Digitally enabling patient flow - How North Bristol NHS Trust tackled the winter crisis

27 February 2019

by James Macpherson Director, Health Provider Transformation

Email +44 (0)7815 188213

by Jake Wilkins Manager, Health Provider Transformation

Email +44 (0)7808 798557

Winter in an acute trust is always a difficult time. And North Bristol Trust (NBT) certainly wasn’t immune with bed occupancy regularly running at 102% last winter, and a four hour waiting time performance of 71%. So in Spring of 2018 they decided they something had to change if they were to avoid a repeat performance - or things getting worse.

They determined that getting a grip on patient flow through digitally enabling the hospital and empowering their staff was key to delivering change and improving patient care. Working together with PwC they went about implementing Perform, a behavioural change methodology, as the framework for their patient flow transformation.

The programme was rolled out across each of the 26 inpatient wards, as well as to the site and discharge teams, with the aim of supporting staff, enabling them to understand the key role they each play in patient flow, giving them digital tools and equipping them to embrace a problem solving mindset.

The programme led to a step change in performance:

  •    reducing length of stay by 13%;
  •    improving capacity by releasing 50 beds;
  •    delivering a 10.2% increase in four hour waiting time target performance; and
  •    a 6.1% increase in elective activity.

But it was more than just the statistics that changed. The cultural shift across the whole hospital has meant that NBT has seen its patient experience scores improve, as well as deliver a significant hike in staff morale and retention.

Three key success factors helped deliver this positive impact on the Trust:

Digitalisation of patient flow

The Trust developed a digital patient flow management system called ‘Flow’. All of the areas in the program received targeted training to improve ways of working on the wards and ensure they understood its benefits across the whole hospital. This led to the establishment of a ‘real time bed state’ which site management teams could trust, giving all staff access to the actual capacity and demand in the hospital at any one time.

Whole-hospital engagement

Engaging the whole Trust, with a wide range of staff from porters to consultants, was vital. Perform linked in with the Trust’s “#OneNBT” vision, with a Trust wide communications plan creating a real buzz throughout the hospital. 820 staff were put through their first series of 10 training bootcamps (the current number is 1,240 throughout all of the sessions they’ve run in total). This engagement and enthusiasm was felt across the whole hospital inspiring a huge uptake of staff using the tools to improve their own teams.

“It was great to hear the encouraging positive feedback about the shift in culture on our wards and how effective our Board Round Processes are since our launch of Perform” - Chief Operating Officer, NBT.

Sustainability - establishing internal capability

Creating capacity for change and establishing a ‘Perform Academy’ for staff is helping secure the long term sustainability of Perform and performance improvements. The Trust invested in 15 of their own staff - including doctors, nurses, therapists and operational staff - to be part of the change team to spread the word Trust-wide. The Trust has now retained its investment in the Academy for the long term while the executive team has committed to embedding Perform in the DNA of the Trust, making it the way business is done.

Most importantly, NBT has been a different place this winter - there are still challenges, volumes have still increased, but they bounce back quickly. The Trust staff know what good looks like, and they have the confidence, know-how and belief that no matter what gets thrown at them, they can get empty beds tomorrow morning if they do what they’ve learnt and achieved.

We are incredibly proud that this impact has led to the programme being recognised at the HSJ Partnership Awards, with the programme being shortlisted for the Best Clinical Service and Treatment Pathway Transformation Project award. The winners will be announced on 20 March.

For more information about NBT and Perform visit our website here.

by James Macpherson Director, Health Provider Transformation

Email +44 (0)7815 188213

by Jake Wilkins Manager, Health Provider Transformation

Email +44 (0)7808 798557