Who?
Oxleas NHS Foundation Trust is a provider of community and inpatient mental healthcare. It has three hospital sites and serves a population of 840,000 in Southeast London.
The challenge
The Covid pandemic took its toll on the nation’s mental wellbeing, causing a significant rise in the number of people attending A&E in need of specialist mental health care. By June 2021 the pressure on Oxleas NHS Foundation Trust had become critical. Unable to find sufficient beds across its hospital sites to meet demand, they found:
- Patient care was impacted due to excessive waits in A&E
- Increasing use of private sector beds
- Considerable expense being incurred
- Patients having to be placed away from their homes and support networks.
The Trust didn’t have a clear view of how changes could be made. To determine how we could help we needed to embed our consultants in their front-line teams, build trust and understand the challenges first-hand.
How we helped
We spent three weeks with the Trust’s clinicians on their six inpatient wards, plus time with the Trust’s Patient Flow Team. In parallel we undertook quantitative analysis to triangulate what we were seeing through data, with what we heard and observed. This, combined with regular debriefs with operational and other senior executives, allowed us to reframe the problem for our client and formulate an approach.
Our diagnostics revealed four critical factors that were compounded by tactical operational decisions being delegated upwards and a history of each hospital site operating with a high degree of autonomy and minimal interaction.
We agreed the priorities for an improvement project, with objectives directly linked to the findings:
- Ward culture and operational processes – to establish and embed standardised best practice to reduce variation. (Harmonising best practice alone could release an equivalent to a 30% capacity increase.)
- Patient flow team – to design and embed operational processes to enable and coordinate activities around patient movement.
- Supported accommodation process – to document and signpost the complex process that ward-staff found time consuming to navigate.
Our solution needed us to create an environment where front-line teams embraced the case for change and were motivated to work as a single cross-site team developing solutions and delivering improvement at pace. We followed a systematic delivery plan with target deliverables for each phase: Co-Design; Implement and Embed.
We held cross-site workshops bringing together consultant psychiatrists, nurses, therapists, admin staff and social workers and used a variety of consulting tools to build consensus, identify root causes and prioritise improvement interventions. We then monitored the impact of each change to ensure that they were having the desired impact. This ensured we created new ways of working that really delivered what staff and patients needed.
As we progressed, we gradually stepped back from coaching, increasing the time spent with the senior leadership team to play a mentoring role as upskilled Change Agents took the lead and ensured outcomes could be sustained.
Outcomes
The objectives of the project were fully realised. Measurable quantitative improvements include:
- Average patient length of stay down 25%
- Standard deviation between wards down 54%
- Average monthly private bed-days down 52%
- Average monthly expenditure on private beds down 52%
- Average number of patients requiring private beds down 42%
Nov 21 – Feb 22, compared to previous 6 months.
In addition, shorter patient stays and use of private beds has delivered improvements to patients’ care and experience, and a roadmap and detailed plans to deliver additional improvements has been agreed.
We were very impressed in the quality of the leadership. Moorhouse displayed an intellect and interpersonal warmth which meant they were able to rapidly engage and motivate colleagues. They fired colleagues’ imagination and desire to strive for ongoing continuous improvement. They have set us off on a journey which we feel very confident we will be able to build upon.”
Ify Okocha, CEO and Iain Dimond, COO
Find out more about what we’ve achieved for other clients in Health & Care.
We’re always here to help
