Targeted improvement work to reduce patients’ length of stay in a mental health trust
We worked with Sussex Partnership NHS Foundation Trust (SPFT) to set up a Trust-wide Reducing Length of Stay Improvement Programme. It encouraged staff-led improvement initiatives to safely reduce the time adult inpatients spend on acute psychiatric wards.
One symptom of the level of need for mental health support amongst the population is the number of people needing to be admitted for hospital treatment. As is the case in other parts of the country, pressure on SPFT inpatient services is significant. Safely reducing the length of inpatients’ stay on the wards is a key part of SPFT's strategy to enhance patients’ experience, maximise inpatient bed and ensure that services improve the quality of life for local communities served by the Trust.
Over 12 weeks, our team worked with SPFT’s senior leaders, operational managers and front-line clinicians to:
- Carry out a current state assessment of the biggest challenges and improvement opportunities for reducing LoS
- Support 15 members of staff to lead their own reducing LoS improvement projects – through training and weekly mentoring
- Develop a sustainability plan for transformational scale-up of prioritised improvement projects
Current state assessment
We demonstrated the opportunity for improvement by highlighting the variation in patients’ LoS across equivalent wards, and calculated the indicative Trust-wide reduction in LoS needed to free up sufficient bed capacity and end reliance on inappropriate out-of-area placements. We conducted snapshot ward-based studies to understand what patients were waiting for next to progress their care, and observed multidisciplinary (MDT) team huddles to understand daily organising rhythms on the wards.
Based on discussions with a wide range of over 30 Trust colleagues, we synthesised a set of improvement initiatives and prioritised them according to their likely impact and deliverability – to inform the choice of projects in the next phase. The biggest priorities to emerge were more action-oriented MDT daily huddles, and standardised early discharge planning.
Support for individual improvement projects
We worked alongside Trust leaders to identify 15 staff participants – across a range of services and geographical areas – to receive intensive support to lead their own improvement projects. The group included doctors, matrons, psychologists, service managers, ward managers and therapists. These staff developed improvement ideas aligned to both the Trust’s priorities and their own individual interests. Projects included action-oriented MDT daily huddles, discharge planning from the start or – or even before – a patient’s admission, therapeutic interventions to promote more rapid recovery and discharge, and improved communication between inpatient and community-based teams.
We ran a full-day training course to introduce The PSC’s D5 structured improvement cycle and equip participants with a range of problem-solving and project management tools, before running weekly 1:1 mentoring sessions with each member of staff to support them lead their projects. Staff also received support from a project sponsor – a senior colleague to provide advice and remove barriers. After 7 weeks, all staff participants presented their projects and the progress they’d made to a panel of executives and senior leaders, and agreed next steps and any support they needed. It was too early at this stage to demonstrate LoS reductions, but there were several signs of promising impact – for example:
- On one ward, the number of patients for whom the MDT had identified specific tasks increased from 6 to 20 over the course of a month – resulting in more focused planning and care
- In one community team, the proportion of relevant ward rounds attended by lead practitioners increased from 25% to 80% over a couple of weeks – resulting in improved communication and discharge planning
These intermediate metrics gave SPFT reason to believe that longer-term LoS improvements would follow, so long as projects sustained momentum and scaled up smartly.
Sustainability plan for transformational scale-up
We developed and signed off a sustainability plan setting out (i) next steps for delivery and locking in improvement of existing projects, and (ii) what it would take to scale up those priority improvement projects with the highest likelihood of impact and delivery. This identified requirements under clinical leadership, resourcing, skills & experience of key roles, management information, communications and governance. The plan also set out a method for scaling up of priority projects, including the mentoring and reporting structures that proved successful to date.
The programme steering group identified numerous benefits of the locally-driven, centrally-supported programme approach facilitated by The PSC:
- Makes LoS everyone’s business, through establishing clear connections between reducing LoS and improving outcomes for patients
- Combines genuine local ownership with Trust-level prioritisation and oversight
- Offers a structured approach to delivering improvement
- Creates a framework of “supportive accountability” through assigning individual project leads, providing training and mentoring, and asking them to present back to a senior audience
- Enthuses senior staff who see locally-powered change, and become more aware of the opportunities and challenges of shop-floor improvement
The value of The PSC’s input, shone through in feedback from SPFT staff:
“I knew what I wanted to change but didn’t know how. This programme has given me the structure and tools to make that change.”
“The project has really energised the day-to-day running of the ward.”
“Great personable support, very organised, great comms, really able to work with clinicians.”
“This mentoring process has opened my mind to the possibilities of replicating [my project] on other wards and finding my own niche in my career – it’s been amazing.”
Contact Harris Lorie on our transformation team to find out more: email@example.com