Strength in unity: the power of redesign to align the hospital team
Authors: Bell Anthony , Cochrane Alastair , Courtice Sally , Flanigan Kathy , Mathur Mandeep , Wilckens Daniel 
Published: May 2014

Objective
The aim of Queen Elizabeth II Jubilee Hospital (QEII) redesign project (QEII United) was to enhance timely access to an inpatient bed and maximise opportunities to value add during the inpatient episode of care.

Methods
A tripartite relationship between the hospital team, system manager and external consultants. The team, QEII United, was formed to ‘diagnose, solve and implement’ change under the unifying metaphorical banner of a football team. A marketing strategy and communication plan targeted the key ‘players’ and outlined the ‘game plan’. Baseline data were collected, analysed and reported in keeping with key aims. Strategies for systems improvement implementation were attached to key performance indicators (KPIs).

Results
Thematic KPIs were developed to embed internal process change to reflect the contributions made towards the National Emergency Access Target (NEAT) at each stage of the patient journey. As such, access block of under 20%, morning discharge rates of 50% before midday, reduced length of stay for selected elective orthopaedic and general medical diagnostic related groupings (DRGs; i.e. relative stay index ≤1) and hospital in the home (HITH) utilisation rates 1.5% of all admissions were all met. Key to sustainability was the transfer of clinical redesign skills to hospital staff and the fostering of emergent ground up leadership.

Conclusions
QEII United’s success has been underpinned by the development of themed solution areas developed by the hospital staff themselves. Robust baseline data analysis used in combination with nationally available benchmarking data provided a quantitative starting point for the work. The collaborative elements of the program re-energised the hospital team, who were kept informed by targeted communications, to establish quick wins and build trust and momentum for the more challenging areas.

What is known about the topic?
Clinical redesign is now commonly used to understand, define and improve those clinical processes that underpin the patient journey across the continuum of care. Different industry models exist and have been extended for use in healthcare settings to involve, engage and educate staff with the primary focus of providing the best possible patient care, in an effective and efficient manner.

What does this paper add?
The clinical redesign process outlined in this paper is instructive in its use of the metaphorical team. Team philosophy, composition and functionality was built up using the vernacular of a football competition. In this way, organisational learning and capability building occurred within empowered local action teams, across the ‘season’ to effect changes at all points of the patient journey.

What are the implications for practitioners?
The implications for practitioners are to fully understand the breadth of issues before deciding upon focus areas for improvement. Resistance to change is inevitable and there are a number of ways to mitigate this and create a sense of purpose within the broader clinical group by structuring teams across traditional reporting lines. Collaboration is crucial in keeping lines of communication open and the use of data and patient feedback is very instructive.