Improving Hospital Performance: King Edgar NHS Trust Case Study

This case study examines the King Edgar Hospitals NHS Trust in 2003, highlighting its struggles with increased waiting times, bottlenecks, and poor patient flow, leading to patient complaints and negative public perception. The trust responded with initiatives like creating new management positions, implementing nurse-led discharge programs, and securing funding for social services. Despite these efforts, challenges persisted, including underestimation of support needed for ward sisters and slow social service operations, ultimately leading to the trust losing its star rating and facing financial difficulties. The case provides a detailed analysis of organizational change, leadership challenges, and performance improvement strategies in a healthcare setting, offering valuable insights for students studying leadership management and healthcare administration. The case study references relevant literature and provides a timeline of events and implemented strategies, along with their outcomes, illustrating the complexities of change management within a public healthcare system.

Leading
Organizational
Change
Improving Hospital Performance

Overview of King Edgar Hospitals NHS
Trust (2003)

Disturbing Symptoms
• Increased trolley waits
• Bottlenecks in the medical admission ward
• Placement of the patients on wrong wards
• Increase in stay lengths
• Poor link with social services
• Delay in patients’ discharge
• Increase in patients’ complaints

The Waiting Game
• Government’s NHS plan- an aspiring pledge
to lower the maximum waiting times
• The patients who are waiting for more than
twelve hours were to be reported to SHA
(Strategic Health Authority)
• Intense legal pressure to meet the targets
of waiting list generated unwanted side
effects for NHS

The road to recovery- Standard Patient Flows

The Case for Treatment
• Lack of senior medical presence
• Patients were not able to move fast enough
• Lack in senior medical presence
• Waiting of patients more than 11 hours
• Inefficient practices and poor communication
• When physicians go for a round and announce that the patient is fit
to get discharged, the process of discharge planning would
commence.
• Poor knowledge about varied car schemes
• Poor communication with social services.

Proposed metrics and targets generated by the group work
from the Marton’s First Workshop (Date- 28 April, 2003)

Toward a more effective operation
• The position of “Discharge Manager” and
“Site Manager” was created.
• Senior Nurses were appointed for these
position
• Regular presentation to the forum of the
nurses
• Physical presence of Green on the wards
• Training of the matrons and ward sisters

Discharge Planning
• Produced a report entitled “Changing
Culture & Improving Discharge
Performance”.
• cartoon posters
• Organizes full day workshop
• Secured funding

Nurse-Led Discharge
• Thorton developed a training program for the nurses who
are going through NLD.
• Many nurses signed off as competent for the NLD.
• The training programs enabled the ward sisters to develop
a better relationship with patients and provide them with
“total patient care”.

Taking a health check
• Thoton monitored on a regular basis whether everything is
running well or not
• The initiative was running well on one ward of neurology
while it was meeting much resistance on the other ward.
• Realized that the amount of support need by the ward
sisters in order to make the decision of the discharge was
underestimated
• Social services were operating at slower pace
• Unsuccessful in establishing a clear baseline data for the
length of stay

Epilogue: The Risk of Relapse
• The gains were not displayed in the public opinions
regarding the trust.
• Trust lost its only star on August 2004
• Fall under the nine worst performing trusts of the nation
• This is lead to high risk of retention and recruitment
problems and led to shrinkage of the hospital
• Financial recovery program was initiated

References:
1. Anon (2002) “Waiting list targets criticised”, Helath Newswire
Consumer, September 18.
2. Revill, J. (2003) “Hospitals faking cuts in casualty wait times”,
The Observer, May 11: p.1.
3. Anon. (2202) “Blocked thinking”, Torkshire Post, February 21:
p.3
4. Waugh, R. (2004) “Health trust fails to shine in ratings”,
Yorkshire Post, July 21: p. 1.
5. Batty, D. (2003) “Q&A: NHS star ratings”,
SocietyGuardian.co.uk, July 16.
6. Anon. (1998) “Bevan’s baby hits middle age”, The Economist,
July 4: p. 55
7. Ham, C. (1998) “NHS 1948-1998”, The Guardian, July 1: 10.
8. Brown, C. (1997) “More than one million waiting for NHS
hospital treatment”, The Independent, February 20: p.2
9. Laurance, J. (2003) “The Blair Years: Helth”, The Independent,
July 30: p. 4.

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