MOD006887 - International Operations Management Consultancy Report

This report provides an analysis of the operational challenges faced by the Mid and South Barsetshire NHS Foundation Trust (MSBFT) following the amalgamation of three separate trusts. It identifies key issues such as procurement and supply chain inefficiencies, layout and flow problems exacerbated by COVID-19, and patient waiting times. The report evaluates potential solutions, including leveraging expertise from the Silver bridge unit, outsourcing maintenance, and redesigning hospital layouts to separate COVID-19 and outpatient pathways. Recommendations include adopting NHS procurement standards, utilizing specialized external partners for maintenance, and implementing strategies to manage risks associated with hospital layout and patient flow. The analysis employs the 4Vs model (volume, variety, veracity, velocity) to improve operational efficiency and suggests that the trust focus on data-driven decision-making and collaborative problem-solving across all units.

International Operations
Management

Executive summary
This study discusses some issues that this trust may face in the future after amalgamation of
all three trusts and hospitals. Supply chain is one of the main issue in which all units may find
problems in getting appropriate supplies, increased waiting time of patients and poor design at
some units. It will further discuss some strategies by which all these problems can be solved out.

TABLE OF CONTENTS
Executive summary.........................................................................................................................2
INTRODUCTION...........................................................................................................................4
Issue 1: Procurement and supply chain to all NHS or MSBFT units..............................................4
Analysis.......................................................................................................................................4
Evaluation....................................................................................................................................5
Discussion....................................................................................................................................5
Recommendation.........................................................................................................................6
Issue 2: Layout and flow for covidious time...................................................................................7
Analysis.......................................................................................................................................7
Evaluation....................................................................................................................................7
Discussion....................................................................................................................................8
Recommendation.........................................................................................................................8
Issue 3: Waiting time.......................................................................................................................9
Analysis.......................................................................................................................................9
Evaluation....................................................................................................................................9
Discussion..................................................................................................................................10
Recommendation.......................................................................................................................11
CONCLUSION..............................................................................................................................11
REFERENCES................................................................................................................................1

INTRODUCTION
Operation management is administration of business practices that helps operation manager
in creating the highest level of efficiency within an organization (Kumrai and et.al., 2018). This
study is based on Mid and South Barsetshire NHS foundation trust, new acute NHS trust. it has
made in 2020 from amalgamation of its three separate trusts. This trust comprises of Framely
court hospital, Uffley university, Silver bridge university, Plumstead and Boxall hospital. By
making use of four V’s model such as: volume, variety, veracity and velocity in operation
management, operation managers can accomplish all of its goals. intellectual property matrix
also plays a vital role in operation management.
Issue 1: Procurement and supply chain to all NHS or MSBFT units
Analysis
In regard to all NHS units such as: Framely court hospital, Uffley university hospital, silver
bridge university and Boxall hospital, it can be said that all these units may face procurement
issues after amalgamation of all these units. NHS wants to combine all these units in order to
provide better and affordable healthcare services. It is stated that after amalgamation, all these
units may face problems in getting supply chain services like: vans, taxis, PPE and others. Only
Silverbridge university hospital is the one who has fully adopted NHS supply chin framework
(Sanchez-Graells, 2019).
It is stated that after amalgamation, it becomes stressful for managers with operational
responsibilities. So, it becomes important to decide that whether all units need to outsource
materials through third party supplier ISS or not. Other question on which NHS is focusing
regarding this issue is: to bring maintenance for MSBFT units within supply chain maintenance
framework. Framely court had rejected this already in the year of 2019. It is important for NHS
to take consent of all units and managers of all sites. So, in this regard, it can be said that it is not
the best idea. On the basis of these 2 solutions of outsourcing from third party providers and
bringing maintenance within NHS framework, it can be said that both these solutions may create
some problems and it may create frustration. Also, it is suggested by one of the managers of
these units that if all units are being provided with specific materials via main centre Silver
bridge then this unit may face problem in shortage of PPE, vans and other materials. It has
known that one of the main problem that this NHS may face or facing is maintenance of supply

chain from outsourcing. For solving this problem, it has decided to make use of 2 different
sources of supply so that it can change the way it does supply chain outsourcing. But as per the
given time, it can be said that it is unnecessary and may create number of problems if it is being
considered at this initial time of amalgamation. So, in this regard, it can be said that it should
focus on making use of software that can manage big data and inventory control in an effective
manner. It can hire more than 4 managers who can manage supply chain inventory from
outsourcing if it makes use of different sources or channels.
Evaluation
On the basis of analysis of procurement problem, it can be said that NHS needs to bring
innovative idea as well as solution by which it can make successful amalgamation of all MSBFT
units. On the basis of evaluation of problem and as an operations improvement consultant, I can
say that BCH’s supply chain and procurement is the main centre of excellence and all other units
may make themselves beneficial by taking suggestions from experts of this unit. NHS may
shuffle some of experts of this centre to all units. By having at least 1-2 experts at all units, NHS
can solve procurement and supply chain problem. But managers of this unit contradicted and
said that by doing so, most of the highly experienced team of BCH is still in post here and it may
lose expertise and can become a mid-range cog in the wheels of NHS supply chain.
In this regard, I believe that Boxal unite should run out its legacy contracts arranged via
South-East Barsetshire PCT and then needs to draw supplies from Silver bridge unit that has
adopted NHS framework supply chain. It is believed that this arrangement regarding
procurement can help all units in getting vans facilities, taxis availability, PPE resources and
others in a timely manner (Feinmann, 2020). But on the other hand, it can increase burden on
Silver bridge university unit and they may have to face problems in managing their own store
because of covid-19. It is the only unit that has fully adopted supply chain framework and by
doing so, this unit might also suffer shortage of procurement so, it is also not the best idea but
may be considered to some extent.
Discussion
Procurement problem and proposed solutions have been analysed already. But still there is
requirement of selecting the best one. For this purpose, all units need to identify strengths as well
as weaknesses of each proposed idea and data analysis method. It can be said that idea of taking
help of expertise of main centre unit BCH may create problems for this unit. It will lose its

expertise and by creating problem for 1 unit and making other units advantageous cannot be the
best idea. In addition, other proposed idea of drawing supplies from silver bridge, the only unit
that has fully adopted NHS framework, can also create burden on this unit. it may face some
supply chain crisis. So, it is weakness of this proposed idea. Overall, it can be said that NHS
should mix all these ideas to some extent as all units’ must follow NHS procurement standards to
some extent, both BCH and Silver bridge should provide their expertise services to remaining
units to some extent and other material supply for all units should be outsourced to an external
specialised partner that can fulfil all requirements of units by allowing joint purchasing
(Skipworth, Delbufalo and Mena, 2020). In regard to NHS supply chain, it is found that it
manages sourcing and delivery of healthcare, food products services to healthcare organisation
and NHS trusts. Its supply chain support NHS in England and Wales. So, in this context, it can
say that it can continue with its own tenders for getting all products in an effective manner after
amalgamation.
4Vs visualisation
By analysing all 4 V elements, all 5 hospitals can make able by which they can perform their
functions.
Veracity: It refers data and projects quality and in this context, it can be said that NHS should
focus on buying products from suppliers that follow qualitative measures.
Volume: It comprises with 5 main hospitals and for providing qualitative healthcare services, it
will require hiring more nurses and staff.
Variety: In regard to NHS and supply chain, it can be said that NHS is a single organisation and
but made up of multiple other organisations.
Velocity: It performs real time processing activities and it also helps this out in improving
quality.
Recommendation
On the basis of discussion regarding procurement or supply chain problem, it can be
suggested to NHS that it should make it compulsory for all units to refer or consider NHS
procurement standard. There is a website where all relevant policies regarding procurement is

attached. It can help all units in making better decision and by cooperating each other’s, they can
solve this problem. Taking help or supply chain services from an external partner for
maintenance can create problems for Uffley unit because it is an average sized hospital. It had
faced problems regarding recruiting professionals. So, on this basis I can suggest that all units of
NHS should be outsourced to an external partner that can allow joint purchasing between sites
(Sawyer and et.al., 2021).
All units that are specialised in specific services such as: Framely court procurement is
expertise in maintenance contract, BCH has expertise in procurement service solutions should
help other units and it is one of the best ideas among all proposed ideas. Plumstead unit can also
solve its problems regarding shortage of consumable and maintenance services.
Issue 2: Layout and flow for covidious time
Analysis
As it is already stated that NHS wants to combine its all 5 main units such as: Framely
court hospital, Silver bridge, Plumstead, Uffley and Boxall. While making plan and deciding
about this amalgamation, NHS identified some problems that may occur at all units. Other than
supply chain, Layout at some units is other operational problem. In this regard, it can be analysed
that silver bridge and Framely court have constructed PFI places for Covidious patients. There is
an ineffective design for outpatients at some of units and after amalgamation, patients may find
difficulties in going here and there due to improper design and layout. There are no separate
pathways for covidious patients and outpatients and it may increase chances for outpatients of
getting affected from Corona virus. Uffley is small university teaching hospital and it is not
physically reconfigured owing to load bearing components of structure. There is requirement for
NHS to think better ways to implement pathways for outpatients that are separate from Covid
risks pathways. It will take too much of cost if NHS build separate pathways at all units. So, it
becomes important for all units to propose some ideas for solving this problem, otherwise it may
increase risk as well as fear among outpatients about covid-19 (Zitkus and et.al., 2020). By
focusing on guidance and NHS standard, this operation problem can also be solved out.
Evaluation
On the basis of analysis, it can be evaluated that all units of NHS, specially Uffley needs to
redesign its site for improving health of outpatients. By making separate pathways for covid-19
patients and outpatients, it can decrease chances of getting affected by covid-19 to outpatients. If

it does not focus on this design and layout problems, then it may decrease patients rate and can
affect its image as well. There are number of reasons of making changes in design and layout of
NHS units such as: isolation of patients, each access, access to medication and others. So, on this
basis, it is proposed by some stakeholders that patients should be restricted in service areas. All
units must hire specific supervisors who can supervise all main areas in hospitals such as:
counselling rooms, corridors and waiting areas. It may help managers in making discipline and
separating outpatients and other patients. In addition, it can also be said that all units need to
identify their low, medium and high risk areas as per the relevant public health England
guidance. It may help out all units in knowing the highest risk area and on the basis of this, they
can adopt appropriate strategies (Slinger, 2021). There are number of strategies of managing
risks that may help all units of NHS in solving this deign related problem. By shuffling some
areas of this unit, pathways for outpatients and for covid-19 as well as inpatients can be
separated and it can solve this problem. In doing so, there will not be requirement of additional
cost.
Discussion
On the basis of evaluation of all proposed ideas for solving design and layout of NHS
units, it can be said that all ideas have some strengths as well as limitations. By analysing all
ideas, the best idea can be implemented. One of the main idea was to redesign Uffley unit in
order to separate pathways of outpatients and covid-19 patients. If this idea of redesigning area is
being implemented, then it may solve this problem but it will require too much of cost. It is its
main limitation. Other proposed solution is: supervision. Supervising all those areas where
patients spend a lot of time. Safety of patients rely on the amount of supervision that patients get
from staff at the time of their stay. In addition, it can also be said that hospitals’ design based on
an assessment of patients as well as staff’s safety. It can provide number of benefits as by
separating pathways for outpatients, staff can improve their productivity. It will ensure them
about patients as to whom they need to provide healthcare services. It will maintain discipline
and decrease crowd as well. There is also requirement for considering all actors that affect health
and safety of patients. Some factors that need to be discussed while implementing the best idea
include: standardisation of room layout, eliminating inefficiency in care delivery process,
controlling noise, using surface that can be contaminated easily. Nurses rooms should also be

attached for in patients. It can help out them in decreasing this problem and it may improve
health of outpatients.
Recommendation
On the basis of above discussion, it can be recommended to NHS that it should shuffle some
areas in order to change pathways for outpatients and in patients. By doing so, they will not have
to invest too much of amount. They just need to change entry/exit for outpatients. There should
be specific areas for inpatients and outpatients. It will decrease their waiting time. It will
decrease crowd and also prevent outpatients from getting infected. In addition, it is also found
that nurses and practitioner may face communicational problems. Nurses and healthcare
providers need to communicate with each other’s and by separating pathways it may difficult for
them to interact. Communicational barrier is another main problem that has been identified while
deciding about amalgamation of all main 5 units of NHS.
Manager of all units need to give consent regarding changing pathways for outpatients and
inpatients. As like Silver bridge and Framely court, Uffley and other units may construct PFI
places. It can help NHS in measuring performance of each unit and measuring total number of
patients at each unit. Overall, it can be said that by shuffling areas of these units as per the
design, pathways for outpatients and outpatients can be separated.
Traffic lights model that NHS is using
There is no doubt as NHS is facing financial pressure and it is important for its staff to
identify products and services that can be provided to patients in a safe manner. There is a
system where it uses three lights such as: red, yellow and green.
Red light refers think, yellow consider and green go. It lets nurse think about using high cost
item with care. But there is a question as nurse asked if less expensive product can do the same
job or not. On the basis of this, it can be said that nurses can make use of products and
equipment’s in an effective manner and by doing so, they can protect themselves against
financial challenges. As per the yellow light, staff need to use amber nurse on middle priced
option. Green is one of the best option that refers the best choice regarding selection of product
and equipment.
Some products that traffic light support system need to consider include: small, consumable
and easy to use products, those products that are available from multiple suppliers and dressing
related products.

Issue 3: Waiting time
Analysis
There were various kinds of operational issues that were identified that were arising at
Mid and South Barsetshire NHS Foundation Trust during autumn, 2021. One of the three issues
was identified was of waiting time. For identifying whether this waiting time is a problem or not
average or mean analysis technical method was used. From the analysis of quantitative numerical
data provided it was clearly identified that mean waiting time before triage for patients was
approximately 20 minutes. Not only this. When data of patients with QR scan was observed then
it was identified that QR scanner was not working and by observing the manual data it was
identified that waiting time of these patients was much higher and was approximately 27
minutes. This data clearly helped in identifying that patients entering between A&E department
and being called by nurses and when they were scanned by triage nurse was much higher. This
clearly explains that it is a major problem which is required to be analysed and intervention for
this problem is required to be identified so that wait time of patient for NHS can be reduced (De
Rosis and et.al., 2020). In order to bring improvement within waiting time of patients as an
operations management consultant, it is further important to evaluate this waiting time for
patients between reception and till the time they are being attended by triage nurse so that
required improvement within operations can be brought.
Evaluation
The main operational problem identified from the above analysis clearly helps in
identifying that third operational problem that Mid and South Barsetshire NHS Foundation Trust
was facing was of waiting time of patients between reception to the time they were attended by
triage nurse was high. Patients had to wait on an average of more than 20 minutes when they
arrive reception and get attended by triage nurse. Some main interventions or practical measures
for overcoming this operational problem are: one of the main practical solution is to develop an
online platform for patients where they can schedule their appointment or visit to triage nurse
online themselves only. This will directly help them to self- register themselves and schedule
their visit to triage nurse themselves through online portal. They can further schedule their time
of visit. This can directly help in reducing average waiting time for patient. Another implication
is provision of training to reception staff members and to triage nurses so that their efficiency can

be enhanced, required skills can be developed. Provision of training would eventually help in
enhancing overall performance of staff members and would reduce waiting time of patients till
the time they are being attended by triage nurse (O’Dowd, 2021). There are various kinds of
models that can be used for provision of training and enhancement of required skills of staff
members. One of them t is to develop a training plan for provision of both online and offline
training of staff members.
Discussion
On the basis of above analysis it can clearly be said that patients' waiting time may affect their
health. Patients are not in the situation to stand up for longer time so, if they have to wait for
visiting their healthcare professionals then it may increase their healthcare problems. Some data
has been given of waiting time for 17 days. On 8th July 2021, average waiting time of patients
was 16 minutes, on 9th July, it was 20 minutes and 12th July it was 32 minutes. So, on this basis,
it can clearly be said that patients have to wait more than 15 minutes.
There are some strengths of proposed ideas include: development of an online platform
for patients where patients can fill details for appointment. It is an effective idea that can make
patients beneficial and patients can know available timing. It will be beneficial for healthcare
professionals in managing data (Yang and et.al., 2021). They should allow google doc to all
patients as this software allow patients to see everything that has been updated by other patients
and receptionist of units of NHS. So, on the basis of this idea, it can be said that there are number
of strengths that can be taken by NHS if it implements it within all units Mid and South
Barsetshire NHS.
Recommendation
It can be recommended to NHS that it should focus on employing more staff and making 2
departments for each disease. There should be 2 specialist departments where patients can go and
get the treatment done in a timely manner. Patients should be allowed to take appointment before
visiting doctor if there is no emergency and attendant should tell the timing to patients. By
knowing the exact time, patients can save their time and it can decrease waiting time.
In addition, it can also be recommended that receptionist should make electronic data, and they
should manage big data on internet. It will save their time, and they can save patients waiting
time as well. Patients will have idea about timing that will be taken by doctor as per the

complexity of problem. Receptionist should ask about patients problems on call while taking
appointments. They need to share information of patients to doctor so that doctor can tell
approximate time that will be taken in treating and consulting patients.
CONCLUSION
It has been summarised from the above study that operational and supply chain problems in
hospitals affect health and safety of patients. Patients have to wait for longer for getting
treatment or healthcare services. It has discussed planning of NHS of amalgamation of all major
units such as: Uffley, Silver bridge, Plumsted, Boxall and Framely court hospital. It has
discussed some major supply chain, operational and process problems. One of the main problem
that has been discussed in this study is waiting time as patients may have to wait for longer after
amalgamation of all 5 units.