Jonathan Lofthouse, Director of Improvement at Aintree University Hospital NHS Foundation Trust, reveals how it is possible to complete a transformative change project in a matter of weeks, and see strong payback as a result
The NHS has a reputation of being more reactive than proactive, and can be very slow when bringing about significant change. This has bred a culture with some suppliers to perhaps slow down their delivery also. It’s a case of we move slowly, so they move slowly. At Aintree, we have tried to reverse this trend, and as a result we’ve found that suppliers can deliver on pace, when they are expected to.
From purchase to installation within 10 weeks
Using an eight-point framework, Aintree has illustrated how it is possible to work at pace, prudently invest a lot of money and see strong payback. We applied these eight principles to a recent outpatient improvement project at Aintree, where we went from purchase to installation within just 10 weeks. This technical purchase will pay for itself within four months of go-live and will save £1.3m per year, which is nearly six times its investment price.
Aintree’s eight-point framework:
- Business cases should always clearly articulate payback.
- Business cases are reviewed on a monthly cycle, as well as annual – the longest Aintree waits for a business decision is 4.5 weeks, as opposed to months and months.
- Increased financial authority – as Director of Improvement I have authorisation rights to £250,000, without reference to another individual.
- We stipulate that every one of our commercial relationships is a partnership – it is never just a transaction.
- We are very robust on the use of technical stage gates for delivery – so this very clearly motivates suppliers to deliver on pace.
- We allocate a named senior responsible office and a named trust project manager for every single commercial partnership.
- We purchase the very best we can afford.
- We apply a robust application of procurement frameworks to all projects.
The recent change project saw us work with InTouch with Health, a self-check in technology supplier, and DrDoctor, a virtual technology supplier, to bring about long-term benefits within the Outpatient Arena.
We introduced self-service options to every one 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 or digitised letters regarding their appointment straight to their phone.
The installation immediately reduced the number of front facing administrative staff, yet, all of the workforce reductions throughout the project were able to be done with natural turnover and churn, so there were no redundancies. We have saved £486,000 in reduced staffing, so far.
Reducing and print and mailing costs, as well as DNAs
At Aintree, we do digital communication by default, not design, so unless you request a letter about your appointment, all of your correspondence will go to you digitally. We currently have about 67% of our patients’ smartphone information. The has substantially reduced our print and mailing costs, and reduced DNAs. By going to digital default for letters alone, that is £560,000 a year saving Aintree.
The project saw suppliers hit their timelines. DrDoctor revealed to us that this was the fastest implementation in the organisation’s history.
As with any major change project, maintaining internal engagement is clearly a challenge. The attitude of the team at Aintree was positive but variable. Our approach has always been that we are 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. So early engagement is crucial. We also arrange either weekly or fortnightly project groups. We wouldn’t wait a whole month for one of these meetings. One; because we are moving on pace, and two; because we want to keep internal engagement up.
What we have also found is that, because our projects develop so quickly, our staff want to attend meetings because they know they can be involved conversations and on decision-making as projects unfolds – the developments don’t feel as if they are ‘lost in the wind.’
The final phase
The InTouch with Health, self check-in technology has now gone live across the entirety of the outpatient site, and the virtual technology is now live to 70% of patient clinics. The final phase, which is the technical digitisation of letters, goes live within the next five weeks.
At the next Healthcare Partnership Network, taking place on 12th and 13th March, I’ll discuss in more detail how Aintree was able to rapidly agree a costed business improvement proposition for transformation, and deliver sustainable change in a matter of months. I’ll also be the Chairman of this event, which is exclusively for director and senior NHS leaders. Read the full agenda here.
