NHS Trust saves £6000 a year with a simple process change

I’d like to introduce you to Kevin Brown, Ward Sustainability Project Officer at Royal Devon University Healthcare NHS Foundation Trust.

Kev and I work in the same team, but on different projects, so I sent Kev a message asking:

‘What’s the most interesting and/or successful project you’ve worked on (before or during your time in transformation)?’

This led to a video call where Kev revealed 11 projects he’s worked on to improve sustainability, save money, reduce waste, and more.

Kev described his disbelief at how smoothly one of those projects went. Everyone was in agreement from start to finish. It went exactly to plan. It only took a few weeks. And it’s still working well.

Now, if the project were replicated in another organisation, or if Kev went back in time and did it again, it probably wouldn’t go so smoothly. There was undoubtedly an element of luck involved.

Equally, though, it’s a testament to Kevin and the project team for getting it done so smoothly, as well as the simplicity and effectiveness of the idea. It was easy for all of the stakeholders to understand and clearly a no-brainer.

I’m excited to share the story with you because, with a little creative thinking, the principles can be applied to identify opportunities to improve any healthcare service.

Before: Time and money wasted on replacing hospital furniture

Until recently, if someone in the Trust wanted to re-upholster a piece of furniture – say a couch, office chair, or patient chair – they’d begin by raising a “ticket” with the estates department.

The request was generally considered low-priority by estates because it was, in fact, low priority in comparison to some other activities.

As a result, the request would sit with estates for a while – weeks, sometimes – until all of the higher-priority activities were dealt with.

Someone in the estates team then asked a company for a quote to re-upholster the item. There was then a delay waiting for the quote to arrive. When it did, estates took the quote to the relevant operational manager and asked: “do you have money in your budget to do this?”

If not, that was the end of it. If so, estates would ask the supplier for an appointment to do the work. They’d then do the work on their schedule.

This process took 2-3 months in total – from the point of identifying the need to re-upholster to the furniture being re-upholstered.

In some scenarios, that was an acceptable period of time. If the furniture could continue being used while awaiting re-upholstery, the delay might not affect decision making.

In other cases – for example, when a row of patient seats could no longer be used and there was no readily-available alternative – then it was unlikely that the member of staff would be prepared to wait 3 months for re-upholstery. Instead, they would probably choose to scrap the furniture and buy new, since that’s the simplest and quickest way to make seating available for patients.

And who could blame them?

The change: An efficient re-upholstery process

Kevin and the team realised the part of the process involving the estates department was the biggest bottleneck.

Estates were delighted to be removed from the process because it reduced their workload. Not only that, it reduced their low-priority tasks which allowed them to reinvest their time and energy in higher-value activities.

To achieve this, Kev worked with procurement to add the most common forms of re-upholstery – e.g. “re-upholster a single chair” or “re-upholster a couch” – to the procurement system as productised services.

Now, anyone with access to the system can find the type of re-upholstery they need and order it in a few clicks. The request goes to an “approver” for the department or speciality. This may or may not be an operational manager. If and when the request is approved, a purchase order is raised, and an order is placed with the supplier. And finally, the supplier completes the work in a week or so.

After: Less waste, reduced costs, recovered time

Here are some benefits of the new process:

  1. Timeliness – Re-upholstery turnaround time was reduced from 2 months to 2 weeks (75% reduction). This makes re-upholstery a good solution in more scenarios.
  2. Less waste – There’s no longer a need to send furniture to landfill if it’s suitable for re-upholstery. Also, producing new furniture incurs waste. That’s avoided by not buying it.
  3. Reduced costs – Replacing furniture incurs costs twice: (1) the cost of disposal, and (2) the cost of buying new furniture. In comparison, re-upholstery is significantly cheaper.

There are also less tangible benefits.

In the old process, there were a lot of back-and-forth emails between multiple parties to organise re-upholstery. In the new process, many of those people are not involved, and now have the time to invest elsewhere. In other words, the old process incurred an opportunity cost on multiple people. With the new process, not only have they recovered their time, but they’ve also gained from doing other activities instead. But as example, service managers were previously involved, so it’s not unreasonable to assume that the new process gave them more time (albeit not a massive amount) to improve patient flow, and the benefits of doing so can be significant.

How to apply this to any area of healthcare

You may not work in a transformation team. You may not be interested in re-upholstery, sustainability projects, or anything remotely to do with hospital furniture.

Nevertheless, I found this story fascinating because it highlights the value of questioning processes that may have been in place for years and then experimenting with other approaches.

In reality, most processes don’t change at all.

The first time someone needs to get something done, they just do it in whatever way seems to be best. If they’re the first person to do it, they invent a process. If not, they might ask someone how to do it. They might have already been taught. Whatever process they follow the first time is then set in stone. They might make minor changes in how they do things over time. But when questioned about why they do it that way, they respond, “because I’ve always done it this way.” They’ve never stepped back from the work and asked:

“Is this really the best way to achieve the result?”

“What IS is the result I want to achieve here?”

“What if we did it this way instead?”

Of course, change is difficult. We all know how it feels to experience a poor process. It can be frustrating. It can drain your motivation. Yet, at the same time, we’re so busy going about our work – applying the existing processes – that it’s hard to find time to step back and make improvements. If we somehow manage to find time, we face the next demon: inertia. If you’ve been following a process for years – even if it’s a terrible process – it’s pretty easy. It’s habitual. It doesn’t require much effort. So to even contemplate changing it can be stressful. And not just for you – but for everyone in the team who follows the process. Therefore, there will be resistance. Which makes experimenting with process changes even harder.

With all of that said, I urge you to follow Kevin’s lead and wage a war against poor processes. It will be hard. But the rewards are worth it – especially if you can bring your colleagues along for the ride and make experimentation a part of the culture.

A simple change to a re-upholstery process – a process that would never even cross the mind of 99% of the organisation’s employees – led to a reduction in costs, waste, and time.

A small saving, perhaps, in the context of a large NHS Trust. But it only required a very small investment of time and energy. It didn’t cost anything. There was no risk.

In a financially-challenged NHS, small changes are no-brainer changes. They require very little investment or risk. And they snowball into bigger improvements.

So I’ll end with a few questions:

Which processes do you encounter in your work that frustrate you?

What result do you want to achieve by following these processes?

Why is it really done that way?

What are some other approaches you could take?

What if you experimented with one of those approaches?