Wards, Admissions and Length of Stay

We have worked extensively with the Medical Directors, Ward Matrons and Ward Managers to make significant cost savings without any reduction in Front Line Services or Patient Care. We have worked on improvements to Ward Staffing Rosters that meet the levels of patient dependency and reduce cost in line with more challenging budgets

Have you installed an Electronic Roster but not had any savings yet ?

Are Wards overspent on Budget but apparently understaffed ?

Do you have higher than budgeted levels of absence ?

Are there issues with Length of Stay, Patient Discharge or bed management ?

SYSTEM 21 has the answer to these and many other questions. We have spent hundreds of hours working side by side with Ward Matrons, Nursing Staff and Ward Managers in developing subtle changes to the planning and staff allocation methods in some of the best run Hospitals in the UK. The models we have developed together have delivered improved patient care, as the primary objective, along with significant savings that were thought to be unachievable at the start of each involvement.

We have developed tables and data sets that specifically allocate the correct staffing levels for the range of patient dependencies, from basic admission through to and including isolation and intensive care wards. All the nurse to patient ratios have been agreed with Clinicians and signed off by Medical Directors In fact, the staffing levels we normally implement with Ward Matrons actually exceed the recommended staffing levels proposed by the Royal College of Nursing (RCN) guidelines due to the risk effect associated with other parts of the Hospital that are outside the scope of our Project.

SYSTEM 21 consultants are experienced in Ward management and quickly work out where the main opportunities are for improvement. One of our consultancy staff is an ex-Ward Manager so we understand the complexities, and many of the "juggling" issues that take place on a daily basis when working out the staff rosters. This "in house" knowledge has been shared with our Hospital Teams who are equally capable of understanding the detail of care issues, relative to the cause and effect of cost related constraints.

We also have solid experience of E-Rostering - where the expectation is that simply installing an e-roster package will automatically generate cost savings. Not So ! ..... In our experience, the savings only start after the detail of the staff Rostering matrix has been adjusted by agreement and taken through a full "Consultation process" as it affects the time slots that nursing staff have become used to working. SYSTEM 21 has the necessary skill and experience to design the appropriate staff rosters that will enable the Trust to access the savings from the E-Roster package.

SYSTEM 21 is capable of helping to deliver substantial recurring annual savings in Wards and Patient Care without any reduction in the Services provided or risk to Patient care. We have successfully worked on all of the following aspects of Ward Management and the success of our approach is illustrated in the CASE STUDIES at the bottom of this page.


    Development of Capacity plan around Dependancy

    Improved scheduling and Planning of Nursing Staff

    Improved Bed management

    E-Rostering implementation and Savings Delivery

    Rebalancing of activities to reduce Peaks and Troughs

    Calculation of Net Hours required relative to Establishment Hours

    Temporary staff allocation techniques

    Inter -Ward communications for better staff movement

    Annual Master Planning of all bed Volumes and Ward


    Improved links between capacity planning, admissions bookings and bed availability

    More balanced consultant workload against capacity

    Reduced cancellation of procedures

    Reduced unit costs in general

    Improved Planning based on availability of resources and procedures,  not purely bed availability

    Improved/Live Discharge planning systems

    More efficient use of bed nights

    Reduced Length of Stay

    Improved nurse / care assistant workloads


    Reduced lead time for manufacturing

    Improved scheduling and planning

    Reduced turnaround times

    Improved stock levels

    Improved batch sizes

    Improved purchasing protocols and cost

    Better re-order frequencies

    Dispensing operation

    Computerised prescriptions

    Checking for Errors and Omissions

    Improved pharmacist time available to doctors for drug advice

    Reduced waiting for TTO



During the summer, the hospital (with 16 wards and 500 beds), was anticipating the impending winter bed crisis.  The previous winter bed crisis had seen much chaos with elective patients being cancelled for theatre on a daily basis.  We were invited to carryout a study on the processes, structure and systems in place to manage the bed base at the hospital. (Management population 28, consultants 44)

Study Findings

Following a three week study, working with the local management team, clinical teams and nursing staff, we identified a number of areas which if addressed would substantially improve the overall productivity of the bed base.

The study evaluated the productivity of the bed base by carrying out a twice daily census. This census analysed the “active” activities happening with all beds on a daily basis.  The outcome revealed that only 68% of beds were active on a daily basis.  There were many reasons for this low productivity; they ranged from “consultant unaware that patient was under their care” to “waiting on social services”.  Following the study it was felt that the “bed managers”, albeit worked tirelessly, looking for beds were very much reactive to the problems facing them.

Project Objectives (20 calendar weeks)

From the study we set out a project plan with the objective of:

    Developing and implementing a “real time” and accurate patient status including

    Patient location

    Expected discharge date

    Discharge check list

    Restructure the roles and responsibilities of the bed management team.

With the goal of reducing the average length of stay

Discharge Planning

The programme integrated into the current hospital systems and used the hospital’s “Immediate Discharge System” to allow information on patient discharge dates and their location within the hospital to be recorded in a systematic and timely manner.

The additional information programmed onto the system included:

    Expected Discharge Date

    Confirmation of the Expected Discharge Date

    Review Date

    Medically Fit Date

    Patient Checklist

    Ward Menu

    Allocation of beds

    Check List

    Ward List

Bed Management

A system of recording patients against a bed number was designed to allow patients transfers between wards and discharges to be recorded at ward level. This ensures that the location of each patient can be accurately traced.

The Bed Management system generated reports in real time incorporating location and discharge information including:

    Patients by Consultant – identifies the location of all patients by wards.

    Patients due for Discharge Today or Tomorrow – Lists patients with confirmed discharge dates and displays whether the Immediate Discharge Paperwork is complete

    Patients without a Discharge or Review Date – identifies patients who have no dates recorded and therefore may not have been seen on a ward round.

    Available Beds- Identifies those beds that are available across the hospital by ward.

Project Results

The delivery of the project was focused on two-pronged approach,

    Developing and implementing the processes required to deliver real time patient information (these processes are integrated into hospital’s “Immediate Discharge System”).

    Delivering the behaviour change required to get all stakeholders, including clinical teams, ward staff, ward management and bed management to use the system in real time.

This new way of working allowed all stakeholders including the bed management team to have a live view of the actual status of the hospital bed base at any given time.  This system enabled the bed management team to anticipate delayed discharges and work out proactive solutions for their discharge in a timely fashion.  After only a few weeks of operation the programme already showed a reduction in the length of stay in the “long stay medical category”, and shorter length of stay in the short and medium category.

The significant savings involved NO REDUNDANCIES. The cost reduction came from bringing in fewer Agency Staff.

CONTACT US for more information or email to info@system21.co.uk


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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
  • - Change Project Management

Contact Us

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Address: 270 Castle Street, Dudley DY1 1LQ, UK
Telephone: +44 (0) 1384 456 760
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