Embedding a 'home first' ethos for patients in Manchester and Trafford

Ushering in a culture shift and new model to drive better outcomes for hospital patients

March 2022 – present

1.5

days reduction in length of stay on intervention wards

25%

decrease in Pathway 3 discharges

49%

increase in understanding of strengths-based practice

Identifying new opportunities to improve outcomes and save money

Manchester and Trafford each have a Local Care Organisation (LCO) – a pioneering new model, launched in 2018 and 2019 respectively, bringing NHS community health and council social care services together into one organisation. They play a leading role in the key interface between health and social care: the discharge of patients.

The two LCOs jointly commissioned IMPOWER to design and implement the Resilient Discharge Programme (RDP) on behalf of all partners in the system. The task was to embed improvements made in response to the pandemic as part of a whole-system transformation programme to fundamentally alter the approach to patient discharge.

The key issue was too many patients were in hospital beds when they didn’t need to be, resulting in inefficient use of resources and poorer outcomes for those individuals. The RDP’s objective is to reduce delays and ensure patients consistently get the right support at the right time and that as many as possible are discharged home.

IMPOWER completed rapid observations to identify opportunities to test new ways of working. Consultants worked with frontline staff, listened to their ideas and built a sense of hope that things could look and feel differently in their day-to-day roles – reigniting them to be the experts in their specialism.

Back to Basics interventions were implemented on three wards within three different hospitals to embed strengths-based practice and a “home first” ethos. This meant understanding their environment and adapting the change to suit them. For example, to deliver strengths-based practice training to staff nurses, IMPOWER designed bitesize training and empowered change champions to carry this on with colleagues.

Creating confidence in seizing these opportunities

IMPOWER created a blended team of its own consultants plus two programme managers from Manchester and Trafford LCOs and a further 15 staff from across the local health and care system.

A programme board made up of key decision makers helped to quickly resolve any issues at the earliest opportunity.

This partnership approach helped to build confidence in – and an understanding of – the new approaches being taken and ensured buy-in, sustainability and resilience were inbuilt from the outset so changes would be embedded and bring about lasting change.

By maintaining daily dialogue and reassurance, IMPOWER was able to encourage prompt decision making and keep the clients focused on the long-term aims of the RDP.

As Oliver Barnes, senior manager at IMPOWER, explains: “We were able to cut through the noise of a very busy, challenged system and reframe what impact this work would have on the outcomes of citizens in Manchester and Trafford. Additionally, we worked from the bottom-up to ensure frontline workers’ voices were heard and sustainable change was able to last.”

Impact

The Resilient Discharge Programme has introduced a more sustainable approach to ensuring patients are safely discharged from hospital at the earliest opportunity:

The average length of stay for patients on intervention wards has fallen by 1.5 days
There’s been a 49% increase in ward staff’s understanding of strengths-based practice
It’s resulted in a 25% decrease in Pathway 3 discharges (higher-cost intensive support, usually in a care/nursing home)
The Hospital at Home offer is supporting 5 patients a week to be discharged from hospital

The success of phase one has led to IMPOWER being commissioned to launch a second phase that will see the RDP rolled out at scale to maximise the benefits for patients and system partners.

Creating a more resilient client organisation

Through the RDP the consultancy has re-energised those working on hospital wards and injected a renewed sense of confidence and clarity for the future among senior leaders across the NHS and local government within Manchester and Trafford.

IMPOWER’s team of consultants has worked skilfully at every level to build trust and help clients seize opportunities for improvement while nurturing a sense of ownership so that the culture shift that’s been started continues to progress.

Examples include:

Back to Basics work is now being led by each of the three hospitals’ directors of nursing – demonstrating the clients’ faith in the approach and willingness to invest and how the approach we’ve coproduced is embedded
A Transfer of Care hub has been established to coordinate discharge across the system with an operational dashboard to provide visibility on demand and capacity in different discharge pathways
There’s system-wide agreement on a new model for bed-based services to support discharge that’s now being implemented

The end result is hospitals have greater confidence – and are better placed – to manage spikes in demand while ward clinicians are now focused on assessing a patient’s strengths and getting them home safely. For example, 2 days after the Jubilee Weekend in 2022 the number of delayed patients was 20% below forecast.

The consultancy’s transformation work has brought partners together around a common goal so that they are now looking at further opportunities to collaborate and drive better outcomes for the residents of Manchester and Trafford.