One Size Cannot Fit All
- 11 September 2017
- Posted in: Healthcare, Science & Technology
A recent report published by the Care Quality Commission on the state of care in NHS acute hospitals has further highlighted the ever-increasing demand for urgent and emergency services. When ambulances are delayed at the hospital door and many parents suffer long waits in emergency departments the pressures on the urgent emergency care (UEC) system has led to a consensus that reform is necessary.
Hillingdon CCG ("HCCG") and The Hillingdon Hospitals NHS Foundation Trust ("THH") are among the many that have experienced this on-going pressure at the front end of the urgent care system for some time. After previous attempts at making improvements have been hindered, in August 2015 the HCCG and THH commissioned Methods Analytics to undertake a study to identify their underlying causes and barriers preventing change.
As a health care analytics business, we are well versed in data and how to transform it into easily accessible, intuitive and insightful evidence that can be used to build a solution, so we were excited to apply our expertise to review the pressures on the emergency department at The Hillingdon Hospital. We needed to ensure that our study was bespoke and did not fall short where other studies have done in the past. The aim was to help
understand and explore in depth the issues affecting the emergency and urgent care service at THH; to identify factors that may have hampered attempts to improve the service in the past; and to support the CCG and THH in developing a prioritised set of interventions aimed at addressing the issues that were uncovered.
All trusts are different so it was also important to not fall into the trap of pre‐empting the overall findings.
To achieve this a three‐phase approach was used, with three distinct deliverables:
Phase 1 – Data driven using national and local data. Used Stethoscope TM and its advanced analytics features to provide a detailed, quantitative and objective overview to examine and challenge the assumptions about the causes and drivers of ED pressures at THH.
Phase 2 – Qualitative analysis of pathways and processes and previous improvement initiatives. Investigated the nine themes identified in phase 1 and looked at other factors not directly amenable to quantitative approaches.
Phase 3 – Supported THH and HCCG to develop a prioritised set of interventions to address key issues identified in phases 1 and 2. Worked closely with stakeholders across the local urgent care system to evolve five initial outline business cases through large‐scale, interactive decision workshops.
The review was five months long in its entirety and was positively received by the CCG and the trust. It generated considerable interest and increasingly strong engagement from all those involved in urgent and emergency care locally. The phase 1 and 2 reports provided new facts and fresh insight into the performance of THH’s unscheduled care system, whilst phase 3 developed a strong consensus on priorities for action.
It was universally recognised that a system‐wide, co‐ordinated approach to promoting and managing change was needed.
The purpose of the study was not to reform the emergency care at THH overnight, but to instead provide the trust and CCG with a clear plan of acon to enable them to build on and sustain the improvements relevant to THH. As all hospitals that offer urgent and emergency care have different demographics and their own set of problems, transforming the emergency care system cannot be based on a one size fits all solution. As with The Hillingdon Hospital, an in‐depth understanding of the obstacles and prioritising interventions will prove more effective at hospital level.
