Posted on December 8th, 2016 by Charlie Gilbert

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CLCH is an NHS community healthcare provider serving four London boroughs. It employs more than 3,000 healthcare professionals and support staff to provide community and in-patient services to almost 1 million people across London. More than half of its patient contacts take place in patients’ homes. CLCH embodies the principle of taking the best of the NHS into the neighbourhood and therefore at greater convenience for patients.

CLCH’s Children’s Health and Development Division has been on a significant transformation journey to improve every child’s experience in its care. This is being delivered through a 2-year programme of work called Transforming Children Services.

As part of this programme, the trust was focused on identifying solutions to improve the quality and efficiency of services delivered to children out in the community. This included where teams should be located and how care can be improved through better management of travel time.

The health visiting department consists of 150+ clinical staff focused on the delivery of the 0-19 Healthy Child Programme. Healthcare and advice is provided by the team, who visit families in their own homes and community venues. The goal is to provide services that are convenient for patients and make best use of clinicians’ time.

CLCH believed there were a number of complex factors preventing its team from delivering this programme as efficiently as it could. It suspected one of the key contributors was the time taken to plan visits and the order they were being taken.

Inefficiencies highlighted

The trust decided to enlist the help of Field Dynamics, a consultancy specialising in reducing chaos in field operations. By providing the trust with a clear and holistic view of its staff’s working patterns on a map, the levels of chaos the trust suspected were highlighted. For example, it showed that different health visitors were frequently being sent to the same location within hours of each other to see similar cases; one clinician could have visited them all.

Appointment process at root of the problem

The team’s appointment allocation model was identified as being at the root of the chaos. When appointments were being allocated patients were being referred to the health visitor with the most availability. Other factors were not being considered in the process.

3 key effects on efficiency

The allocation model was having three key effects on efficiency:

1. Travel Cost: The dispersed nature of the appointments incurred a cost in terms of time spent travelling.
2. Time Management: The time required to travel between appointments limited the number of appointments in a day.
3. Appointment Management: Ability to adapt to Did Not Attends (DNAs) was limited due to health visitors not remaining in the same locality.

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Working closely with the team at CLCH, Field Dynamics modelled an alternative appointment allocation model.

Creation of new boundaries

Location plays a key part in this model – before appointments are even assigned the health visitors are now allocated geographic zones.
These were typically based upon their historic caseload but additional considerations were also taken into account. These considerations included staff’s local knowledge and the demands of the diverse population needs of inner London where there are pockets of deprivation.

How the new appointment allocation model works

When a new appointment is now referred, the patient is first allocated to a zone, based upon where they live, and then allocated to a clinician, who works within that zone, and then to a session. This new process focuses patients in the same area onto the same health visitor via the newly allocated boundary. Because the staff work within a much smaller area, they travel less and gain the significant operational advantages from knowing this area.

Roll-out of model across four London boroughs

This model was first piloted across Westminster. The pilot included the provision of a stand-alone operational tool for its ongoing management. Following the pilot’s successful completion, the model was rolled out across Hammersmith and Fulham, Kensington and Chelsea and Barnet. CLCH now plans to roll out this initiative to other departments within Children Services and across the wider organisation.

The roll-out of this model has reduced health visitors’ travelling time by 27% and will save the trust £142,000 per annum.

This project has succeeded in increasing patient facing time as health visitors now spend less time travelling. It has also enabled them to provide better continuity of care and the uptake of the 2 year review has improved from 30% to 65%.

Managers now have greater control as their time has been freed up from administrative planning activities and they have greater visibility of staff. Staff morale has also improved as health visitors spend more time doing what they went into the profession to do.

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