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coaching & performance development |
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case histories - improving quality
West Hertfordshire Hospitals Trust: Improving the quality of emergency care
It was identified that the performance of the trust in delivering emergency care was failing to satisfy expectations; the most visible and obvious evidence of underperformance were long A&E waits.
The reasons for this performance were many, but included the following:
- Clinical engagement in reaching targets was low, a situation exacerbated by many clinicians’ not having come to terms with being part of a larger trust and the need to change working practices as a consequence
- Traditional A&E procedures were incapable of handling the load at peak times, despite hard work by dedicated staff
- The Rapid Assessment Unit was not being used as intended, and patients being sent as emergencies by GPs were waiting inappropriately in A&E
- Internal management information systems and processes were inadequate, and analysis not directed to delivering future performance
- In addition to these immediate difficulties, the trust had a stubborn financial deficit
Quo formed part of a “Task Force” to turn the Trust around.
A wide range of interventions were put in place, including the following:
- Sophisticated computer modelling was used to forecast demand and create forward planning
- New protocols for A&E procedure were developed with clinical involvement and implemented with the required resources
- The RAU systems and procedures were upgraded to prevent clogging
- Clinical engagement was driven by an ongoing series on workshops that led to far greater involvement in the issues (and in fact led to several clinicians volunteering to help spearhead the necessary changes)
- Better management procedures and the allocation of clear individual responsibility were introduced
The task force achieved an enormous amount was achieved in a short time including major reductions in long-stay patients and A&E waits over 4 hours.
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