Analysis of Liverpool Community Health NHS Trust Case Study Report

This report provides an analysis of the Liverpool Community Health NHS Trust case study, which highlights failures in patient care due to a poor process map. The study reveals issues such as long patient waiting times, inadequate nutrition and hydration, and insufficient nursing staff. The report details the failed process map, identifies areas of concern, and discusses NHS standards and expectations. Recommendations are offered to improve service quality, including the creation of waiting areas, patient prioritization based on disease severity, assignment of a chief nurse, and continuous patient monitoring. Finally, an implementation plan is outlined to address these issues and improve overall healthcare quality and patient outcomes.

DRIVING QUALITY
IMPROVEMENT IN HEALTHCARE
PROFESSIONAL PRACTICE

EXECUTIVE SUMMARY
This report has undertake in the analysis of, the case Study of Liverpool Community
Health NHS Trust had been discussed where the failing of poor process map had been disused
due to which their quality care is hampered. As per the case study, Liverpool Community Health
NHS Trust failed to provide their patients with proper, safe and effective care and has to wait,
receives poor services and treatment due to which their patients had to suffer and they were
needed to wait for hours for diagnosis, treatment, many times they failed to provide their patients
proper nutrition and hydration which impacted in health of the patient in many ways. Based on
this case study failed process map of the hospital had been discussed in this assignment where all
the areas or phases where patients had to suffer wait are discussed. After this NHS standards and
expectation with their mission, vision and objectives had also been discussed. There were
various flows in Liverpool Community Health NHS Trust within their service quality that was
being provided to the patients so based on all the above flows few recommendations were given
to the patients like creation of waiting areas, patients admitted according to their seriousness of
their diseases, assigning chief nurse, continuous monitoring and supervision of patients, by
providing training programs to the hospital staff etc. Lastly based on these recommendations
improvement plan had been made.

TABLE OF CONTENTS
EXECUTIVE SUMMARY.............................................................................................................2
INTRODUCTION...........................................................................................................................1
TASK 1............................................................................................................................................1
Enquire findings...........................................................................................................................1
Failed process map.......................................................................................................................2
Organization's standards and expectations and identify whether they failed or passed to
achieve those................................................................................................................................3
Current mission and vision..........................................................................................................4
TASK 2............................................................................................................................................4
Recommendations to improve service quality.............................................................................4
TASK 3............................................................................................................................................6
Implementation plan....................................................................................................................6
CONCLUSION................................................................................................................................7
REFERENCES................................................................................................................................9

INTRODUCTION
Quality improvement in healthcare is one of the most important thing that should be seen
and considered by all the hospitals. It helps in improving all the healthcare services provided by
the hospital (Antonacci and et.al., 2018). This assignment is on the case Study of Liverpool
Community Health NHS Trust. In this case study it has been identified that that due to a poor
process map they are failing to provide proper patient care in-fact they provide poor, ineffective
and unsafe care to the patients Due to which their patients are harmed in one way or the other.
Not only this in this case study it has also been described that all the patients that are cared some
serious harm were not reported due to which unnecessary harm was caused to the patients. In this
assignment the failed process map is described, then all the failures in it has been identified.
Based on those failures some recommendations have also been given and how those
recommendations can be implemented in the implementation prcess so that it can be improved.
All the above points have been explained in details in this report.
TASK 1
Process mapping can be defined as to map patient's journey within the hospital and
identify all the opportunities that where improvement can be made (Gellad and Day, 2016). This
case study is about Liverpool Community Health NHS Trust who failed to provide their patients
proper service and care.
Enquire findings
Liverpool Community Health NHS Trust failed to provide their patients with proper, safe
and effective care and has to wait, receives poor services and treatment. One of the most
important thing that they fail in is that patients need to wait for hours for diagnosis, treatment etc.
they are not even provided with waiting area where they can wait for their turn. They need to
wait at each and every step of the process. This sometimes create serious incidents as many times
few serious patients were referred to Liverpool Community Health NHS Trust and were not
provided with proper service. They also failed to provide proper service to them.
Not only this, if a patient is admitted in the hospitals then there are not adequate nurses to
take care of them. Many times they fail to provide proper nutrition and hydration to patients due
to their failed time management. Due to this many times outcome of the their service impacts in
health of the patient in many ways (Lemos, Haddad and Morgan-Jones, 2016). It has also been
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seen that due to this lack of seriousness towards patients many serious incidents happened to the
patients and were not reported as a result unnecessarily harm was caused to the patients.
Failed process map
For this case study the overall process map of patients entry in the hospital to the patients
treatment has been taken (Andreamatteo and et.al., 2019). This is taken because at each and
every phase of the patient's treatment within the trust they face lots of issues and their care is
not taken properly. As a result they face waiting issues, lack of proper nutrition and hydration
issues, lack of adequate number of nurses etc. are the major problem that are faced by the patient.
So this complete overall process map has been taken.
In the above process map the main areas where patients suffer the most is first when the
patient is referred to the GP, second when they are diagnosed and treatment is provided to them
and third at the time of treatment.
 When the patient's are referred to the GP they need to wait for long for their number.
Their are no waiting rooms for the patient's where patients can wait for their turn. Many
times it happens that they need to wait for hours for their turn.
 After being referred to the GP, if they are referred for the diagnosis so that further
treatment can be started. They still need to wait for long for their turn as there are not
many nurses who can attend the patients in a timely manner.
 Next the main area where they face much problems is in the treatment phase where they
are provided with the treatment and if required they are admitted to the hospital. When
they are admitted they are not provided with proper nutrition and hydration due to which
many times serious problems have occurred due to dehydration or lack of proper
nutrition. Many times these problem took a serious turn but those problem were not
reported and identified and as a result patients suffered unnecessary harm.
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Ill
ustration 1: Failed process map

This lack of seriousness towards patients in providing proper and healthy nutrition,
hydration, adequate number of nurses so that patients can be attended in a timely manner are the
failure in their current process system (Rosen and et.al., 2018).
Organization's standards and expectations and identify whether they failed or passed to achieve
those
NHS has their own standards as well they follow government specified standards as well.
They have implemented a plan using CQC standards (Care Quality Commission Standards)
where they have specified all of their standards and have specified all the standards that they
have achieved, they want to achieve and failed to achieve (Barber and et.al., 2017). There are
many standards of NHS but few of them are quite important to be achieved and followed which
are.
 Patient is to be observed at least once within 24 hours so that all his problems and issues
can be identified.
 All the hospital staff members should be trained and should be adequate in number so
that they can address their patient's problem much more easily.
 Patient flow within the hospital should be effective and responsive so that after treatment
patient's leave the hospital with proper treatment and medicines.
 Waiting time for the patients should not be too long and should be responded and
attended quickly.
 All the patients are diagnosed and treated in an effective and effective manner.
However, from all the above standards there are few standards that the NHS trust failed
to achieve and due to which their quality of patient care has been degraded (Phelan and et.al.,
2015). Standards that Liverpool Community Health NHS Trust failed to achieve are as follows:
 They failed to observe the patient in timely manner. They are observed one in 24 hours
which is not enough. In those 24 hours they provided with nutrition and hydration many
times which is not taken care of properly.
 There are not adequate number of nurses who can attend all the patients on time and can
take proper care of them.
 Patient flow within the hospital is not proper as patient has to wait for long at all the
phases of their treatment.
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 Waiting time for patients is too long as they need to wait to be checked and referred by
the GP, they need to wait for the diagnosis and treatment as well.
Current mission and vision
Vision: to develop a partnership between patients and practitioners in order to provide high
quality health care service (Canedo and et.al., 2018).
Mission: Work together and receive best evidence based care within the available resources. To
ensure that patients views are heard throughout their journey of treatment in the hospital.
Objective: Deliver high quality, efficient service with available resources. Improve mental
health and well-being. Prevent and manage long term conditions in order to improve health care
quality and reduce health inequalities (Ancker and et.al., 2015).
TASK 2
Recommendations to improve service quality
It is important to improve health related service quality in all the organizations. There are
various flows in Liverpool Community Health NHS Trust within their service quality that is
being provided to the patients. It is important to be improved as so that all the failures and flaws
that are identified within the process flow of Liverpool Community Health NHS Trust can be
improved or in other words the overall service quality of the hospital can be improved so that all
such kind of similar failings can be improved (Mohammed and et.al., 2016). Here, few
recommendation will be given in details so that the current failed process mapping can be
improved. All those recommendations will be given so that National and local quality stands
followed by the patients can be improved and achieved, benchmarking can be achieved and
Evidence based practice can also be improved, so that effective and efficient healthcare service
can be provided to the patients.
 Waiting areas can be made for patients so that they can wait their till their number to be
checked by the GP doesn't come. These waiting areas can be made in the diagnosis area
as well where patients can wait till their turn to be tested and diagnosed does not come. If
another GP is available then form this waiting area they can be referred to the new GP so
that their time is saved and they do not have to wait for hours to be checked by the GP
(Beaussier and et.al., 2016).
 Patients should be admitted as per their condition and seriousness of the disease so that
they can be provided with proper and adequate care according to their seriousness of the
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disease and the kind of treatment they are to be provided. This will also help the hospital
to distribute nurses duty in the wards as that all the patients can be treated and taken care
of equally as per their seriousness of the disease.
 A chief nurse should be assigned to each and every ward so that she can check whether
all the patients are taken care off, all of them are provided with proper nutrition and
hydration so that any kind of serious issue related to nutrition can be reduced or any other
kind of issues can be identified and solved.
 By doing continuous monitoring and supervision of the patients so that their quality of
care can be reviews, if the are facing any kind of problems then it can be reviewed as
well, their quality of care can be monitored and reviewed (Callaghan and et.al., 2016).
This will help the trust to check whether their patients are being provided with proper and
adequate care. This will also help the patients to report whether they are facing any kind
of problems or not treated well etc. this will also help the hospital to identify whether any
patient is harmed or is in serious condition so that they can be attended in a timely
manner.
 Training programs and seminars can be conducted for the hospital staff so that they can
be trained in such a way that patients quality care can be improved. This training will will
help the nurses to understand the importance of nutrition and hydration in healthcare i.e.
how it can either improve a patients health or can degrade their health (Ham, Berwick
and Dixon, 2016). This training program will also help the hospital staff to learn different
ways to attend the patient such that the overall quality care of the patients can be
improved and the can be treated well.
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Using those recommendations process map can be improved in such a way so that
patients are continuously monitored and waiting time for the patients can be improved.
TASK 3
Implementation plan
All the recommendations given above can help in improving the overall quality of patient
care of the hospital (Tom, Ewan and Mitchell, 2017). It will also help in improving the overall
quality of the hospitals well as review their current performance. In this improvement plan
stakeholder group and SMART objectives will be considered.
In this improvement plan few things will be addressed and tried to be improved such as:
 Waiting time for the patients will be improved. Timely access to service care is extremely
important for the patients as some of them face some serious issues which are needed to
addressed as soon as possible.
 Nutrition and hydration of the patients will be improved.
 Monitoring of the patients will be done continuously so that patients quality care can be
monitored continuously (Rolland and et.al., 2016).
Implementation plan to improve the overall quality care of the patients is:
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Illustration 2: Improved process map

Quality Dimension Indicator Change Idea
Time efficiency Most of the patients are not
attended on time and they have
to wait for long time at most of
the phases such as in referral
to GP, At diagnosis stage also
they have to wait in order to be
diagnosed.
Waiting areas can be made for
the patients where they can
wait for their turn and if
another GP or diagnosis place
is empty then they can be
referred their so that they won't
have to wait too long in order
to be attended.
Patient monitoring and
supervision
Patients are monitors once in
24 hours which is not enough
as they sometimes are not
provided with proper nutrition
and hydration. Not only this
sometimes they face few
serious issue that affect their
health and get hurt
unintentionally and are not
even reported.
A separate monitoring and
supervision department should
be made where all the patients
are monitored and supervised
at a fixed interval of time. Not
only this patients can also give
their feedback or complain
regarding any issue related to
quality and patient care.
All the stakeholders that will be affected by this improvement plan will be doctors,
nurses, patients etc. Doctors and nurses will have to improve their patient monitoring,
supervision and care method so that overall improvement can be brought within the hospital.
Patients will be treated and attended within a short duration of time. This will also help the NHS
Trust to achieve all of their objectives which will help them to drive the quality improvement
within their organizations concerned with patient care.
CONCLUSION
From the above assignment it has been summarized that there were various kinds of
failures in the initial process mapping of Liverpool Community Health NHS Trust due to which
their quality care for patients was getting affected. It has been analysed that there they failed to
attend their patients on time and were also not able to diagnose their diseases or problems
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without making them wait for long. It has also been seen that they were not able to provide
proper nutrition and hydration to their patients which further caused some serious problems. In
the above assignment first of all the failed process map and loop holes were identified then all
the national quality standards that they achieved and failed to achieve were identified. Then the
main objectives, vision and mission of the NHS trust were identified and described. After that
few recommendations were given so that the current failed process map can be resolved and their
quality care towards patients can be improved. Lastly, out of those few recommendations two of
them were chosen and a improvement plan was made in order to improve their patient care
quality.
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REFERENCES
Books and Journal
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health record functions in ambulatory care. Journal of the American Medical
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Antonacci, G., and et.al., 2018. The use of process mapping in healthcare quality improvement
projects. Health services management research. 31(2). pp.74-84.
Barber, R.M., and et.al., 2017. Healthcare Access and Quality Index based on mortality from
causes amenable to personal health care in 195 countries and territories, 1990–2015: a
novel analysis from the Global Burden of Disease Study 2015. The Lancet. 390(10091).
pp.231-266.
Beaussier, A.L., and et.al., 2016. Accounting for failure: risk-based regulation and the problems
of ensuring healthcare quality in the NHS. Health, risk & society. 18(3-4). pp.205-224.
Callaghan, T., and et.al., 2016. The NHS Wales Skills and Career Framework for Healthcare
Support Workers. British Journal of Healthcare Assistants, 10(2), pp.88-94.
Canedo, J.R., and et.al., 2018. Racial/ethnic disparities in diabetes quality of care: the role of
healthcare access and socioeconomic status. Journal of racial and ethnic health
disparities. 5(1). pp.7-14.
D’Andreamatteo, A., and et.al., 2019. Institutional pressures, isomorphic changes and key agents
in the transfer of knowledge of Lean in Healthcare. Business Process Management
Journal. 25(1). pp.164-184.
Gellad, Z.F. and Day, T.E., 2016. What is value stream mapping, and how can it help my
practice?. The American journal of gastroenterology. 111(4). p.447.
Ham, C., Berwick, D. and Dixon, J., 2016. Improving quality in the English NHS. King's Fund.
Lemos, J., Haddad, F. and Morgan-Jones, R., 2016. Patient-centred relationship mapping. The
Bulletin of the Royal College of Surgeons of England. 98(6). pp.240-243.
Mohammed, K., and et.al., 2016. Creating a patient-centered health care delivery system: a
systematic review of health care quality from the patient perspective. American Journal
of Medical Quality. 31(1). pp.12-21.
Phelan, S.M., and et.al., 2015. Impact of weight bias and stigma on quality of care and outcomes
for patients with obesity. Obesity Reviews. 16(4). pp.319-326.
Rolland, Y., and et.al., 2016. Improving the Quality of Care of Long‐Stay Nursing Home
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Rosen, M.A. and et.al., 2018. Teamwork in healthcare: Key discoveries enabling safer, high-
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