D2A maturity matrix, and if your organisation requires any support in implementing D2A best practice initiatives, please contact Mike Meredith.

In addition, based on the D2A maturity matrix, Akeso have put together a short D2A survey for D2A leaders, Organisations and system leaders.  Organisations and systems completing the survey will receive a tailored benchmarking report against their peers.

The next article in this series will focus on how technical innovations, for example tech enabled virtual wards, can improve patient experience and discharge effectiveness, followed by a D2A implementation guide.

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Martin Shiderov

Martin Shiderov

Associate Director
A door to redesigning a one of a kind NHS shared service facility
Case Study

Redesigning a one-of-a-kind NHS shared service facility

Home Performance Improvement Process Modelling & Design
Published Read Time 2 minutes

We’ve helped shape the NHS Wales Shared Services Partnership (NWSSP)’s long-term use and vision of a one-of-a-kind NHS physical shared service facility.

NHS Wales Shared Services Partnership – Potential

Challenge

In 2018, Welsh Government acquired a 275,000 sq.ft. warehouse in Newport to store core medical supplies as part of the EU Exit preparations. Longer term, the Welsh Government intended that the warehouse would be a strategic investment for Wales. NWSSP were responsible for defining the future shared service opportunity and asked us to develop a strategic outline case, demonstrating that the facility could generate broad benefit to Wales and be financially sustainable in the future.

NHS Wales Shared Services Partnership – Opportunities

Solution

We understood the importance of maximising the warehouse’s potential to contribute towards NHS Wales and broader government strategic priorities. We broke the project into four phases to determine how best to respond to the opportunity.

The first was to engage with key stakeholders to identify how everyone might benefit from the warehouse. The second was to evaluate service options that could deliver clinical, social, operational, and financial benefits for the Welsh Healthcare system. The third was to outline how the warehouse space could be best configured to support different functions and balance a range of benefit opportunities. And the final phase was to draft the strategic outline case and recommend the preferred future option for the Welsh government’s approval.

NHS Wales Shared Services Partnership – ROI

Results

The NWSSP Executive approved the preferred option and ring-fenced ongoing funding, with the adopted approach estimated to generate over £8m in benefits over the next 10 years. The recommended configuration will serve as a cornerstone for key Welsh strategies including the Wellbeing of Future Generations Act, Taking Wales Forwards and A Healthier Wales. It also provides an opportunity to fast track and accommodate initiatives already underway, including the Transforming Access to Medicines Programme.

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Peter Marshall

Peter Marshall

Associate Director
Optimisation of diagnostic specimen collection network
Case Study

Optimisation of Diagnostic Specimen Collection Network

Home Performance Improvement Process Modelling & Design
Published Read Time 2 minutes

NHS Pathology Laboratories in England process nearly 800m blood specimens per year. Of these, c. 50m tests (6%) originate from the 7,800 GP practices (av. 6,440 tests per GP practice) the others originate from Hospital Provider network and other sources.

We were engaged by a number of Pathology Service Providers, individual providers and regional collaborations, (the largest handling up to 1.75m samples from almost 400 GP practices and community locations operating Phlebotomy services) to assess, design and implement efficiency improvements to the Community Specimen Collection Network.

Insight

Like any network, the Specimen Collection Network is dynamic and evolves over time. It quickly begins to change as individual GP practices and community care providers makes changes to their practice locations, opening hours and service locations and new providers enter the market providing Phlebotomy services.

We used a number of Network Modelling methodologies and tools, combined with our sector experience, to understand the current network and design a solution which best met the customer and Laboratory requirements (better service, reduced collection cost per reported test result, etc.).

Action

Our consultants analysed the volumetric, activity and financial data from across the network to baseline costs. We engaged key stakeholders in the Pathology Laboratory and sample of key GP and community customers to understand the current situation, key challenges and customer requirements.

We led the engagement with local and national Transport and Technology providers to identify relevant solution options. We modelled a range of solution options and developed a recommendation which best met the customer requirements. We led the implementation of our recommendations which included the development of specifications, competitive tenders and the implementation of change management providing the client with a toolset to track benefits and monitor volumetric going forward.

Results

We delivered savings ranging from 9% to 17.5% (reduced collection cost per reported test result, reduced carbon footprint) through the consolidation and redesign of collection routes and times whilst keeping within the critical four hour collection-to-test window. We improved the customer service and provided enhanced sample traceability (sample collection to test) and further ensured that the efficiencies are sustainable and would enable the Pathology provider to keep apace with future developments of the network.

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Scott Healy

Managing Partner
Laboratory Diagnostics
Case Study

Laboratory Diagnostics Non-pay Cost Reduction Programme

Home Performance Improvement Process Modelling & Design
Published Read Time 2 minutes

NHS Pathology Laboratories in England process nearly 800m blood specimens per year. Working on behalf of a vanguard Pathology Services Collaboration (following the Lord Carter report) involving 8 Hospital providers, over 400 community sites and over 28m reported tests, we were engaged to evaluate current testing costs, baseline non-pay, diversity and opportunities to consolidate Diagnostic and Laboratory Equipment portfolio, Consumables and Services with the aim of delivering efficiencies and cost reductions across the newly formed Pathology operation.

Insight

As in any post-merger cost reduction situation, the key to success is to rapidly bring together data and information from a number of disparate sources and organisations and develop a working view of the merged reality that allows the client to understand which areas of spend are addressable, which are committed and for how long, the opportunities to drive value and what needs to happen to enable and maximise these opportunities.

We used a number of methodologies and tools, including Opportunity Assessment, Financial Modelling, Category Workbooks for Pathology Equipment, Consumables and Services and Programme Planning to understand the current situation, identify cost reduction opportunities and recommend a cost reduction programme.

Action

Our consultants gathered and analysed spend, contract and activity data from across the newly merged organisations to baseline costs. We engaged key stakeholders in the Pathology Laboratories and Hospital Customers to understand the current situation, key challenges and customer requirements.
We led the engagement with leading providers, incumbent and competitor, to understand leading technologies/ solutions and identify relevant value opportunities. We modelled a range of programme delivery options and developed a recommendation which best met the client requirements.

We led the implementation of our recommendations which included development of specifications, sourcing and implementation of Managed Pathology Services for Biochemistry platforms and consolidation and sourcing of Research Consumables. We also provided the client with a toolset to track benefits.

Results

We delivered a savings programme that yields annualised savings averaging 8% on a total non-pay spend of £22m. Sub-category initiatives delivered savings ranging from low single digit to high double digits.

We supported the implementation of Hub and Spoke strategy delivering a Diagnostics Platform strategy that consolidates and standardises test platforms over three years.

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Chris Robson

Chris Robson

Managing Partner