CASE STUDY Wellton NHS Trust Wellton is a medium sized NHS Trust in the north of England. With an annual turnover of 330 million and around 6,000 clinical and support staff it provides medical services to a population of 450,000 people. The Trust Board is responsible for setting the strategic direction of the Trust lead by the Chief Executive Officer (CEO). Departments are organised into three clinical directorates, medical, clinical support and surgery, each lead by a director of services. Within each directorate there is a traditional hierarchy of medical and administrative staff, paid according to the type and level of job on a rigid pay band structure implemented by the national Agenda for Change project. Staff receive 27 days annual leave (rising to 33 days after 10 years service) and access to the generous NHS pension scheme. A package of childcare services and vouchers, occupational health care and counselling services, work related training and development, as well as a range of discounted products and services for NHS employees are also available. In addition the Trust presents a range of long service awards to employees to recognise their commitment to the organisation. The Trust has recently been through a major change process following the decision to merge with a smaller Trust. This has seen expansion of the Royal George hospital site to absorb services from the closure of two small community hospitals. The strategy was developed to achieve cost savings and service improvements however the hospital closures have unsurprisingly caused considerable concern in the local communities they serve. This has been escalated by media reports of problems in the Royal George and a rising number of complaints about patient care. The Trust has also dropped 10 places in the latest national inpatient survey. In September a new HR manager joined The Trust. In their first meeting together the CEO informed the HR manager about the difficulties they had been experiencing in the last 9 12 months. With 11 other NHS Trusts (NOT including Wellton) being placed on special measures following major failings in July 2013, growing media interest in NHS failures and continuing financial and political pressures on the NHS, the CEO knew he could not ignore these problems. He asked the new HR manager to take some time to observe and research what she thought was going on and to present a report of her findings and recommendations to him and the Trust Board to help them to understand and improve the situation. During her first six weeks she spent time talking to and observing the different departments and made some key discoveries to inform her report. The Surgery Directorate: Theatre Department Last year the Trust completed a multi million pound investment and development of the theatre department at the Prince George hospital as part of its merger strategy. This included the addition of six new operating theatres, bringing the total to 26, and the opening of a hospital sterilisation and disinfection unit (HSDU) enabling theatre equipment to be cleaned on site. This offered a more responsive service to the operating theatres than contracting the services to a 3rd party, ensuring that sufficient surgical equipment is available when required. However things do not appear to be running to plan in the new department. There have been quality issues in the HSDU with the return of dirty surgical equipment holding up operations. In addition, inadequate maintenance records, which could possibly put patients at risk, resulted in five of the older operating theatres being closed down for 2 weeks. This put a huge pressure on the remaining theatres and resulted in the cancelation of elective surgery with a critical impact on surgery waiting lists and an increase in patient complaints. Despite a well run recruitment campaign to staff the new unit the department also appeared to be experiencing some significant staffing problems. To ensure the required levels of clinical cover to run the department safely the HR manager notices some staff have been working for 12 days in a row without a break. This might go some way to explain the low scores in the staff survey regarding the Trusts commitment to helping staff balance their work and home life. Staffing problems have also been identified in the theatre departments team of porters who are responsible for moving patients around the department and between the theatre and the hospital wards. Sickness rates in this team are well above the hospital average and the staff shortages caused by this have had significant impacts on the speed at which patients move through the department. The late arrival of patients for their theatre slots has resulted in medical staff standing around waiting for patients to arrive. As a result the scheduled theatre sessions have regularly been running late. While many of the theatre nurses have been happy to work during these over runs for free in the past this has now become so regular that they are asking for overtime payments to be made and staff have made complaints to their Trade Union representative. Clinical Support Directorate: The Medical Records Department In the Medical Records Department changes have been implemented to bring all of the Trusts records and appointment services into one central department to reduce costs. Staff have relocated from two community hospital record departments to a new purpose built administration and records library on the Royal George site which has provided them with greatly improved working conditions. Jobs within the department have been redesigned with the move. In the community hospitals, records staff covered all jobs in the department, preparing medical records for clinics, sending out appointments, setting up new clinics on the computer system, filing and answering telephone queries from hospital staff and patients. In the new move, these functions have been separated out so each employee can specialise in one area and build their expertise. Detailed procedures have been drawn up for each function to help improve consistency of service, for example when dealing with patient enquiries staff now follow a script on the computer to ensure they cover all the necessary information. Staff have been carefully briefed on the procedures relating to their own jobs and trained on the new computer and telephone system. The records manager also holds daily team briefing sessions with staff to cascade information to them about the departments performance. She appears to be in firm control of the department giving clear directions about what needs to be done each day, allocating each task to a member of staff. She has also completed all the staff appraisals and set every team member the same performance objectives to meet the departments key performance targets (KPT). However this department has also experienced some difficulties. One of the biggest complaints from the clinics has been the loss of patient records. Clinics have been held up and some patients have had to have medical tests repeated as a result. This has led to a lot of in fighting in the team, with the old Royal George staff blaming employees who have transferred from the community hospitals for filing records incorrectly on the new system. When the records manager investigated some of the missing records she actually found a number of the missing files had been withheld by the doctors and consultants themselves, revealing a problem with the overall process rather than with the ability of any of the team members. She is working on designing a new process to tackle this but her discovery has done little to heal the rift in the team. Two of her best staff have left the hospital to take jobs elsewhere. This has left the department short staffed, a problem made worse by difficulties persuading the staff who are left to move their shifts around. The department is regularly short staffed on Friday afternoons and out of hours (evenings and weekends) so staff who do work those shifts come under considerable pressure to keep up with answering queries and dealing with problems. The manager tells the HR manager she is concerned that two further members of staff have told her they are looking for new jobs. They say they dont enjoy coming to work anymore and feel that a threat of job losses has been hanging over the department since the merger. The Medical Directorate: Accident and Emergency Department (A&E) The HR manager notices there appear to be far fewer problems in the Accident and Emergency Department. An increase in patients attending the Royal George A&E department of 5% compared to last year has placed considerable pressures on the department to cope with just short of 100,000 attendances. To cope with this the new Clinical Manager has spent a lot of time in the department talking to patients and staff and observing its day to day operations. She set up a number of action teams and asked them to look at developing and putting in place solutions to a number of the key problems including speeding up the patient booking in service, the treatment and discharge of minor injuries and the completion and return of results from blood and radiological tests. Each team consisted of a mix of staff including doctors, nurses, administrative staff, and porters and was asked to spend 15 minutes, twice a week working on their solutions. As a result of new initiatives implemented by the action teams the department is now meeting its performance target to see and discharge 95% of patients within 4 hours for the first time. Due to its success, the Clinical Manager has suggested that the department continues to use the action teams to look for further ways to improve the service and has asked the staff to make suggestions about what areas they think the department should look at next. The staff have decided they think infection control is an important area they want to look at and have suggested to the Clinical Manager that they would like to look at this issue in other departments as well to help them identify good practice which they could implement in A&E and to see if they can also share any of their own ideas with the rest of the Trust. The manager told the staff she thinks this is a great idea and has offered to help the team by talking to the other Clinical Managers to see if they would be willing for their teams to get involved with the project. Checking the staff survey results back in her office, the HR manager notices the A&E department recorded the highest scores in the Trust. 87% agreed or strongly agreed that they would recommend the Trust as a place to work and 73% said they always or often look forward to going to work. I enjoy it. If I didnt enjoy it I wouldnt like coming and I enjoy coming to workI wouldnt change jobs unless I really, really needed to (Nurse A&E) Questions Compare the organisation of work in the Medical Records Department at Wellton NHS (National Health Service) Trust with the principles of scientific management and answer the following questions 1. With reference to your experiences in the paper aeroplane activity we completed in class, what are the advantages and disadvantages of the scientific management approach? (10) 2. Outline any evidence of this approach in the Medical Records department. (10) 3. What would you suggest could increase staff motivation and reduce employee turnover? Explain why. (10)
Wellton is a medium sized NHS
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