As the nation celebrates the 70th year of the NHS and all that it has achieved, there has also been focus on its long-term sustainability and what the future might hold. There’s no denying that there continues to be a spotlight on the increasing pressure on hospitals, particularly as
we enter the winter period.
The government has announced increases in NHS funding over five years, beginning in 2019/20, with the NHS tasked with contributing to a ten-year plan for how this funding will be used.
Like most NHS Trusts, we are always on the lookout for ways to improve patient outcomes and productivity without driving higher costs. When our orthopaedic product tender came up for renewal, we saw the opportunity to do things differently. We wanted to find a solution that supported our mission to transform the service provided to patients and improve pathways to care through innovation.
Defining the objectives of the partnership
In short, we set out to find an external partner that would help us do a number of things, such as improving patient outcomes whilst reducing time spent in hospital; releasing capacity in our orthopaedic theatres; increasing the Trust’s income by improving patient throughput; optimising the patient pathway through raising the standard of clinical practice; and achieving good value in procurement by innovating in the way we undertake commercial partnerships.
When Johnson & Johnson Medical Devices Companies (JJMDC) put in its tender, which included the value-based CareAdvantage offering, we were really pleased as we felt that this matched what we were setting out to achieve.
Diagnostic and goal-setting
A dedicated team was put on-site to work with us and, following an extensive diagnostic exercise to identify areas of improvement, a number of plans and ways of working were put in place to help us meet our objectives of delivering increased utilisation of hospital resources, specifically via:
- Improving elective joint length of stay by 1,500 days per annum.
- Improving theatre utilisation within elective orthopaedic theatres by 12 per cent.
- Improving Patient Related Outcome Measures (PROMs) scores by one point.
Implementing the partnership
As part of the implementation phase of the partnership, we moved to standardised products across three
of our large sites to streamline our supply chain. We also standardised clinical best practice and reduced process variation having refreshed our multi-disciplinary team approach to comply with enhanced recovery principles with the support of the JJMDC change and project managers.
They supported us in achieving protocols and standard operating procedures for consistency across the patient pathway. In turn, this contributed to reducing length of stays in hospital and releasing bed capacity.
We implemented a range of initiatives to support and inform our patients, with effective messaging and expectation setting, completing a refresh of patient literature and collaborating cross-site to standardise this. We are developing an engagement app to provide a digital approach to patient engagement and put them more in control.
Thanks to the introduction of a standard utilisation measuring tool and on-the-day visual management, we have seen an increase in activity throughout our theatres and achieved higher levels of utilisation. The
creation of “super-lists” to optimise theatres has enabled us to treat five patients per day instead of the previous three, giving more patients access to care and in turn driving increased income for the Trust.
These outputs have reduced patients’ length of stay and released bed capacity with initial results showing the partnership to be on track to deliver 1,500 bed days and a 12 per cent increase in theatre utilisation.
These are fantastic results and there are multiple ways that the project has demonstrated additional value to the Trust. The value created by team working and learning from the external support team who have brought an industry voice to our working practices has in itself been hugely beneficial. In addition, the collaboration of teams across the board – be it in theatres or on the ward – has enabled our front-line staff to work together to solve problems and improve patient outcomes.
Stakeholder engagement has been a crucial part of the success of the project, with a range of methods being introduced. These included regular workshops to engage with key players across each site. Cross-site interactions were key to gaining agreement on multi-site initiatives, such as educating carers and patients on the positive changes taking place within the Trust and the opportunities of these changes was important in securing further buy-in.
Sharing best practice
A real sign of the partnership’s success is how the practices implemented within the orthopaedic theatres have been expanded to other theatres outside the project scope. The whole project has been a collective effort across multiple professions at various levels across the organisation, working together and sharing successes.
The possibilities that collaboration between the NHS and industry holds make it an exciting era for us. At a time when we need seamless, integrated working more than ever before, I believe partnership is a key element to the successful future of our healthcare system.
Lucy Morrisey is deputy director: strategy at Barts Health NHS Trust.