An NHS Under Pressure- Using Governance to Reduce Waiting Times & Hospital Admissions

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An NHS Trust identified the need to provide universal governance to their Same Day Emergency Care (SDEC) environment. To deliver this objective, MIGSO-PCUBED were engaged to equip the organisation with standard practices for measuring the individual performance of each SDEC and establishing metrics that would signify best practices in the SDEC environment.

The application of Project Controls and Change Management practices as well as the development of workstream processes provided the structure needed for the client to facilitate future transformations.

SDEC (Same Day Emergency Care) is one of the many initiatives used by the NHS to provide the best patient care hospital. Within a southwest England NHS Trust, they aimed to adhere to ‘the right care, in the right place, at the right time for patients.’ In order to achieve this, the client implemented SDEC environments, which are alternative pathways whereby walk-in patients can be diverted to help reduce waiting times, hospital admissions and reducing the overall pressure on the health care system.

During this engagement, MP were deployed to support the Trust with PMO governance and to accelerate the pace of progress within the Hospital Flow improvement Programme. This article will address the challenges faced and highlight the solutions implemented within the Trust.

The Challenge

Within the trust, our team was involved with six SDEC units per hospital: Medicine, Cardiology, Older People Services (OPS), Trauma and Orthopaedics & Surgery. Between the SDEC units, there were no universal metrics to assess progress against the Hospital Flow Transformation Programme. 

The NHS Trust was undergoing a transformation project worth £250 million that involved the merging of two hospitals. This allowed emergency cases to be handled at one location with increased consultant and specialist team coverage seven days a week. This new set up meant a reduced number of patients transferring between hospitals, a reduction in ambulance calls, and improved patient outcomes. 

During this period of transformation, the Hospital Flow Improvement Programme sought to manage the complex change and ensure, whilst there may be disruptive periods, that the Trust could effectively manage and ultimately improve patient flow throughout their journey in the hospital. The programme had four workstreams; Emergency Department (ED), Same day emergency care (SDEC), Operational Flow and Discharge. 

Across SDEC, the different reporting medical areas had a series of target objectives that needed to be reported to the directorate: 

  • Successful SDEC Attendance (75%-85%) 
  • Emergency admissions from GP% (100% in opening hours) 
  • Opening Hours 08:00 – 20:00 M-F 
  • Direct Referral from SWASFT (South Western Ambulance Service NHS Foundation Trust) 
  • Streaming from ED  
  • Pulling from ED 


The clinical leads comprising of nurses and doctors were already overstretched with the day to day responsibilities of managing a hospital and did not have the capacity to take on new responsibilities, such as governance reporting. The target objectives highlighted above, had not been clearly communicated to the clinical leads within the SDEC areas, which led to subjective report outputs per clinical area as leads only highlighted the critical issues to them at that moment in time. 

Each month, the group director of operations would have a monthly highlight report meeting with the immediate executive team. However, the deputy director of operations struggled to provide feedback on the key metrics since it was unclear to the SDEC areas what was the important data to call out in the reports.  

The reporting metrics were extracted from the Cosmos dashboard. The dashboard was pulling information from two different hospital systems and wasn’t a finished product. The data insights team needed engagement with the SDEC areas to support the information validation which would boost the accuracy of the data within Cosmos. 

In its current state, the information being displayed was inaccurate and didn’t match the reality of the SDEC units. An additional issue facing the NHS Trust was that the analytics team were trying to pull data from two hospitals using two different systems. Since the merger was in the early stages, the analytics team needed engagement from the medical areas to validate the information and support them with cleansing the data. 

However, the staff didn’t engage with the platform or the analytics team to help correct the data as it was deemed ‘unreliable’. It also caused an issue because the Deputy Director of Operations was unable to extract data from the system and report to her leadership the current state of her SDEC environment. 

Not being able to report on the SDEC environments meant that the Deputy Director of Operations wasn’t able to provide her leadership team with the clear visibility they need on the SDEC workstream. 

It was clear to MP that they were going into a pressurised environment, and our involvement with stakeholders was extremely limited at times due to hospital pressures. Additionally, the number of MP consultants on the engagement grew, so it was important to prepare them for a tense stakeholder environment. Initially, some of our NHS stakeholders resisted engaging with us, as it added to their already overwhelmingly stressful schedules. 


Photo by EVG Kowalievska

The Solution

During one-on-one meetings with the Deputy Director of Operations, our lead MP consultant was able to find out on which key metrics the NHS Director would be measured. It was important that these metrics were specific, measurable, achievable, and relevant to enable accurate metrics tracking for each SDEC.  

Our lead MP consultant designed a weekly reporting pack using Microsoft PowerPoint that collated the metrics into an easily, readable format. It contained a screenshot from the Cosmos dashboard which enabled the SDEC clinical leads to familiarise themselves with the report, as well comment boxes showing the SDEC metrics and space for commentary from the SDEC areas. Next, we presented the format in the weekly governance meeting and walked the team through the reporting mechanism. 

The MP team were involved in the initial set up and led the reporting of these metrics during the weekly SDEC governance calls. This ensured accurate reporting and limited the amount of additional work to key SDEC workstream leads. 

After a few sessions co-leading the weekly SDEC report-out with the SDEC team, they had the confidence to continue the cadence and structure on their own. We were able to fulfil the objective of providing a cohesive view of the programme for the Deputy Director of Operations. 

Organisational Benefit

A key aspect that led to the success of the deployment was stakeholder management & communications. NHS environments are large and complex in nature. It is common that consultants will work with stakeholders that are at maximum capacity and have limited time to engage. 

Coming in as an external party, the MP team needed to be compassionate and highlight the need to the client, that this piece of work provides visibility to the directorate of all the hard work they are doing on the ground. By taking the time to show the reporting systems, explain how a highlight report works and bring that governance and consistency to the table, we were able to win over the clinical and nursing leads and get them to follow the SDEC governance reporting process. Additionally, we provided structure and organisation for the Deputy Director of Operations for when the client had to report upwards to leadership. 

By providing senior management with a standardised and integrated view of the entire SDEC environment, it successfully facilitated informed decisions and an in-depth understanding of the progress and shortfalls of each SDEC ward. The customised reports catered to the deputy director of operations highlighted key metrics which was crucial for her reporting. 

During the engagement and proceeding withdrawal, the client was equipped with effective governance to improve project performances, through standardisation and improvement in documentation, processes, procedures, and methodologies. 

“MP has been extremely, helpful, professional, organised, knowledgeable, friendly and challenging where needed. They pulled together the SDEC services programme within our NHS Trust, delivering the right amount of professionalism and friendliness to get the job done.”

This article was written by Vanessa Erivona, Senior Consultant.

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