The Finance Teams at the Leicestershire Partnership NHS Trust (LPT) and at the University Hospitals of Leicester (UHL) were invited to work as pilot sites for the development and implementation of the NHS Improvement (NHSI) Finance Operating Model Project.
NHS Improvement had identified the need to better understand the systems and processes within Trust Finance functions in order to:
- Identify opportunities for improvement for each Trust
- Develop a robust set of Key Performance Indicators, to be used in benchmarking and identification of the support needs of NHS Trusts as part of the NHS Model Hospital Programme
- Develop a high level ‘Target Operating Model’ describing the structure, systems and processes required to ensure optimal function of a hospital finance department
£10 million of savings identified and delivered
We put together a small team to support this project, with a combination of senior NHS financial, contracting and operational management experience and operational and finance management experience from other sectors.
The detail included below relates to our work with the Leicestershire Partnership NHSFT (LPT), although we took a similar approach to the project with each of the two Trusts involved.
The Trust nominated their acting Director of Finance to act as the project sponsor for this piece of work. At our initial meeting with her we identified that the Finance team had experienced a high degree of change and disruption in the recent past due to organisational mergers. We designed our project involved maximising input from as many staff as possible across all teams in the finance function and encouraging their commitment to change.
We started the project by involving 24 finance staff members in structured interviews and a number of workshops to develop a Value Chain Map for each finance function, identifying bottlenecks, delay and duplication within current processes and a number of potential ideas for improvement. We also completed an Operational Health Check for the service, working with service users (budget holders) and the finance team, to identify what was working well and what areas needed attention across eight . We then completed some data analysis and ran a series of workshops to validate potential process changes and solutions.
Finally we ran a 3 hour workshop for the entire finance team to share findings and to prioritise the service improvement projects. We also used this session to develop and test a simple approach to managing changes and to identify training and development needs.
Working in partnership with the two Trusts we devised a prioritised set of improvement plans for each Trust, which they have begun to implement. These include a redesigned Accounts Receivable process aimed at reducing debtor days and improving cashflow and a more consistent set of management accounts processes.
We went on to identify opportunities to streamline financial systems, replacing manual workflow with electronic workflow, in particular for paper-heavy Accounts Payable processes and we also developed simple Key Performance Indicators to enable the Trusts to track progress.
Finally, we shared an improvement toolkit, including straightforward tools for project management and process improvement.
We used our findings from the work with Trusts to produce a high level finance function Operating Model and a set of Key Performance Indicators for NHSI to use in their Model Hospital programme.