Facilities and Estates

SYSTEM 21 has developed a methodology that delivers the fully implemented and working solution.  Identification of Best Demonstrated Performance (BDP) reveals what “can be achieved” and in most areas, using these specialist techniques can deliver staggering cost savings and performance improvements.

Facilities and Estates is one area that is particularly suited to this type of approach (BDP) as it is non-confrontational and easy to understand. It is non-confrontational because the performance targets have all been achieved before. The element we all work towards, in participation with our clients, is how to repeat this performance more consistently, through better control and improved planning techniques.

SYSTEM 21 was nominated for an HSJ AWARD in 2013 for our work on a Facilities and Estates Project where the savings delivered were over 6 times the fee invested.

Here is the Health Service Journal's (HSJ) description of the prize nominated project :

SYSTEM 21 NHS PROJECT IN FACILITIES SHORTLISTED FOR AN HSJ AWARD 2013

Gloucestershire Hospitals Foundation Trust -

Cost Improvement Plan to increase efficiency and save £3.7M In December 2011 the Estates and Facilities Division (EFD) of the Gloucestershire Hospitals NHS Foundation Trust (GHT) needed to make significant savings. Initiatives in prior years had not delivered and the savings target for the year 2012-2013 and beyond was at serious risk. GHT chose a transformation partner - SYSTEM 21 - who were invited to conduct an analysis of the EFD division within Gloucestershire Hospitals NHS Foundation Trust.

The analysis findings identified potential savings of £3.765 million across the EFD. The project actually ran for 26 calendar weeks and involved he areas of

Domestic services

Capital & Development,

Catering,

Maintenance - Estates, repairs, call outs etc

Medical Engineering,

Portering,

Transport

Divisional Management Structure.

The Divisional management team reviewed each new initiative on a weekly basis and agreed or rejected each submission. After a series of consultations with all members of staff, the new structure and the revised shift rosters were fully implemented.

The actual results of the project were identified savings of £4.325 million, This gave the Trust a potential full year Return on Investment of 8 to 1. The Division delivered a Cost Improvement Plan of £3.3M by 31 March 2013. The full year effect of the savings was planned to meet 2013/14 target by 31 March 2014.

OUR SERVICES APLIED TO ESTATES AND FACILITIES :

Each area be positively impacted by our methodology - Porters, Catering, Estates Management, Engineering, Buildings Maintenance, Technical Maintenance, Call Centres and other services.

BDP forms part of the methodology we use as it provides the perfect example for staff to realise that they can deliver increased operational performance.  All we have to do is to develop the plan, communicate the plan, measure how we did and make further improvements. We implement the planning and management system that will enable staff and management to repeatedly deliver this increased level of operational performance and to reduce cost.

PORTERING, CATERING AND OTHER NON-CLINICAL SERVICES

    Correct staffing levels per area
    Improved productivity
    Better response times
    Capacity planned porters when needed
    Faster response to maintenance requests
    Improved cleaning standards
    Reduced cost throughout Facilities
    Better Stock Control
    Improved cost control
    Greater utilisation of staff
    Reduced overtime
    Improved patient service levels
    Increased efficiency
    Integrated Reporting
    Improved Accountability for action

CASE STUDY -Sterile Services

Background

Sterile Services were based on two sites:-

Site 1 - A modern state of the art facility which is fully compliant with European directives regarding sterilisation of Surgical Instruments.

Site 2 - An older facility which does not comply with European directives and would require expensive upgrading.

The brief was to examine the feasibility of improving productivity & utilisation at Wakefield and develop a feasibility study for the consolidation of all Sterile Services at site 1.

STUDY FINDINGS

Following a three week study, working with the local management team we identified a number of areas which if addressed would substantially improve Capacity & Resource Requirement Planning & Scheduling, the potential to develop economy of scale in the Management Structure. Significant Productivity & Utilisation improvements were also identified. The Productivity gains would require considerable re-alignment of shift patterns and rosters.

The study was carried out using a “Rough Cut” Capacity Planning Methodology. Resource Requirements were calculated and Hours were rostered as required by incoming workloads & SLA turnaround targets.  Comparison of Hours actually worked versus hours required to handle the incoming workload within the SLA targets demonstrated that the Day Shift was over crewed and started too early in the morning. Shift start 8:00; first delivery of instruments from theatres 10:30. This underutilised time at the start of the day generated excessive overtime at the end of the day to meet the Service Target which was expressed as “Use it today; It will be back in your Sterile Store by 8:00 tomorrow. Utilisation Studies on the Washers & Sterilisers demonstrated that there was Washer Capacity to handle about 65% of the site 2 requirements & Steriliser Capacity to handle 100%. 

PROJECT OBJECTIVES AND DELIVERABLES

Develop detailed Capacity & Resource Requirement Plans for the current situation and for the future, consolidated situation.

      Develop crewing guides & rosters to minimise overtime. This was a very contentious issue which was resisted very forcefully by the staff. The changes in core shift times from 8:00 – 4:00 to 10:00 – 6:00

      Identify the economies of scale in management & equipment which would be realisable as part of the consolidation.

      Develop a simple Management Information System based on monitoring Inputs & Outputs & correct rostering of staff & monitoring overtime.

      Performance Management System with productivity calculated based on Hours Earned vs Hours Worked.

      Provide Sterile Services with the information required to augment the Washer Capacity to enable preparation of the Business Case for consolidating Dewsbury Sterile Services into Wakefield.

    PROJECT RESULTS

    The Capacity Plans (Daily Plan for the Week and Hourly plan for the Day) identified significant savings which could be realised by realigning shift patterns & rosters to have the right people in the right place at the right time.

    The Equipment Capacity Studies confirmed that consolidation of site 2 into site 1 could be achieved at a modest cost compared with upgrading the site 2 facility to comply with European Directives. 

    The client decided to increase the Capacity by more than the minimum requirement in order to compete for Private Sector & G.P. Surgery Sterilisation requirements.

    Agenda for Change negotiations were ongoing between Management & Staff. The revised shift patterns required to realise the productivity & overtime savings formed part of these negotiations.

    The Client accepted that realisation of the identified result would only happen as the consolidation plan & the Agenda for Change negotiations were complete.

    A net reduction of 9 WTE’s was identified from a payroll of 54. This includes converting the cash value of overtime & on-call saving to WTE’s and the reduction in Management & Supervisory requirements in the combined unit. Additional logistics costs were reflected in the net savings

    The Project Schedule for the Washer Upgrades & the Consolidation was developed with the Sterile Service Manager.

CASE STUDY NHS, CATERING DEPARTMENT

Background

This study relates to an NHS Trust with a 500 bedded general hospital, a psycho-geriatric unit with 120 beds and a small rural unit of 30 beds.  During the 1997-1998 financial year the catering department overspent in excess of £196,000 which represented 20% of the annual budget. During the first 6 months of the 1998-1999 financial year the department was heading towards a similar overspend.

There were a number of service issues surrounding the quality of the food on offer and out of hour’s provision for medical staff. Exit poles from junior doctors completing training at the trust highlighted poor catering provision as a major drawback of working at the trust.

Objectives (12 calendar weeks)

  1. To install a management control system to monitor key performance indicators for patient meals such as cost per meal.
  2. To ensure that commercial activities such as the dining room and shop were at least breaking even.
  3. To implement a sales and marketing programme to boost dining room and shop sales
  4. To improve the delivery of the catering service to staff.

The Patient Food Service

The food delivery service was examined at ward level and a survey of nursing staff carried out at the smaller hospitals. The questionnaires highlighted problems in the quality of food, particularly of pre-prepared meals, food choices and temperature control. A recent report from the NHS had highlighted cases of patients being undernourished in hospitals and there were concerns from the Chief Dietician that a number of vulnerable groups of patients in the hospital could be at risk. Observations at ward level showed that feeding patients was not a high priority on most wards and there was generally a poor perception of the catering department.

The process changes put forward by the SYSTEM 21 team were further endorsed by a visit to another NHS Trust whose catering department operated a system very close to the model being proposed and supplied a satellite hospital from a central kitchen. This was a previous SYSTEM 21 client and the staff were very enthusiastic about the positive benefits they have delivered with our help. The feedback from the visit confirmed that the new system would be beneficial and the catering managers were able to develop and work with the solutions proposed, which led to significant improvements in patient meal quality at the point of delivery.

The Nurse Managers and dieticians were consulted on the proposed changes to the system and a pilot ward was set up with a trolley service in the general hospital and a pilot ward in the smaller hospital piloted the food prepared in the central kitchen and transported to a hot trolley on site. Observations were made on the time to serve meals at ward level and monitoring of food quality took place during the test period.

The Management System

The catering managers forecast the expected volumes of each meal item based on a scanning system which collated information from the patient’s menu cards. The Chefs then plan their staff and materials on a daily basis according to the projected meal numbers. An hour before each meal, final figures were made available from the menus system and additional meal produced if necessary. Waste monitoring was set up on a meal by meal basis and the chefs measured against cost per meal targets.  The volume of meals served from the trolleys was recorded based on the number of trays issued and individually packaged items used to eliminate food waste. SYSTEM 21 has templates to collate the data without duplication, with automatic generation of Senior Management Reports.

The stock of raw materials was monitored weekly with raw materials issued against a specific meal type; the cost of each meal was also monitored weekly. Other Key performance indicators were also recorded such as meal volumes and labour costs. As a result of the changes in the production and distribution process the use of temporary staff has been curtailed and the overall wage bill has reduced significantly. Again, the SYSTEM 21 templates were invaluable as they had already been agreed several times by managers and staff in other NHS Hospitals, so were not considered to be a "threat" when put in front of the client Project team

Conclusions

  1. A comprehensive management control system was designed and installed to measure cost per meals and the profitability of the commercial units.
  2. A long term strategy is in place to close the smaller hospital kitchen and make substantial savings.
  3. The Cost per meal was reduced by 27% during the course of the project.
  4. The Dining Room sales increased by 25-30% when compared with the previous year’s figures, without any price increases.
  5. The projected return on investment for the project was 5:1 by week 10 of the 12 week project.
  6. Staff motivation improved significantly.

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Services Overview

Professional change management and transformation services, including full implementation of all recommendations. SYSTEM 21 has an enviable track record of 100% successsful projects.

  • - Profit improvement with full implementation
  • - Busioness diagnostics and transformation
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