The viability of hospitals has been at the centre of domestic debates recently – but it’s not a UK-specific challenge. Colleagues in other parts of Europe tell me they face similar issues related to the sustainability of acute providers, often sharing intelligence on initiatives their local hospitals have put in place to improve operational efficiency and reduce costs.
One example brought to my attention is the experience of the Brussels-based St Pierre Hospital, which has successfully introduced lean management systems to its operating theatres, leading to significant efficiency savings.
To put it in context, this is a 636-bed public hospital with around 2,000 staff and an annual budget of €335 million. It treats around 400,000 patients a year and provides the largest A&E service in Brussels, with 95,000 emergencies per year. The hospital operates in a challenging environment, with many in the local population living below the poverty income threshold. It also has a legal duty to provide healthcare to disadvantaged groups, such as asylum seekers.
Faced with increasing pressure on services and a mounting budget deficit, the hospital management team decided to look at new ways to achieve efficiency and reduce costs. A decision was taken to reduce task duplication by applying lean management principles and focusing on ‘added value’ tasks. This approach, which they called ‘Well-Organised Work’ (WOW), is based on the promotion of team work outside hierarchical relationships and encouraging initiative and innovation.
Starting with the operating theatres, where significant efficiency issues had been identified, an operational management committee was set up, bringing together representatives from anaesthetists, surgeons, nurses and an administrative coordinator. The committee was charged with looking at how existing working practices could be streamlined and become more efficient, while improving patient safety and experience.
As a result, a number of inefficiencies were identified across different areas, requiring change and new ways of working to address them. Actions were taken in the following areas:
- Human resources: the working time of nurses and other professionals was reviewed, to allow more surgical procedures to take place and to ensure better continuity of care for patients. Staff were coached on how to communicate better with colleagues and improve working relationships.
- Drugs supply management: a computerised, more efficient point-of-use medication management system was introduced to manage drug supply from the pharmacy.
- IT system: one of the first meetings of the WOW operational management committee revealed that nurses had to use at least six different programmes to get information on a patient before a surgical procedure. This was a significant waste of time, all the more so as some crucial information was not available, such as information on infectious diseases. A new software system was designed to fit the needs of staff, taking a more holistic approach.
- Logistics: before WOW was implemented, 356 different steps were needed to prepare a single surgical procedure. This has been significantly reduced by creating a new and bigger central storage for surgical supplies and using software that makes the management of surgical materials easier. This is complemented by regular preventive reviews of surgery rooms and materials.
Looking at the outcomes, the WOW programme has resulted in clinical activities being conducted in a much more efficient way, and in health professionals being more satisfied and able to spend more time with patients, rather than with administrative or logistical tasks. For example, better information about patient flow has saved each nurse on average 27 minutes in telephone calls per day.
Importantly, the measures introduced have resulted in significant growth in surgical activity, with the hospital now able to conduct 60 surgical interventions a day, as opposed to ten, and with elective surgery occupancy rates increasing from 60 per cent to 95 per cent in two years.
An interesting aspect of this initiative is its focus on staff engagement and ownership, with professionals working as a team to identify problems and possible solutions. The success of the experience, which has allowed the hospital to save €1 million in two years, on top of the income generated by the increased surgical activity, has paved the way for an extension of the WOW approach to other hospital departments.
This experience reminds us that the NHS is not alone in facing the challenge of delivering high-quality patient care at lower cost. Providers in other countries across Europe must also find responses to similar challenges and have developed a variety of interesting initiatives – of different complexity and size - in a range of areas to improve operational efficiency.
While several NHS trusts have already embraced operational efficiency as part of the QIPP agenda, and the NHS is viewed as an innovator in many areas by our European counterparts, at a time when the sustainability of hospitals and cost efficiency are at the heart of many policy debates domestically, there is certainly value in looking at approaches trialled in other countries – and their outcomes – and whether we can learn from them.
Elisabetta Zanon is director of the NHS European Office, a part of the NHS Confederation. Follow the organisation on Twitter @NHSConfed_EU.
Want to know more about international models of care?
Read Elisabetta’s posts on the Alzira model in Spain and the ‘chains of care’ model in Sweden.
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