Jonathan Lofthouse, Director of Improvement at Aintree University Hospital NHS Foundation Trust, explains how the NHS can bring about significant change and see strong payback, while working at pace.

The NHS is renowned for world-leading care but has a reputation of being more reactive than proactive, the agility required to bring rapid change is often lacking. But it is possible to invest sizeable finds that bring strong payback while working at pace.

We continue to illustrate this at Aintree, our recent outpatient improvement project went from procurement to installation within just 10 weeks and will pay for itself within four months of go live. £1.3m of annual savings will be generated from this, nearly six times its investment price. Furthermore, the transformation of our pre-operative assessment process saw us double our capacity for a very modest initial outlay.

Coordination and delegation

Swift team assembly is essential, at Aintree we allocate a named Senior Responsible and a named Trust Project Manager for each of our commercial partnerships.

As a Director Improvement, I have increased financial authority over such partnerships. The authorisation rights of the role are equivalent to an Executive Director of Finance at a University Foundation Trust, where decisions can be made without the constraints of delayed sign off systems.

We also stipulate that each one of our commercial relationships is a partnership, never simply a transaction.

Articulating direct payback

For the recent Outpatient change project, we partnered with InTouch with Health, a patient flow software technology supplier, and DrDoctor, a virtual digital platform technology supplier, to bring about long-term benefits for our outpatients.

We introduced self-service options to each of our clinic and outpatient therapy locations, so that patients can simply swipe their smartphones when they check in. This self-service solution has been linked to the digital communication platform so that patients now receive text messages and in phase two, digitised letters regarding their appointment, straight to their phone.

The installation immediately reduced the number of front-facing administrative staff, yet all workforce reductions throughout the project were done through natural turnover and churn, without redundancies. So far, we have saved £486,000 in reduced staffing.

Digitisation of the letter process has had brought £560,000 in annual savings, and we currently only have 67 per cent of our patients’ smartphone information.

Articulating indirect payback

For our pre-op assessment change project, the business case was very clear from the start. Aintree undertake around 21,000 pre-operative assessments a year. These are resource intensive one-to-one, complex clinical assessments. The manual nature of this process meant that we could not audit or extract statistics from these assessments.

We were less than happy with this time-consuming and, frankly, archaic basis of assessment and we knew this could be a better service for both patients and staff alike. We saw a small selection of market products, and worked with Synopsis IQ, a framework supplier, to bring about the change.

Implementation began in September 2018 and by December we had a fully digitised algorithmically-weighted pre-operative assessment tool. Patients still receive appointments with named clinicians, but parts of the assessment are now undertaken as a self-service method. Within the first five days of go-live, our average time for a pre-op assessment went from 44 minutes to just 18.

This is a win for both quality and safety. The actual clinical information depth is of significantly greater quality than it once was, and it has essentially halved the time taken, therefore doubling our capacity. 1,200 patients have used the tool thus far, and the post-implementation satisfaction survey revealed that 98 per cent of patients are happy with the new digital solution.

Robust use of technical contractor stage gates

Technical stage gates very clearly motivate suppliers to deliver on pace, and our outpatient improvement project saw suppliers meet their timelines. DrDoctor revealed to us that this was their fastest ever implementation.

We bought the pre-op assessment system, Synopsis IQ, straight off the framework with agreement of our clinical teams, so it was a case of sign and buy. We set up three technical stage gates throughout the implementation period, which meant the supplier stayed on track, and delivered within the time-frame.

Regular review of business cases

Business decisions at Aintree will never take longer than a month and we keep staff engagement up by arranging either weekly or fortnightly project groups.

As with any major change project, internal engagement is essential and can be a challenge to maintain. Our approach has always been to be very inclusive on early-stage demonstrations – when we are considering purchasing a piece of kit. We often have an audience of 30-40 trust staff in the room who can see the product being demonstrated.

Our healthcare system’s reputation of being hesitant to change has bred a culture with some suppliers to perhaps slow down their delivery. It’s a case of we move slowly, so they move slowly. At Aintree, we are bucking this trend, and as a result we’ve found that suppliers can deliver on pace, when they are expected to against clear frameworks.

Jonathan Lofthouse recently chaired the Healthcare Partnership Network. The next HPN takes place on 16-17 July, at Oulton Hall, Rothwell Lane, Leeds.