From Lord Carter’s 2015 report through to Scan4Safety in 2017 mandating GS1 and PEPPOL compliance, the call for improved patient safety through better inventory management prior to and following the COVID-19 pandemic has long been stated. Yet despite these initiatives, many Trusts are still grappling with a lack of the right systems and processes to enable achievement of these aims.
In June 2023 the government published a mandate to address the most urgent needs for the NHS. Amongst the three key priorities outlined, a target was set for all Trusts to adopt barcode scanning of high-risk medical devices and submit data to the national, mandatory Medical Device Outcome Registry, by March 2024.
Nine months later and we’ve seen several programmes and initiatives kick start with the aim of supporting the advancement of patient safety through barcode scanning, including the NHS Supply Chain inventory management programme, which Akeso supported to mobilise, as well as more recently the reinvigoration of the Scan4Safety programme.
Whilst there has been notable investment, a significant number of Trusts do not have the right inventory management systems and processes in place to enable Scan4Safety effectively. Based on our analysis, we understand that almost half of acute Trusts in England do not currently have sufficient capability to meet the mandate requirements set out through barcode scanning capabilities. Furthermore, we estimate that only 30% of acute Trusts have the capability to manage inventory at the point of care and therefore meet Scan4Safety requirements.
Untapped Benefits within Inventory Management
Given the significant gap between Trusts with and without barcode scanning capability, there is an opportunity to tap into the wide-reaching benefits that optimised inventory management can achieve – from improvement to patient safety, greater traceability and operational productivity, to cash-releasing supply chain efficiencies. The below outlines some of the expected benefits Scan4Safety through inventory management optimisation can bring.
Based on our analysis we estimate that the average Trust could achieve the following key benefits:
Equivalent of 5 clinical WTE released back to critical patient facing activities
One-time cash releasing benefit of c. £1 million and recurring financial benefit of £50,000-£100,000
Wider supply chain and logistics efficiencies through greater visibility and control of ordering as well as improved supplier relationship management
However, despite this, the reality can be quite different for many Trusts. With common barriers, including siloed working across functions and Trust data maturity, understanding the landscape and due consideration to the change required is critical to the success of achieving positive and sustainable change.
Key Success Criteria
Based on our experience we have summarised the key success criteria that are required to effectively optimise inventory management through barcode scanning. Together these key success criteria make up the core fundamentals which enable inventory management optimisation best practice.
How We Can Support You
Akeso have worked hand-in-hand with a number of Trusts from business case development and benefits modelling through to implementation and benefits realisation, including most recently the establishment of the NHS Supply Chain inventory management programme. As such we are well positioned to support Trusts and ICBs navigate the current landscape and support accelerate your Scan4Safety proposition.
Sign up to access our free ‘how to’ guide for further information on how healthcare organisations can accelerate Scan4Safety through inventory management optimisation:
Olivia is an experienced consultant in the private and public healthcare sector specialised in delivering tangible benefits to supply chain operations and strategic sourcing. Prior to joining Akeso, Olivia worked in the FMCG sector developing innovative products for global and market-leading healthcare brands.
Risk management processes play a key role in building the resilience a business needs to operate smoothly during disruption. This is particularly the case in pharmaceutical and MedTech businesses, in which supply chains are often complex and services are multi-layered.
Disruption can come in many forms, including challenges caused by the rapid growth to regulatory changes and rare but destabilising events such as the Covid-19 pandemic. A vigorous business continuity plan (BCP) enables businesses to weather these storms. They have also become a requirement in many commercial tendering processes, which puts companies that do not have one at a competitive disadvantage.
Here we explore how to successfully identify risks and prepare to mitigate them with a robust BCP.
Developing a business continuity plan
Although different parts of an organisation may understand the risks specific to their function, a holistic view of risk across a business is often lacking. Robust organisation-level BCPs will ensure there are structures in place to keep core services running in times of uncertainty and constraint.
The pharmaceutical sector is diverse and each BCP needs to be tailored to each organisation’s specific situation, but there are three overarching steps we would recommend you take when devising one:
Carry out an enterprise-wide risk assessment process to identify, assess and prioritise key risks – to make the most of this exercise, you will want to engage with a broad group of stakeholders, from board level to teams on the ground, ensuring you cover a range of perspectives. This will involve interviews and workshops designed to identify and prioritise risks, pinpoint what risk management initiatives are already in place and establish who, if anyone, is responsible for managing each scenario. This process is likely to reveal risks that may not have been considered previously, which makes this part of the process so crucial.
Examine if and how the risks that have been identified could impact the business and which functions need to be incorporated into business continuity planning – to understand the key priorities, we use our risk assessment matrix, which you can see below. This matrix helps create a risk register by plotting the likelihood of an event occurring against the extent of its impact on revenue and reputation.
Develop a contingency plan that responds to the information that has been gathered – it will set out the BCP structure and the core roles and responsibilities within it. This plan will also establish recovery strategies that will minimise the impact of any disruption and detail how they should be implemented.
This thorough three-step process will lead to a comprehensive plan that strengthens a business’s ability to respond effectively to change and disruption, as well as embrace the opportunities that often come with it.
A living document
When the facts change, plans need to change with them. The development of a BCP described above is not a one-off event, it is the start of an ongoing process.
From the beginning it should be established that roles and responsibilities outlined are continuous, and the risks posed to the organisation will be kept under regular review. In this way the BCP document can be amended and refined to reflect evolving circumstances.
Those responsible for certain risks can then playback renewed strategies with the business continuity management team, to meticulously test their logic and probable effectiveness.
Our planning in action
Akeso & Co put these principles into play when we developed a business continuity plan for a leading mid-sized pharma company with a range of licensed therapeutics.
As a growing business with a complex supply chain, the disruptions of the Covid-19 pandemic highlighted the need to review and update its continuity plans, including assessing the vital third parties it works with.
A new plan then had to be developed that ensures the organisation and its network of manufacturing and distribution partners is able to respond quickly to disruption in the future. Together with the Chief Operating Officer and a senior team, we followed our three-step approach to do this.
Alongside common risks such as IT failure and disaster, we identified specific issues unique to their business model. For example, certain raw materials where supply could become constrained, and weaknesses in distribution channels such as the Suez Canal. We also located potential single points of failure, where one employee had sole responsibility for a business-critical relationship.
The BCP we developed has provided the business with a flexible framework that will enable the senior leadership team to overcome disruptions to critical business functions. They also now have visibility of the key risks facing the business, supported by effective controls and a process to monitor and manage changes to their risk profile.
Building this kind of agility into a pharma or MedTech organisation enables it to adapt to change and provide a continuous service to its clients. To discuss how Akeso & Co can strengthen your business’s ability to thrive during uncertainty, get in touch.
As recent headlines have highlighted, the NHS backlog in routine operations and procedures has reached worrying heights during the pandemic. Data from NHS England shows that currently more than 5 million people in England are waiting for hospital treatment, with 3.63 million fewer elective surgeries carried out between April 2020 and May 2021. Meeting this backlog of care is going to be one of the key challenges for Trusts across the country over the coming months.
To achieve this, every element of a Trust’s service needs to be operating as effectively and efficiently as possible. One critical area that is often overlooked is decontamination and sterilisation services. Without effective surgical instrument sterilisation, even basic procedures cannot be carried out.
This insights article looks at some of the problems Trusts face when it comes to providing sterile services and how they can be addressed within integrated care systems (ICS) in a post-COVID world.
The current SSD landscape
There are more than 3,000 NHS hospital theatres across England, carrying out 10 million theatre operations each year, all of which are supported by sterile service departments at an estimated annual running cost of more than £200m.
Typically, sterile services are provided on-site on a Trust-by-Trust basis and are co-located adjacent to Theatres. The size and scope of this service provision is contingent upon both volume and type of a Trust’s elective caseload. The graphic below shows how this £200m spend breaks down by region and ICS, with percentages representing the proportion spent by each ICS within a region.
Figure 1 – ICS annual spend on sterile services across England by region
Disparities across NHS Trusts’ Sterile Services
Given the scale of these services, some variation in service performance and delivery is expected. However, digging deeper into NHS Digital data, Akeso & Co found significant disparities across Trusts that need to be addressed.
In fact, the total annual spend on sterile services per ICS, varies extensively in relation to the number of theatres in a Trust and the floorspace their sterile service department takes up. These variations are outlined in the graphic below which plots ICS spending driven by surgical activity and case type, against number of theatres and SSD floorspace.
Figure 2 – Unwarranted variation in sterile services performance in England, shown by the total annual spend of STPs/ICSs compared to the number of theatres and SSD floorspace (sqm)
There is significant variation in spend on sterile services by ICS and Trusts when accounting for a hospital’s number of theatres, volume and scope of surgical activity, and unit size. One major cause of this unwarranted variation, highlighted above, is the varying age and condition of sterilisation equipment and assets.
Because the service is capital intensive, with high-value complex assets and costly support facilities, this commonly results in the assets operating beyond their lifespan. Inevitably, this leads to high levels of breakdown, maintenance costs and downtime which impacts a theatre’s ability to operate. In a capital-limited environment, most Trusts do not have the funds to upgrade their sterilisation assets to a standard which would be optimal and compliant.
However, where there is variation in service performance and efficiency, and an increasing backlog of demand, there are clear opportunities for Trusts to improve how they run these services. Trusts should welcome the challenge of further ICS integration as a means of combatting these issues. This will also enable them to redefine operational processes within the entire peri-operative value chain, embrace novel technologies and explore a variety of commercial models.
Addressing the challenges
How Trusts transform sterilisation services to reduce inefficiencies and unwarranted variation will depend on a number of determining factors specific to each Trust. Addressing each one will enable Trusts to create efficient sterile services that allow theatres to function as effectively as possible, as they tackle the backlog of cases caused by Covid-19. Moreover, in reshaping the provision of sterile services, Trusts also have the opportunity to better manage their equipment and explore how they can optimise their floorspace, not least in the context of required theatre expansion programmes, where floorspace is at a premium.
We have identified several factors that will influence a Trust’s decisions, including:
Hospital site type, number of sites and location
Level of collaboration within an ICS / STP
Theatre case volume and type
State of assets and equipment
Financial position and capital availability
These all need to be taken into account when considering how to best prepare a Trust for the demands of a post-pandemic world.
To achieve this there are three steps we would recommend taking:
1.Understand the Trust’s requirements and activity
Theatre case volume, case type and surgical preference all impact decontamination activity. For example, orthopaedic surgeries require the greatest volume of associated surgical equipment and, in turn, sterilisation. Moreover, in larger Trusts, having a detailed understanding of the relationship between multi-site and multi-organisation environments is crucial. Only once the demand on sterile services has been accurately understood, can Trusts begin planning their bespoke sterilisation improvement strategies.
2. Tackle mismatches between theatre activity and decontamination volume
Through improved operational planning, Trusts will be able to manage surgical instrumentation to better meet peak demand and rapid turnarounds when necessary. Currently, the level of sterilisation activity does not always align with the volume of theatre cases, as illustrated in Figure 3 below.
Typically, cases and elective surgeries run throughout the working day, with sterile services running alongside them, often at max capacity. Trusts should look to adopt, where possible, a hybrid working model, whereby sterile service activity is better managed to align with demand and activity. This hybrid model would see the core volume of activity processed outside of the traditional elective window (also shown in Figure 3). This will improve their ability to respond to ad-hoc surgical demand and reduce pressure on already burdened capital assets, enabling crucial machine downtime.
Figure 3 – Misalignment in theatre cases and sterilisation activity
3. Adopt technological capabilities to maximise current operations
Alongside better planning, advances in technology can help ensure the instrument peri-operative value chain is as efficient and effective as possible. Track and trace technologies, such as Radio Frequency Identification (RFID), offer full visibility over surgical instrumentation from surgical use to decontamination and other movements. This enables workflow optimisation and full utilisation of the existing asset base. Work conducted by Akeso & Co discovered that a third of one leading Trust’s surgical instrumentation had not been used for three years, with instrument dormancy going as far back as 2004.
In situations like this, RFID can pinpoint where medical instruments are dormant. Although there are valid clinical reasons for not using certain instruments, a clearer oversight of assets gives Trusts the option to generate value by disposing of unnecessary equipment and freeing up hospital floorspace.
4. Explore a variety of commercial models
There are a number of different commercial models which Trusts should consider, such as joint ventures and managed services that can reduce the significant capital investments required. The graph below shows the range of commercial models currently available, and the different value propositions they offer depending on a Trust’s objectives.
Figure 4 – The range of commercial models available, including the level of service each offers and the advantages of a managed equipment service (MES)
Each commercial model comes with various advantages and opportunities. Depending on the selected model, Trusts have the possibility of further integration within the ICS to share capital and the option of taking sterilisation services off site if appropriate. Further to this, there is the opportunity to create revenue by acting as a lead partner in a commercial SSD network and offering services to the private sector.
Choosing the right model
There are benefits and risks to every solution and weighing up a Trust’s specific needs is an important part of the process when deciding which is the right route to take. We have worked with several Trusts over the years to identify the best direction for their SSD and build a business case to support this.
In transforming sterile services departments, Trusts will put themselves in a stronger position to deal with the fallout from the pandemic. Additionally, this will also increase theatre efficiency, improve infection control measures, generate space savings that enable theatre expansion programmes and potentially create much-needed income.
To discuss how Akeso & Co can help sterile service departments perform their critical role more effectively, get in touch.
Akeso & Co supported Homerton University Hospital Foundation Trust (HUHFT) in the design and implementation of a Scan4Safety Programme and Inventory Management System (IMS). Captured in a detailed business case, the initiative is set to drive significant operational efficiencies and improvements to patient safety and care.
Challenge
Homerton University Hospital Foundation Trust (HUHFT) is a major NHS provider of acute care in the London Borough of Hackney. With services spanning 75 locations across East London, including approximately 450 beds, 11 wards, three day-surgery theatres and six main operating theatres, HUHFT has a complex set of services and supporting supply chain.
Following a thorough opportunity assessment, a number of challenges were identified with regards to the current operations, accumulating in clinical time wasted, health and safety risks, as well as opportunities for cost improvements.
Some of the key challenges identified include:
Inefficient and inconsistent supply chain processes across wards and departments
Lack of visibility and control of inventory levels due to limited reporting capabilities
Segmented spending on products and consumables across wards and departments
Limited traceability of theatre implants through the supply chain to procedure due to manual processes
Strained working relationships between clinical and material management staff
Solution
To address the challenges identified, the project recommended HUHFT would benefit significantly from a Trust-wide IMS to improve inventory management and achieve patient-level costing. We supported HUHFT through a three-phased approach from business case development through to successful implementation.
Phase 1) Secure investment through a robust business case
With the support of key HUHFT clinical and operational stakeholders, we developed a compelling business case and secured the required backing to proceed to procurement. Through a detailed appraisal of the potential qualitative and quantitative benefits and risks, it was identified that implementation of a trust-wide IMS could deliver £1.4m in benefits over the next five years, from an initial £469k one-time investment.
Phase 2) Source and partner with the optimal provider
Following a route to market assessment, we facilitated a phased procurement process through a formalised ‘mini-competition’ to assist the Trust in their rigorous selection of a suitable IMS provider. Through taking this approach, we were able to secure an optimal solution balancing system capability and total five-year cost.
Phase 3) Implementation through rigorous PMO and change management
We project managed the implementation of the new IMS and change management of associated processes encompassed within the Scan4Safety programme, reporting to the patient safety board. From the outset, programme governance was implemented to ensure the new system and its related benefits were achievable and sustainable. This involved the recruitment and setup of a programme board of Trust directors, and the chairing of regular meetings and presenting programme updates at Trust-wide Scan4Safety engagement sessions.
Results
The full benefits of the IMS solution will be seen during the next five years but it is already delivering significant savings and process improvements.
The one-time investments equating to £469,000 and subsequent improved processes is expected to generate £1.4m in cost savings, including:
In addition to the projected quantitative benefits, implementation of a Trust-wide IMS is also expected to deliver number of qualitative benefits, including:
A reduction in the likelihood of ‘never events’ thanks to the patient level costing functionality which improves the traceability of implants, surgical instruments and medical equipment.
The release of up to six clinical WTEs, allowing them to re-focus on patient facing activities.
Automated processes, such as Barcode-driven ordering, that drive efficiencies in areas including procurement and recall.
Additional management information insights that enabled further efficiencies.
Increased clinical confidence in supply chain processes.
Compliance with GS1 and Scan4Safety.
What is next for HUHFT?
Following the success of the IMS and Scan4Safety pilot programme, HUHFT will continue to drive adoption of Scan4Safety to extended use cases, including potentially Blood Transfusion Scanning, Pathology samples, eMedicine, and many more.
Scott has dedicated his career to performance improvement in healthcare and life sciences working both within a multinational consulting firm, and for the last decade as a co-founder of Akeso.
As a Managing Partner of the company, he has led the development of Akeso as an established boutique consultancy committed to improvement in UK health. His project specialisms and areas of interest are systemwide performance improvement, the national and international healthcare supply chain and the use of data to drive tangible and actionable improvement insights.
His approach is flexible, warm and fact-based and he is proud to have delivered numerous collaborative/ICS projects being able to engage positively across multiple stakeholders, specialisms and styles to achieve outcomes around aligned goals.
Outside of work his passions are almost all sports (mainly watching nowadays although can be found trying to find his wayward golf balls in the woods / long grass / water) and spending time with family, including Rump the cocker spaniel who is also the honorary office dog.
Guy’s & St Thomas NHS Foundation Trust (GSTT) comprises two of London’s best known teaching hospitals, St Thomas’ Hospital and Guy’s Hospital, providing a full range of hospital services to the local community and specialist services nationally. GSTT is one of the largest Trusts in the UK with a turnover of almost £1.5bn and 15k staff, treating over 2.4m patients per year, including 88k inpatients, 103k day cases, 1.2m outpatients and 800k patients in community services.
GSTT operates a wholly owned subsidiary, Essentia, which provides Facilities Management (FM) for GSTT. Essentia was challenged to deliver cost savings, improve service quality and manage an aging asset base to maintain uptime through a blend of in-house and externally contracted services. Akeso were engaged by Essentia to complete a total cost review of the Hard Facilities Management service (Engineering and Building Maintenance) to identify near term and long-term cost reduction and operational efficiency opportunities in 3rd party spend and the internal service.
Insight
Essentia was challenged to deliver cost savings in addition to assuring service quality and maintaining an aging and diverse asset base, with very limited funds for investment. We brought a number of methodologies, tools and experiences to support the client through each stage of the project including a proven Opportunity Assessment approach, Capability Development (People & Organisation, Process and Systems) and Hard Facilities Management-relevant Category and Market Intelligence.
Action
In Phase 1, our consultants led the process to identify the value through benchmarking GSTT to peer Trusts in terms of scale/ size and location using latest Estates Return data from NHS Digital. We completed in depth reviews and analysis for a number of key product and service contracts with the client and incumbent providers to evaluate fulfilment of requirements and to develop strategies to improve performance and leverage benefits where suppliers were failing to meet performance standards. We then prepared a Board level recommendation for a Programme Delivery setting out a range of tactical and strategic options.
In Phase 2, we designed and led a joint Consultant:Client delivery program to implement the recommendations. We developed and ran multiple Tenders, which included soft supplier market engagement, the development of output based specifications and the design of contract models that would permit the involvement of local SME providers. We finally designed and costed a detailed process improvement plan to transform the end-to-end Hard FM Callout process handling 50k callouts per year.
Results
We established and mobilised a structured Trust-wide improvement programme which delivered savings and improvements across all areas of Engineering and Building Maintenance to improve customer service and regulatory compliance and reduce cost to serve.
Scott has dedicated his career to performance improvement in healthcare and life sciences working both within a multinational consulting firm, and for the last decade as a co-founder of Akeso.
As a Managing Partner of the company, he has led the development of Akeso as an established boutique consultancy committed to improvement in UK health. His project specialisms and areas of interest are systemwide performance improvement, the national and international healthcare supply chain and the use of data to drive tangible and actionable improvement insights.
His approach is flexible, warm and fact-based and he is proud to have delivered numerous collaborative/ICS projects being able to engage positively across multiple stakeholders, specialisms and styles to achieve outcomes around aligned goals.
Outside of work his passions are almost all sports (mainly watching nowadays although can be found trying to find his wayward golf balls in the woods / long grass / water) and spending time with family, including Rump the cocker spaniel who is also the honorary office dog.
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.
Scott has dedicated his career to performance improvement in healthcare and life sciences working both within a multinational consulting firm, and for the last decade as a co-founder of Akeso.
As a Managing Partner of the company, he has led the development of Akeso as an established boutique consultancy committed to improvement in UK health. His project specialisms and areas of interest are systemwide performance improvement, the national and international healthcare supply chain and the use of data to drive tangible and actionable improvement insights.
His approach is flexible, warm and fact-based and he is proud to have delivered numerous collaborative/ICS projects being able to engage positively across multiple stakeholders, specialisms and styles to achieve outcomes around aligned goals.
Outside of work his passions are almost all sports (mainly watching nowadays although can be found trying to find his wayward golf balls in the woods / long grass / water) and spending time with family, including Rump the cocker spaniel who is also the honorary office dog.
