Why trust is at the heart of transforming emergency care in the NHS

By Susan Thomas, Partner, EY

Reducing wait times in Accident & Emergency departments is one of the biggest and most public challenges facing the NHS. Hospitals have tried multiple approaches, yet the waiting time standard – which requires 95% of A&E patients to be treated within four hours – has not been met nationally since 2015. And even now, given the potential removal of this specific target to more granular targets focusing on patient experience and care, how can the NHS improve its performance in this area? We worked shoulder to shoulder with doctors, nurses and management in 12 NHS trusts in England to find answers.

Creating a dashboard for change

In all the NHS trusts that we worked with, staff told us that their improvement programmes for managing patient progress through A&E departments lacked clearly defined outcomes and metrics – despite all the targets and reporting they had to do. To change this, we helped to develop a new dashboard which used client data to break the four-hour challenge into bite-sized chunks. This identified the patients most at risk of waiting for too long and crucially provided staff with the information they needed to understand obstacles and create solutions to address them. These programmes of improvement were designed to deliver rapidly, with clear and measurable impacts on patient care.

As a result, clinical and management teams had a clearer understanding of what was causing performance issues and the data to support the changes required. This allowed our team to support delivery, embed improvement and help our clients to target scarce resource during the NHS’s busiest winter on record.

Pulling the trigger more effectively

Hospitals typically use a system of clearly defined ‘triggers’ which are activated when services deteriorate. These provide clearly documented and standard actions that each role and grade need to take to right the situation. Our work showed that the calculation of these trigger tools was labour-intensive and highly person-dependent. Also, the actions they triggered often lacked clarity and direction and, as a result, were not always carried out.

We worked closely with NHS teams to allow data to be pulled directly from the trust’s information systems, thereby eliminating the manual process. We also co-developed an app which allowed staff to see escalation levels on their phones / tablets at any given time. As a result, trigger actions started more quickly, patients received care sooner and valuable resources in A&E were freed up. We also saw greater engagement from staff as some of the time-consuming and repetitive tasks were removed. “The improvements and changes that EY led in the trust will have a lasting impact,” said Beth Weston, Chief Operating Officer, Aintree University Hospitals, NHS Foundation Trust.

What were the results?

We are delighted that this work has been recognised within our industry, with EY being named finalists in the Performance Improvement in the Public Sector category of the 2019 MCA Awards. But, more importantly, we are delighted that it has improved the speed of access to high quality care for over 350,000 patients. Working with NHS trusts across England, we have collaboratively:

  • Reduced unnecessary waiting time by an average of 40 minutes per patient;
  • Eliminated corridor waits for patients and provided care within four hours for 30 more patients per day – that’s 11,000 patients a year;
  • Reduced 12 hour trolley waits from an average of 67 per month to 0 across 3 Trusts
  • Driven a 58% increase in early hospital discharge, reducing the amount of unnecessary time patients spend waiting in hospital; and
  • Improved client staff morale and motivation as a result of them seeing that their actions can influence change.

From our perspective, the key learning from this wide-ranging project was that although technology undoubtedly offers lots of new opportunities, to be successful any initiative must win the trust and fit the day-to-day needs of the NHS’ dedicated and hardworking A&E staff.


For further information please contact:

Susan Thomas 

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