NHS Case Study

Midlands NHS Hospitals Trust

Historical problems and issues within Rheumatology department

New processes defined, agreed and signed onto by Rheumatology staff and senior hospital management

A major NHS Hospitals Trust in the Midlands

Historical problems and issues within the Rheumatology department included:
- Poor quality referral letters and inadequate information to allow prioritization of patients Outdated and cumbersome patient monitoring systems
- Lack of sustained investment in buildings and equipment
- Fast growing and inadequately resourced bone densitometry and osteoporosis service
Poorly differentiated communication channels and management structure
Lack of investment in infrastructure
Lengthy queuing by patients during clinics
Need to develop and nurture the required 'attitudes and behaviours' of staff within the department
Need to develop a review and re-engineering approach to be added to a hospital wide change management 'toolkit' and applied to other areas within the hospital

Interviewed consultants, nursing and administrative staff to gain their perceptions and insights
Interviewed patients to gain understanding of their experiences, issues and concerns
Coached selected members of the management and staff in our review and re-engineering methodologies and techniques
Reviewed the current Rheumatology administrative processes and information flows in detail
Jointly critiqued process with managers and staff highlighting process weaknesses, inefficiencies and problem
Developed improved processes and information flows
Examined infrastructure and made recommendations for improvements
Defined implementation programme

New processes defined, agreed and signed onto by Rheumatology staff and senior hospital management, new processes feature:
- Introduction of a training process for all new Rheumatology cases
- Development of monitoring activity back to GP's
- Significant saving on nurses 'data input' and administrative activities / hours
- Upgrade links with densitometry IT system for use of data in research and analysis of drug effectiveness
Improved structure to address the balance of Senior Nursing staff per Consultant
Recommendation to appoint a clinical lead for the department
Improved balance between Consultants, use of Physiotherapists and suitably qualified Nursing Staff
Implementation of processes by Rheumatology managers and staff proceeding
Implementation of improved facilities and equipment proceeding