Patient Journey

19 February 2010

Delivering a sustainable patient environment is at the heart of the partnership between Interserve and University College London Hospital Trust (UCLH) which won the PFM Award 2009 for the Partners in Healthcare FM category

AS THE LARGEST OPERATIONAL NHS PFI healthcare project, over the past decade the UCLH Trust’s modernisation plan has transformed its facilities, concentrated services at one site, and saved an estimated £12m a year that is being ploughed back into patient care.
Interserve manages and delivers a range of fully integrated FM services, worth £10m a year over a period of 38 years, to the Trust’s estate.
In 2000 Interserve started delivering services to UCLH’s estate during the construction of the new hospital, which was fully mobilised in April 2005. UCLH and Interserve worked together to support the achievement of the foundation status for the Trust in 2004, supported the major incident response programme on July 7th 2005, and has most recently seen the completion of Phase Two, the final stage of the PFI construction.
The key priority for both UCLH and Interserve is the patient experience. By establishing common goals and objectives, the team has been working together to ensure the best possible ‘patient journey’. From the moment the patient steps through the doors at UCLH to the moment they leave, their experience is shaped by Interserve. Typically a patient will be greeted and directed to their appropriate department by Interserve employees. As inpatients, they will sleep in a bed that has been washed, cleaned and made by Interserve employees, they will be brought a fresh and healthy meal, selected from a multilingual menu developed, prepared and delivered by Interserve employees. Their visitors will dine in the Time Out restaurant which is operated and managed by Interserve employees. The patients will be transported by a porter, protected by a security guard, walk past a cleaner and hear the help desk operator, all of whom are Interserve employees.
UCLH, Interserve and Health Management (HMU) Plc have been working closely together to set new standards in patient care, constantly striving to develop and shape non-clinical support services to better suit them to the to patient’s needs. This patient-focused support services model puts the comfort, welfare and safety of the patient at the heart of the FM services operation so patients feel comfortable, cared for and safe. It is a different approach that is proving to be the model for the sector.
With a strong, well established relationship and a long term contract going forward, the partnership approach is enabling the teams to implement strategy, innovations and initiatives now and for the future. Together, they have launched an ongoing improvement programme called Back to BASICS (Benchmark, Action, Service standards, Innovation, Communication and Sustainable solutions). The ‘Back to BASICS’ programme was designed specifically as a way to create a cohesive working environment, consistent standards and an effective way to share best practice and information with each other for the benefit of the patient.
Since the launch of this programme at the beginning of 2008, the team has identified key success areas, benchmarked service disciplines and implemented new initiatives to drive improvements and value for the Trust going forward. Among these is the creation of a ‘cohesive working environment’ which has established clear channels for communication so that all Interserve employees understand the requirements of each other and, most importantly, the needs of the patient. This is being achieved by the partners through its communications strategy and tools such as job shadowing, consistent standards and clear processes, in-house training, the ‘Bright Sparks’ employee suggestion scheme, food and nutrition steering group, helpdesk handbook with information on service lines and procedures, and a focus on positive first impressions.
Collaboration is the key to Interserve’s success at UCLH. On the ground, their employees work alongside hospital employees every day to deliver real improvements designed to improve patient care. It is vital that this partnership is based on transparency to create a cohesive working environment to provide the highest quality service to the patient.
It was also identified that there was a need to formally review and amend processes to adapt to the changes in the patient environment and sharp increases in required bed turnaround times. In response, Interserve implemented Project Apollo, an initiative that looks at processes to understand their impact on patients.
Project Apollo adopts the well-known principles of Lean and Six Sigma, and seeks to eliminate process waste and delays (in terms of work and/or costs) at every stage of the patient’s journey. It is but also about addressing working frustrations and aimed to ensure consistency throughout the workforce.
The UCLH contract has seen a massive increase in demand and scope since it began and particularly the need for an increase in turnaround times for patients. A formal review of processes to change how patient related processes are operated was undertaken where necessary. Project Apollo was first trialed with the 35-strong portering team at UCLH. Porters provide a critical service to the hospital, delivering patients and medical supplies to wards and theatres, and supporting medical teams to keep to the demanding schedule in the effective management of hospital waiting lists.
Interserve conducted a thorough analysis of patient movement tasks using a task management system. Porters were also asked to record the reasons for non-completion of tasks within agreed KPIs. At first, this was met with some resistance. Many of the long service porters had never before been formally challenged about what they did on a task by task basis. However, the results revealed an interesting picture. There were inconsistencies in the reported workloads of the three shift patterns. By monitoring tasks, the workload has been re-distributed evenly.
To date, Project Apollo has identified significant efficiencies across a number of service disciplines, including portering, cleaning, logistics and catering, resulting in £120,000 of efficiencies on the portering services and improved response rates by 20 percent. Since the start of Project Apollo, a number of seminars and open-days have been organised, to communicate the purpose of Apollo to staff, and the need for their input. These have been very successful, with staff understanding that Apollo is an opportunity to improve services and remove any frustrations that they may have.
Benchmarking UCLH and Interserve are committed to benchmarking all service disciplines and sharing best practice, not only with each other, but with the wider industry. As part of their commitment to continuous improvement, they regularly and actively participate in exchange programmes designed to enhance organisational learning and operational effectiveness, by sharing best practice in professional methods, training and management.
A strong focus on social responsibility is also a core part of this partnership, and Interserve sponsored and supported a UCLH medical team in the refurbishment of the ageing, 44 year old Diabetic Ward at Mulago Hospital in Kampala, Uganda. Interserve supplied new sinks, plumbing, lighting and electrical cabling to ensure all showers, toilets and sinks were in working order. They also cleared drains, installed over-bed lighting, curtains, curtain rails and mosquito nets.
Carbon reductions
Interserve is also supporting UCLH with its target to reduce carbon emissions by 10 percent by 2010 through systematic carbon footprint analyses and structured action plans from current levels of 49,000 tonnes CO2 and £5.4m in energy costs. UCLH engaged Interserve to review and understand which factors were causing poor operational energy performance and to develop a programme to save energy.
This involved investigating, interpreting and explaining the factors (both operational and
non-operational) which were causing poor energy performance consumption and the development of programmes to save energy to help meet requirements of the Display Energy Certificates. A full audit of issues impacting on energy consumption was carried out and a practical cost effective solution was developed through the use of benchmarking and whole life costing analysis, enabling informed decisionmaking, accurate prediction of future energy performance and delivery of tangible cost savings and environmental benefits.
Interserve developed its RENEWABLES programme as a framework for managing the sustainable priorities of the clients and themselves. At UCLH, sustainable solutionsarising from this programme have included enzyme based urinal cubes saving £9000 and 3,185kg CO2 a year on a just 50 urinals; steam cleaning using fewer chemicals and water; Dyson Airblade handryers using 83 percent less energy.
UCLH is also at the heart of the response programme to any major incident in London. Interserve erects decontamination tents for chemical, biological, radiological or nuclear incidents before the ‘walking wounded’ are allowed into the hospital. Staff participate in MAJAX incident training and Interserve has developed a bespoke Decontamination Training programme to establish a clear set of roles and responsibilities.
Since the beginning of the contract, Interserve has been supporting UCLH to achieve its objectives and increase the quality of the patient experience. This is evident in the UCLH
achieving a three star rating and reaching ‘Foundation’ status. In addition, Interserve supported the UCLH in improving their Patient Environmental Audit Team (PEAT) rating from red to green, within just 15 months and maintaining that standard by implementing innovative maintenance and cleaning solutions.
The success of the partnership has also been recognised by the RoSPA, from whom the team received a joint silver award for their partnership approach to health and safety in 2008 and a gold award in 2009. The partnership has also recently being recognised by Boris Johnson, Mayor of London, with a London Green 500 Gold Award.
University College London Hospitals NHS Foundation Trust (UCLH) comprises University College Hospital; (PFI hospital incorporating the Elizabeth Garrett Anderson Maternity Hospital), Eastman Dental Hospital, Hospital for Tropical Diseases, National Hospital for Neurology and Neurosurgery, The Heart Hospital, The Royal London Homeopathic Hospital 4 Delivers healthcare services, medical research and training Turnover of £560m; 4 +500,000 outpatient appointments a year; 100,000 inpatient or day case treatments a year.
The judges said, “This is an impressive contract at one of the country’s largest PFIhospitals. There is a strong feeling of partnership and that everyone is in for the ‘long haul’. There is a genuine effort on both sides to succeed.”
The judges said, “The relationship with the Trust started at the beginning of the construction of the new PFI in 2000 and is now a close working partnership providing all FM services. They have developed together shared goals and objectives and these are taking the partnership forward as the hospitalcontinues to develop”