Our Track Record

Since our first piece of work at Cambridge University Hospitals NHS Foundation Trust, we have rapidly built a track record for improving performance in some of the most challenged Trusts in the NHS

Cambridge University Hospitals

Programme Summary

At Cambridge University Hospitals NHS Foundation Trust (CUH) in February 2017, the average 4-hour access standard was frequently as low as 68%. A provider of acute and tertiary services, the Trust had historically faced challenges with patients who had overly long lengths of stay. In March 2017 when a Prism Improvement (formally Hunter Consulting) delivery team was placed on site to support the delivery of an improvement programme, the Trust achieved and consistently held 90%. The Prism Improvement Approach was founded here and has since been developed to recognise the unique needs of different trusts. One of the key lessons from the work at CUH was the ability of small highly-experienced groups of subject matter experts to make a significant impact on standards of care, by working together and interfacing the key elements of the emergency care pathway. In particular dedication from the on-site delivery team during the first 4-6 weeks of the improvement programme on validating themes, practices and behaviours - instead of solely focusing on data analysis - enabled Prism Improvement to develop traction and garner buy-in from key members of staff.

Key outputs at CUH include:

Most improved A&E performance in the East Midlands for Q1
Achieved 95% in Q1 – for the first time in two years
Achieved 95% for 3 consecutive months
All the above were achieved whilst Trust shut 42 beds (28 winter contingency plus 14 planned CIP)
Almost total elimination of medical outliers that led to great reduction in cancellation of electives
ECIP improvement site, with over 15 external visits to see how new process and performance management can improve patient journey and satisfaction as well as performance

Oxford University Hospitals

Programme Summary

Oxford University Hospitals NHS Foundation Trust (OUH) is the largest member of ‘The Shelford Group‘ – which features the top ten teaching trusts in the UK. It is also a world-renowned centre of clinical excellence, providing tertiary, acute, and community services to the region. When Prism Improvement arrived on site at the John Radcliffe Hospital in November 2017, the Trust had historically faced challenges with patients who had overly long lengths of stay and 4-hour emergency access performance was 82.1%. Prism Improvement focused on supporting delivery of key workstreams by using an experienced team of ex-NHS operational and clinical leads who were capable of ensuring change whilst providing an appropriate level of support and challenge. These individuals were underpinned by a model that focused on operational support, coaching, and a series of ‘Test & Learn’ improvement cycles. The aim was to achieve tangible improvement outcomes, supported by a shift in culture, to ensure continuous improvements to performance and patient experience.

Key outputs at OUH include:

4-hr emergency access performance improved from 81.2% in December 2017 to 86.4% in December 2018
Non-elective discharges improved by 9% from December 2017 to December 2018 and matched the level of nonelective admissions
The average length of stay improved from 3.5 days in December 2017 to 2.95 days in December 2018
Discharge for zero length of stay patients increased from 40% in December 2017 to 45% in December 2018
In general medicine the number of patients staying more than 7 days has reduced from 18% down to 7% in terms of total discharge proportions
Overall bed demand reduction at John Radcliffe site was approximately 36 beds in December 2018 compared to December 2017

Evidence

Extension of work

Although Prism Improvement was originally commissioned for four months, the Executive requested the team to continue supporting the Urgent Care Improvement Programme for a further three months. During this period the on-site delivery team were able to see through the initial changes made and the Trust delivered above 90% for their A&E 4-Hour performance for 8 consecutive weeks through June and July. Most notably, there were continued improvements in performance over the following months, with year on year performance displayed in the above graph.

OUH Integrated Improvement Programme

In June 2018, the Executive team requested that Prism Improvement extend their time at the Trust, to support the delivery of a broader Integrated Improvement Programme that covered five key areas of improvement: Urgent Care, Planned Care, Finance, Workforce, and Governance. During this phase of work we assisted in co-designing, mobilising and implementing the Programme Management Office for the Integrated Improvement Programme, as well as remaining as Subject Matter Experts for Urgent and Planned Care. Over the period since this phase begun the 4-Hour performance has remained in line with trajectory, though clearly the pressures that come with the time of year have still had their effect.

London North West Healthcare NHS Trust

Programme Summary

NHS England and NHS Improvement commissioned Prism Improvement to provide an Improvement Programme to London North West University Healthcare NHS Trust (LNW). The initial scope of work outlined a need for support to improve the flow of patients across LNW, both in terms of front door emergency access and back end discharging of patients. The Trust had previously experienced challenges meeting the national A&E 4-hour performance standard despite a history of involvement from management consultancy firms. The Improvement Programme ran across two phases, spanning a 6-month period. During this six-month timeframe, the on-site delivery team executed a series of improvement cycles, focusing on pathway-specific workstreams. Following the course of the programme A&E 4-hour performance showed a significant improvement when compared against the previous years figures (see below graph) and the Trust was subsequently featured in the Health Service Journal (HSJ) as one of the ‘Most Improved A&E Departments’ in the UK for 2018/19.

Evidence

Extension of work

The legacy from Prism Improvement’s approach, through collaboration with trust staff, was demonstrated by continued improvement in the A&E 4-hour performance — even after the delivery team had left all sites In order for sustainable improvement, the approach from Prism Improvement needed to be agile enough to respond to the dayto- day needs of the system and it’s processes, whilst also being attentive to changes in the behaviours of clinical and operational teams within the system. The on-site delivery team needed to work in partnership with members of the Trust to achieve new ways of working going forwards.