Royal United Hospital Bath NHS Trust has been working to ensure that its clinicians and senior managers are actively involved in financial management, including identifying and implementing actions to address any variances.
The Trust’s challenge was to:
- Increase levels of engagement in financial management, without creating structures that would become cumbersome or counterproductive
- Integrate these initiatives with performance management, rather than as an isolated finance project
The Trust adopted two main approaches to this challenge:
- Reaffirming and enhancing the existing management structure
- Launching an organisational change programme called RUH 2010
RUH 2010
Working with external consultants, the Trust has set up RUH 2010 as 14 inter-related projects, which aim to provide financial and non-financial benefits through organisational development.
These projects are based on staff involvement and accountability, and also help the Trust to find more efficient ways of meeting its performance targets and generating financial stability for the future.
Examples of the resulting enhanced role for senior managers and clinicians in taking responsibility for the resources for which they are accountable include:
- Empowering clinical staff to innovate and transform their working areas through changing working practices and infrastructure, for example through Local Action Teams. These changes are linked to clear performance metrics and financial targets, which the project leads and sponsors (both clinical staff and senior management) are responsible for setting, monitoring and achieving, including corrective action where necessary
- Strengthening the links between activity, resource, and income and expenditure, to improve forecasting and operational decision making at specialty level
- Setting up a monthly Clinical Reference Group to review and share RUH 2010 progress, which regularly attracts 40 or more people from across the clinical staff and senior management. This group has developed to the extent that it is now considering business models for specialties and discussing autonomy, accountability, and information needs for effective decision making at specialty level including service line reporting.
The Trust is realising significant benefits from RUH 2010 including the removal of delays in patient care, reduced lengths of stay and releasing beds, which provide the Trust with financial efficiencies.