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Upping the performance of an NHS trust

We were proud to be recognised for our work supporting North West Bristol NHS Trust manage their patient flows in winter 2018.

Setting the scene

Winter is an extremely challenging time for NHS hospitals and trusts, often resulting in increased demand, longer waiting times and fewer beds. In the case of North Bristol NHS Trust (NBT), it proved to be the starting point for a lasting, staff-led transformation of how it delivers care.

In winter 2018, NBT saw a demand increase of 12.2%, with bed occupancy regularly running at 102% (meaning patients waiting in corridors) and only 71% of patients in A&E receiving the care they needed within four hours.

Come the spring, the trust decided changes were needed. To get a grip on patient flow, its operating model needed to be digitised. But the trust realised that an approach which engaged staff from across the trust, not just those in A&E, was the key to creating something lasting.

The trust articulated an ambition of ‘OneNBT’ with a series of commitments - valuing patients' time; eliminating delays in care; always having a patient bed available; enhancing its reputation as a surgical centre of excellence; and using the full skills and capabilities of staff.

How we helped

We partnered with NBT to implement Perform, which was designed to change behaviours across ward, site and discharge teams, as the framework for its digital patient flow transformation.

The aim was to make individual members of staff realise their role in patient flow, use the tools which were available to them to improve this, and to redefine roles and responsibilities - with data at its heart.

By developing and embedding their digital patient flow management system our team established a ‘real-time bed state’ that site management teams could trust, giving all staff access to the actual capacity and demand in the hospital at any one time.

A joint PwC-NBT team of more than 30 people, spread across each of the 26 wards, site and discharge teams, supported staff at all levels. The aim was to make sure they understood the key role they each play in patient flow, the digital tools they have to help them and how to redefine roles and responsibilities to ensure impact across the whole site.

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“Through the recent publication of the Long Term Plan, the NHS has made clear its ambition to deliver a world-class service despite reduced resources and increased demand.

Initiatives like this, that use the best that technology offers, are essential to our partnership with the sector to make this objective a reality. The result is real impact on patients' lives with improved results across the whole Trust.”

David Morris, Public Sector Health Leader at PwC

Making a difference

This continuous improvement, using a new methodology backed by data to offer NBT staff a different way to mobilise, led to an immediate upturn in results:

  • Length of stay reduced by 13%
  • 50 beds released
  • A 10.2% increase in four-hour performance
  • A 6.1% increase in elective activity (procedures chosen by the patient or doctor that are advantageous but not urgent).

The cultural change leading to these outcomes saw our partnership with NBT win Best Clinical Service and Treatment Pathway Transformation Project at the 2019 HSJ Partnership Awards.

And according to the trust, the positive outcomes go beyond this. Staff talk of enjoying coming to work again which is improving morale and ultimately patient experience. Also, scores have improved in the Family and Friends Test, which is an important feedback tool for those using NHS services.

We have also used Perform with other public sector clients including Haringey Council where we worked on a project with their social care team meaning service users could access help quicker.