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Perform: Improving patient flow at Barts NHS Trust

Setting the scene

Patient Flow is a critical issue facing all hospitals. Emergency performance in the NHS has deteriorated to its lowest ever level since targets began in 2004. Bed occupancy and emergency department (ED) performance have become unsustainable and are burning time and energy which needs to be more focused on the direct clinical care and strategic priorities.

At Barts Trust, there have been more patients attending A&E at each of the sites than ever before and they had been running at up to 98% bed occupancy. That means patients in corridors, operations being cancelled and poor performance against the National A&E four-hour waiting target.

“I’ve been at Newham for 14 years and it is because of this programme that patients now say thank you to me. Now that I understand my role in organising the patient’s transport home, I more actively do it, patients see me doing it and that’s why they come and say thank you to me when they leave.”

Ward Clerk, Newham Hospital

How we helped

Making a step change in patient flow required a large change programme which reached all major workforce groups influencing the patient pathway. Perform is a systemic training programme which uses behavioural change and active learning to increase individual and team effectiveness. Together with advanced analytical techniques to illustrate and predict performance, we helped optimise what clinicians, managers and their teams do, how they do it, and the tools they use. In essence, we helped the Trust to embed a “self-help” problem-solving culture across the acute hospital operations.

Making a difference

Over the course of the project, length of stay has reduced by 13%. This has given the Trust capacity to improve emergency department activity by 4% and increase the number of patients that they're able to treat by 19%. We're immensely proud of the benefits achieved. These have been delivered through the very close joint working with the Barts teams. The priority has been – and remains – the development of sustainable improvements in performance that continue after our support is complete. Since we completed our work, the Trust has continued to improve its performance ahead of comparable London Trusts and nationally.

“You have been our trusted advisors which, together with the expertise and sheer hard work of the team, allowed us to make huge strides forward.”

Medical Director, Whipps Cross Hospital

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Corporate Affairs, PwC United Kingdom

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