Improving operational efficiency in Acute NHS providers Chair & Chief Executive Network 8 th December 2015 DH – Leading the nation’s health and care 1
Adjusted Treatment Cost • Health systems all over the world, be they ‘for profit’ or ‘not for ATC profit’, have adopted a common Meantime Ideal set of metrics to monitor and improve the performance of their individual hospitals (hospitals in the US have been operating such Apply to real-time variable 1.Accounts data (annual metrics for 50 years) cost data: snapshot) • Workforce • By examining methodologies • Drugs 2.Reference cost data around the world, we have now • Clinical supplies 3.Any other national data we developed a metric for NHS Enabling trusts to monitor can get our hands on e.g. providers - the ‘Adjusted daily/ weekly/monthly/ • Workforce ESR data Treatment Cost’ (ATC) yearly and compare with • Pharmacy systems peers • ERIC Estates data • Accept it wont be perfect from • Procurement systems day one but will develop over time Vision is to enable trusts to have a dashboard of • The most important thing is how real-time indicators they can use to keep a the metric is used…………. relentless focus on their costs 2
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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…… 4
For example in workforce….. National Averages Trust A Trust B Wide variation in workforce management practices: 52 weeks x 37.5 hours 1950 hours 1950 hours 1950 hours • Long term training / workforce planning Annual Leave 300 hours 298 hours 302 hours • Productive time / contact time Maternity 68.25 hours 57 hours 95.5 hours • Skill mix Sickness 68.25 hours 48.5 hours 70 hours • Rotas Training 48.75 hours 30 hours 32 hours Assumed Availability 1465 hours 1517 hours 1451 hours Required vs Actual Nursing Hours Per Patient Day 5
For example in doctor productivity, inputs and outcomes Example: Trauma and orthopaedics data for six anonymised trusts Data indicates significant differences between trusts on 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 6
All non-specialist acute trusts have now received a pack setting out their estimated efficiency opportunity 7
Several trusts have highlighted the problem of lost income from cancelled operations due to a lack of beds Definition of a Delayed Transfer A SitRep delayed transfer of care from acute or 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. 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? 8
Trust boards need the tools to do the job………… The Model Hospital and Dashboards 9
Executive level dashboard (draft example) People Patients Money National Current National Peer 1 month Nursing Hours per Patient Day leader month average benchmark trend 10
Developing the metrics Testing throughout September, October and December 2015, including: example: NHPPD • 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 • Changing nature of healthcare needs a unit Trusts in total) of measurement that is simple and flexible • ‘Deep dive’ with 5 Trusts, undertaken on a daily basis using a acuity and dependency tool to capture data ‘real time’ • NHPPD is a simple calculation by which we can match hours needed to hours available • 3 month data review of UNIFY and HES data to establish if data can provide a NHPPD measure and compare to the 1 • Required NHPPD are adjusted for acuity month daily data collection and dependency (e.g. ward type) These data collection methods mapped against international benchmarks will provide the information to set the ‘NHPPD • Allows management to make decisions i.e. the cost consequences of overstaffing and Next steps understaffing are visible and can be acted • Identify most appropriate way of collecting, analysing and upon presenting NHPPD data • Allows assessment of utilisation of nursing • Develop model hospital dashboards and tools resources on a daily, weekly, monthly basis • Ensure NHPPD stands alongside other indicators of staffing sufficiency and quality • NHPPD has become a common unit of measurement all over the world • Consider application of NHPPD principles to other staff groups such as AHPs 11
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) 12
We are working closely with our partners including the organisations that will take this work forward 13
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 14
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