Themes
- Improving clinical outcomes for patients
- Benchmarking performance
- Engaging staff to target improvement
Central London Community Healthcare NHS Trust (CLCH) provides more than 90 clinical services to a population of over four million across 11 London boroughs and Hertfordshire. As one of the largest community healthcare providers in the country, the trust's 4,600 staff are dedicated to providing high-quality care to patients in their own home or across over 650 sites located across the trust's footprint.
Taking a holistic approach to improving productivity
At the forefront of CLCH's approach to improving productivity is clarity about what that word really means for their organisation. For example, understanding what goods looks like for them might differ from other trusts' approaches. This local understanding tells a more nuanced story than national media headlines which suggest a drop in productivity since before the pandemic. CLCH staff are often seeing similar, if not more, numbers of patients with higher care needs than they would have done prior to the pandemic. Therefore, viewing their productivity as an organisation through the lens of increasing activity levels is not the optimal way to target improvement. Instead, the trust has channelled its energies into improving clinical outcomes for patients, with the wider aim being that this will have a corresponding impact on the trust's productivity too.
In recent years, the trust has experienced a significant growth in demand which has resulted in planned care teams often working at full capacity. The challenges this presented have been exacerbated by nation-wide difficulties recruiting additional district nurses to help manage rising caseloads. One example of an innovative approach taken at CLCH to address this issue is with a service for patients with leg ulcers. CLCH took the decision to hire a leg ulcer specialist as part of a pilot programme within one of their community nursing planned care teams based in Hertfordshire. While this was initially more expensive, it reduced the number of visits required per week for people on the team’s caseload by 43%, increasing the capacity of the service. The pilot also reduced the average hours of community nursing time required before discharge from 110 hours to 68 hours, indicating that the pilot has also helped to improve healing rates for patients. By primarily focusing on improving outcomes for patients, CLCH is simultaneously unlocking productivity gains and adding more value for patients.
With the aim of helping patients to become more independent, CLCH also developed a pilot programme across their community nursing team based in Merton which seeks to provide more personalised care for patients. The programme sought to empower patients to take an active role in their ongoing care, helping them to understand their individual care needs and help them move further towards a more independent care plan. As well as improving the independence of patients, the programme also reduced the total number of visits required for all patients suitable for self-care during the pilot and 20% of patients were able to be discharged earlier from the service.
The trust has also looked towards digital solutions to help improve the quality of care offered to patients and free up service capacity. In Barnet, across CLCH's musculoskeletal physiotherapy service, the trust has introduced a digital self-management tool to help provide personalised self-management to support the clinical journeys of patients. Average uptake of the self-management tool is approximately 300 patients per month who are able to self-manage using the digital platform following triage. This has helped to reduce the trust's first to follow up ratio for the service and has provided the trust with additional capacity to focus on reducing waiting lists. The move to more integrated care presents an opportunity to standardise the different delivery models previously commissioned by clinical commissioning groups (CCGs) and implement a more productive model of care. Through bringing clinical leadership teams together, the trust found several examples where the same service was being provided in different ways. With a view to establishing a common approach to care, the trust engaged with clinical leaders from a range of services to establish standardised processes and a set of desired clinical outcomes for each service. By focusing on a desired outcome model, the trust continued to emphasise improving the quality of care provided to patients as a key route to being more productive.
Measuring and benchmarking productivity in the community sector
At the centre of the trust's approach to improving productivity is a newly designed productivity framework which will provide the board with timely and accurate data across a range of relevant productivity metrics, for example, throughput ratios and the utilisation of clinic appointments. The aim of the productivity framework is to assist the trust in enhancing its own understanding of current productivity levels through providing sufficient data across a variety of standardised metrics to help benchmark performance against historical performance levels. CLCH monitors data across all its pathways – in a similar way acute trusts would measure performance across referral to treatment pathways – which has helped CLCH to ensure no patient waits over 40 weeks for the care they need.
The trust has also strengthened partnerships with fellow community providers across London and in Birmingham and Cambridgeshire. Provider collaboration has enabled CLCH to co-design and develop core standards that will enable meaningful data comparison across organisations. Unlike the acute sector, where data comparison between providers is more straightforward and relatively commonplace, the community sector faces challenges in agreeing common and comparable measures to generate baseline data to benchmark performance across organisations.
Reflections
CLCH is striving to improve productivity levels and to deliver maximum value for patients. The trust recognises that it is on a journey to improve how it views its own organisational productivity. The newly designed productivity framework will help guide the trust’s approach to improving its productivity and identify areas across a variety of services where improvement can be targeted. Critically, the trust’s ambition is to ensure that its approach to productivity engages front line staff on identifying opportunities for improvement and continues to put patients first.
Looking ahead, the trust is planning to continue to divert energy into thinking more strategically about earlier intervention to prevent the deterioration of illness and create a more sustainable service.