Oxford University Hospitals NHS Foundation Trust

Prism Improvement was engaged to support improvement of the 4-hour emergency access standard at Oxford University Hospitals after being recommended by the executive team at Cambridge University Hospitals


When Prism Improvement arrived on site at the John Radcliffe Hospital in November 2017, the Trust had historically faced challenges with patients who had overly long lengths of stay and 4-hour emergency access performance was 82.1%.

81.8 %
4-hour access performance achieved*
  • 4-hour baseline → 81.86%**
  • Hospital sites in scope → 1
  • Programme length → 7 months

* Figure is based on the average within the last 4-weeks of the improvement programme.
** Calculated according to the 6-week average prior to Prism Improvement’s on-site start date.

Key outcomes at OUH include:

  • 4-hr emergency access performance improved from 81.2% in December 2018 to 86.4% in December 2019
  • Non-elective discharges improved by 9% from December 2017 to December 2018 and matched the level of non-elective admissions
  • The average length of stay improved from 3.5 days in December 2017 to 2.95 days in December 2018
  • Discharge for zero length of stay patients increased from 40% in December 2017 to 45% in December 2018
  • In general medicine the number of patients staying more than 7 days has reduced from 18% down to 7% in terms of total discharge proportions
  • Overall bed demand reduction at John Radcliffe site was approximately 36 beds in December 2018 compared to December 2017

Although Prism Improvement was originally commissioned for four months, the Executive requested the team to continue supporting the Urgent Care Improvement Programme for a further three months. During this period the on-site delivery team were able to see through the initial changes made and the Trust delivered above 90% for their A&E 4-Hour performance for 8 consecutive weeks through June and July. Most notably, there were continued improvements in performance over the following months, with year on year performance displayed below. 

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

Background & Context

Oxford University Hospitals (OUH) is the largest member of ‘The Shelford Group‘ – which features the top ten teaching trusts in the UK.  It is also a world-renowned centre of clinical excellence, providing tertiary, acute, and community services to the region.

When the Trust engaged with Prism Improvement in October 2017, there had been a range of input from various management consultancy firms over the course of the last few years. 

Improvement Approach at Oxford

The Prism Improvement approach focused on supporting delivery of key workstreams by using an experienced team of ex-NHS operational and clinical leads who were capable of ensuring change whilst providing an appropriate level of support and challenge. 

These individuals were underpinned by a model that focused on operational support, coaching, and a series of ‘Test & Learn’ improvement cycles. The aim was to achieve tangible improvement outcomes, supported by a shift in culture, to ensure continuous improvements to performance and patient experience. 

Prism improvement assigned a series of dedicated subject matter leads to the front, middle, and back elements of the patient pathway. This was combined with additional specialist PMO and senior transformation support to ensure that the governance and progress of the work was maintained – in keeping with the Trust’s expectations.

The challenge is to bring the working practices of the Trust and the system together in order to enable resources and time to be focussed on joint solutions to any limitations that might exist.

Jez Tozer - Founder & Managing Director at Prism Improvement

Integrated Improvement Programme

In June 2018, the Executive team requested that Prism Improvement extend their time at the Trust, to support the delivery of a broader Integrated Improvement Programme that covered five key areas of improvement: Urgent Care, Planned Care, Finance, Workforce, and Governance.

This work is currently in progress – further detail will be provided at a later date.

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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