London North West Healthcare NHS Trust

London North West University Healthcare NHS Trust named 3rd for ‘Most Improved A&E Departments' in a recent HSJ article


In December 2017, NHS England and NHS Improvement commissioned Prism Improvement (formally Hunter Consulting) to provide an Improvement Programme to London North West University Healthcare NHS Trust (LNW).

The Improvement Programme ran across two phases, spanning from December 2017 until June 2018. During this six-month timeframe, the on-site delivery team executed a series of improvement cycles, focusing on pathway-specific workstreams.

Following the course of the programme A&E 4-hour performance showed a significant improvement when compared against the previous years figures (see Fig. 1) and the Trust was subsequently featured in the Health Service Journal (HSJ) as one of the ‘Most Improved A&E Departments’ in the UK for 2018/19.

The legacy from Prism Improvement’s approach, through collaboration with trust staff, was demonstrated by continued improvement in the A&E 4-hour performance — even after the delivery team had left all sites (see arrow marker on Fig. 1)

Fig. 1. Year-on-year 4-hour performance at LNW
Fig. 1. Year-on-year 4-hour performance at LNW

Background & Context

The initial scope of work outlined a need for support to improve the flow of patients across LNW, both in terms of front door emergency access and back end discharging of patients. The Trust had previously experienced challenges meeting the national A&E 4-hour performance standard despite a history of involvement from management consultancy firms. 

Prism Improvement Approach

In order for sustainable improvement, the approach from Prism Improvement needed to be agile enough to respond to the day-to-day needs of the system and it’s processes, whilst also being attentive to changes in the behaviours of clinical and operational teams within the system. The on-site delivery team needed to work in partnership with members of the Trust to achieve new ways of working going forwards.

The programme was delivered through small improvement cycles, that formed pathway-specific workstreams. Those responsible for delivery were able to actively contribute to changes, take ownership of the process and learn whilst doing so.

We believe our approach enables us to work with organisations in an effective manner that takes local differences into account

Barney Pascall - Director of Operations at Prism Improvement

The Prism Improvement Team ensured continuous reflection formed part of the improvement cycles so that changes were embedded in the Trust and would continue after their departure. 

For more information about our track record at this Trust, or any other Improvement Programmes delivered by the Prism Improvement team, do not hesitate to contact us. A member of our team will be in touch shortly with further information. 

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