Case Studies

What is benchmarking?

Benchmarking has long been recognised in industry as an effective means of improving business performance but navigating the range of advice and making sense of benchmarking can be a challenge.

Benchmarking is the process of comparing your business processes and performance metrics to industry bests and/or best practices from other industries.

Dimensions typically measured are quality, time, and cost. Learning through benchmarking can provide assurance as to the effectiveness of existing arrangements as well as identifying improvement points. Improvements mean doing things better, faster, and cheaper in future.

The Benchmarking Network uses the following definition as a simple and accessible statement of what benchmarking is and why we do it:

"Benchmarking is the use of structured comparisons to help define and implement best practice..."

We benchmark to help our members implement change and make services better for patients.

Below is a compendium of good practice case studies from our members who have used the Benchmarking products to support/ improve and implement changes within their services. The full case studies are available for member organisations to download from the members’ area under “View outputs”.  

If you would like to share your good practice case studies and particularly how you have used the benchmarking information to support change and improvement, please contact Lindsey Ashley.

CAPA improves clinical efficiencies and patient access

Learn how NHS Greater Glasgow and Clyde Health Board used the Choice and Partnership Approach to improve access and waiting times for their CAMHS service by 86 weeks in just 26 months..

Specialist Children’s Services care for a range of 0-18 year old children and young people throughout NHS Greater Glasgow and Clyde

The challenge facing many Mental Health services is delivering quality services with limited resources. Services can often be overwhelmed by demand and seemingly not have the capacity to manage the growing workloads effectively. Not only does this result in staff dissatisfaction, but the question must be asked: “Are service user’s needs being met in the best way possible?”

With the implementation of EMISWeb into NHSGGC CAMH Services improving the opportunity to analyse data, CAPA assumption and benchmarked performance data can now be considered to determine what is working well with the CAMHS service model and where improvements can be made. 

NHS Benchmarking Network project support

The NHS Benchmarking Network has helped us consider the relevant data sets, monitoring and assessing efficiency and access to service performance throughout NHSGGC CAMHS. We are able to compare our CAMHS team’s performance to identify areas of best practice. We have initially locally benchmarked our data sets to some data sets available in other Scottish Health Boards, and this has given us a good comparison of our performance. This has now been enhanced with UK data sets as part of the NHS Benchmarking Network, which gives us an excellent national picture of benchmarked NHS Greater Glasgow and Clyde performance data.

Benchmarking identifies new funding opportunities

Learn how a national audit of the provision of Perinatal services in England provided evidence for options to utilise additional funding announced by NHS England.

The aim of benchmarking Perinatal Mental Health (PMH) services in 2015 was to provide NHS England (NHSE) with an up-to-date stocktake of provision in England to assess the current availability of NICE-concordant PMH services and identify gaps. This was then used as evidence for options to utilise the additional funding announced by NHSE for perinatal mental health services.

NHS Benchmarking Network project support

In order to develop an investment strategy for perinatal mental health care, NHS England / NCCMH commissioned the NHS Benchmarking Network to undertake a stocktake of the provision of perinatal services provided by the specialist mental health trusts in England. This was carried out in June 2015 and reported on 2014/15 outturn positions.

The results were reported to the Perinatal Expert ReferenceGroup in July 2015 and the resultant analysis was used to recommend the following:-

  • There should be an expansion of mother and baby unit capacity and a particular focus in three areas of the country where access for women is especially limited,
  • Perinatal mental health networks should be established across the country, and
  • There should be investment in specialist community perinatal mental health service provision. 

Benchmarking supports more people at home

Learn how a redesign of intermediate care services in Bolton reddressed the balance between bed and home based services, provided care 24 hours a day and allowed more service users to be supported in their own home, rather than in a hospital bed.

“The benchmarking outputs have enabled the local health & social care economy to interrogate their benchmarking metrics to aid local understanding of key priorities, and allows tracking of progress over time”

Adrian Crook, Assistant Director, Health and Adult Social Care

The approach of the Bolton Health & Wellbeing Strategy is to transform the current positionof reactive care over time to proactive care to prevent hospital admissions and long termadmissions to residential/nursing care through individual person-centred care planning.  This paradigm shift was enabled through investing in prevention and earlier intervention, reducing demand for hospitalisation and more complex care, further enabling reinvestment. There design of intermediate care services was only one element of a wider integration project, supported by the Better Care Fund.

NHS Benchmarking Network project support

The NHS Benchmarking Network was commissioned by the Bolton health & social care economy to carry out a review of intermediate care provision with the aim of redesigning services, focused on improving service user/patient abilities, reducing the demand for long term care services and care homes. 

The benchmarking demonstrated that if Bolton could re-balance the intermediate care system, with no additiona linvestment, then an additional 305 people could be cared for at home, or go straight to home from hospital. 

Utilising POCT to deliver efficiencies

Learn how an overhaul of the existing AEC service at James Paget UHFT, and implementation of POCT in line with existing NHS best practice guidelines achieved; reduced LoS, over 90% same day discharge and increased patient satisfaction.


The James Paget University NHS FT Hospital is located near Great Yarmouth in Norfolk; serving a patient catchment area of approximately 240,000 with 390 general and acute beds.

A 7.61% year-on-year increase in medical inpatient activity has been observed, which, when combined with financial and operating pressures, has required all at the James Paget to seek innovative ways of working to reduce patient length-of-stay, reduce unwarranted admissions, and provide high-quality, patient-centred care.

This innovation opportunity was identified by an acute/emergency Consultant at the Trust. The decision was made to overhaul the existing, limited AEC service (which closed frequently due to operational pressures), using process change and POCT implementation; in line with existing NHS best practice guidelines.

Further work since

The unit, since the completion of the ‘proof-of-concept’ pilot, has led to permanent, and now extended service provision. Furthermore, the evidence-based approach adopted has led to an extended project which will reconfigure the patient pathways for our ‘short stay’ medical cohort ; as well as the newly implemented, Trust-wide ‘Visual Hospital’ and ‘Plan for Every Patient’ systems (provided by our process-engineerpartners, Operasee Limited) to dramatically improve patient flow.

A seven day service that puts people first

Learn how North Middlesex University Hospital NHS Trust redesigned a 5 day service for better continuity of care that lowered readmissions and improved patient outcomes.


North Middlesex University Hospital NHS Trust is a secondary hospital situated in the borough of Enfield. 

The challenges faced by their dietitians included; pressures during the week, late Friday afternoon referrals, patients not being seen/treated prior to discharge, being left NBM or without any dietary intervention over the week-end or longer. 

The aim for 7 day working was essential to ensure early and timely dietetic interventions, contribute towards better patient outcomes including better patient care and safety, patient experience, safe discharges, reduced length of stay (LOS) and readmissions, without affecting the weekday service.

NHS Benchmarking Network project support

The biennial benchmarking exercise for Acute Therapies allows North Middlesex University Hospital NHS Trust to monitor their services and provide assurance to their board about the resourcing and productivity of their service.

Benchmarking Secures additional funding

Learn how comparative data evidenced efficient work at Livewell Southwest and secured additional funding to meet increases in patient demand. 


“The national annual benchmarking exercise allowed Livewell to demonstrate that its District Nursing service was operating above the national average in the majority of indicators, thus enabling an objective review of its relative efficiency.”

Dan O’Toole - Director of Finance/ Deputy Chief Executive, Livewell Southwest

Livewell Southwest (formally known as Plymouth Community Healthcare) is a social enterprise that provides community and inpatient based physical, mental and children’s and families’ healthcare and adult social care as an integrated care organisation.

The District Nursing team continuously experience increases in demand due to the development of innovative community based treatments and the constant drive to enable earlier discharges from an inpatient setting. These additional demands were not being met by increases in available resources and there was a need to ensure that the service was operating as effectively as possible.

The District Nursing service was an early adopter of Livewell Southwest’s activity based reporting systems and used this in combination with a number of other initiatives such as the productive community services series to improve the efficiency and effectiveness of the service.

NHS Benchmarking Network project support

The annual Community Services benchmarking exercise allowed Livewell SouthWest to demonstrate that the district nurse service was operating above the national average on the majority of indicators, providing an objective review of its relative efficiency.

Accreditation win through benchmarking

Learn how the Peterborough and Stamford Hospitals NHS Foundation Trust achieved Imaging Service Accreditation Scheme accreditation with support of the Radiology benchmarking project.

"The NHS Benchmarking Network Toolkit enabled the Radiology team to examine our good practice and to use this data as evidence for the Imaging Service Accreditation Scheme.  The national conference also revealed good practice from other Trusts that we could take on board."

Claire Bevan, Clinical Governance Radiographer, Peterborough and Stamford Hospitals

Peterborough and Stamford Hospitals NHS Foundation Trust was one of the first wave of NHS Trusts to be granted Foundation Trust status in April 2004.

ISAS is a patient-focused assessment and accreditation programme that is designed to help diagnostic imaging services ensure that their patients consistently receive high quality services, delivered by competent staff working in safe environments.

Undertaking the Imaging Service Accreditation Scheme has been beneficial enhancing all aspects of service delivery, driving efficiency and quality of care and also providing a competitive advantage.

“I think that much of what ISAS ask us to do improves our practice. This is refreshing and inspiring." Staff feedback.

NHS Benchmarking Network project support

The The NHS Benchmarking Network Toolkit helped to analyse the data and make comparisons with other hospitals of a similar size to see how the Trust was performing against standards. It enabled the Radiology team to examine their good practice against other services and to use this data for ISAS evidence.

NHSBN 2014 Radiology Project - University Hospitals of Leicester NHS Trust

Demand for patients to have Radiologically-guided lines, including Hickman Lines and PICCs, is met by a variety of service models within Acute Trusts. University Hospitals of Leicester (UHL) has an interesting and highly successful approach to meeting demand.

Background

Demand for patients to have Radiologically-guided lines, including Hickman Lines and PICCs, is met by a variety of service models within Acute Trusts. Some service models are more successful than others and from time-to-time the issue of patients being delayed in their treatment or discharge whilst awaiting such lines is reported by the press, particularly when the delay has been determined at Inquest to have contributed to a patient’s death.

University Hospitals of Leicester (UHL) has an interesting and highly successful approach to meeting demand. In fact, their Nurse-led service, developed over a number of years, has been so successful that demand has significantly increased as they deliver the service to all patients who would benefit from a line insertion, rather than only carrying out the procedure for patients with high acuity.

Service

In 2000, the UHL Hickman Line Service operated by Radiology had an 8 week waiting list, performing approximately 300 procedures per year. The Service was run by a single Consultant Interventional Radiologist, Dr Kim Krarup, assisted by a Sister working in Radiology. The Sister, Sharon Hubbard, asked if she could be trained to perform the procedures.

In 2014, Sharon is now the Lead Specialist Practitioner for Vascular Access and manages the Nurse-led Vascular Access Team. This 3 member nursing team (2.4 WTE and a Scrub Assistant) operates a Monday to Friday service in a dedicated room, performing in excess of 1300 procedures a year, including direct access referrals from local GPs, and undertakes sessions in neighbouring hospitals.

Their turnaround time, from the point of request to performance, averages less than 24 hours. In a typical week, Sharon and her team will perform a mixture of urgent lines and planned lines, including offering a service for haematology and oncology patients to have their lines installed at the optimal time for their treatment.

Benefits

The University Hospitals of Leicester NHS Trust has one of highest Interventional Radiology Procedure counts per 100,000 Occupied Bed Days and per £100m turnover from all Trusts who participated in the NHSBN Radiology Project in 2014. This reflects both the high number of procedures undertaken as well as the impact that such procedures have on reducing bed days; already under average compared to their peers, UHL’s mean number of bed days per SPELL has fallen a further 2% in 2013/14. This service, therefore, makes a direct contribution to improved patient flows and reduced length of stay at the Trust.

A frequently audited service, Sharon and her team have a >90% success rate for placing lines and an exceptionally low complications rate (0.3%). Their service has reduced the overall burden on the Trust, enabling more patients to receive treatment in the Community, improved the speed at which patients can be safely discharged, reduced the demand on theatres and reduced screening (exposure) time to patients.

The team now trains Medical and Surgical trainees in the placement of lines, as well as nurses and other clinical staff in the efficient maintenance of lines.

Their gold standard service has been recognised following peer review with a Level 2 accreditation for Treatment of Gastrointestinal Failure.

For further information on the UHL Nurse-led Vascular Access Team, please contact:

World Class Theatres

World Class Theatres” at Wrightington, Wigan and Leigh NHS Trust’s is defined by improving the safe, effective care we provide to our patients.

This is fantastic, it will definitely be a great tool in driving improvement within our organisation.

Toolkit feedback, February 2014

In line with recommendation outlined in the Francis Report it promotes accountability, ownership and enables staff to improve the processes in which they work. The benefits to both patient and staff in Year 1 are very transparent and include; £207k CIP, 67% reduction in DNA’s, 22% reduction in charter cancellations, 5.2% increase in elective activity, huge improvements in staff survey and satisfaction.

By bringing all staff groups together, who are involved in the patient journey, in an open transparent forum, has been a key enabler to these achievements. Benchmarking ourselves against peers has enabled us to identify areas where we can improve and those Trusts that are leading the way in those areas. This helps identify best practice and where we can learn and share with our NHS colleagues across the country. WWL NHS FT has hosted a number of site visits from other Trusts to share our best practice, which has been reciprocated. We have taken some of this learning into our ways of working.

Innovation in Radiology

The Network’s Radiology project is the largest source of comparative Radiology data available within the NHS. The project covers all modalities and produces thought provoking comparisons, analysis and good practice case studies from Radiology departments across the NHS.

“The benchmarking exercise has provided useful information on where Radiology at Stockport NHS Foundation Trust sits in relation to its peers. Such information has previously been unavailable. We hope to use the data in the future as evidence of our strengths and weaknesses in an effort to support further service developments and investment.”

Stockport NHS Foundation Trust have been active participants in our Radiology benchmarking project and used the process to test performance and inform local innovations in practice. The Trust now have extended scope practice for Radiographic and Nursing staff across many areas in the department including the delivery of ultrasound (soft tissue, neck, testes), CT brain reporting, MSK x-ray reporting (ED and GP’s) and advanced GI imaging. The Trust have also developed processes to allow mammographic staff to undertake stereotactic breast biopsy, an Advanced Nurse practitioner undertakes hystero-salpingograms and the reporting of DEXA is radiographer led. The Trust are also undertaking a comprehensive Myocardial Perfusion Imaging service in which the stressing agents are administered by nursing staff. Other notable practice includes a recently acquired vacuum assisted biopsy device for use in mammography. It is intended that the expansion of use of this as a tool will decrease the reliance on elective surgery if used to remove benign lesions from the breast. Breast services are provided for the symptomatic patients of Stockport and we operate a formal double reporting standard for these patients which we feel offers a greater degree of sensitivity and specificity on mammographic reporting.

The equipment portfolio at Stockport NHS FT is of a high standard. Within the past 3 years, we have moved towards full digitalisation of our plain film services with a reduction in the number of plain film rooms from 9 rooms to 6. Over the same period, we have purchased a second CT scanner, digital dental x-ray room, numerous replacement Ultrasound units and upgraded the MR system to the latest platform.

Benchmarking supports viability for service

Learn how Royal Manchester Children’s Hospital CAMHS department utilised benchmarking to prove financial viability to the Trust Board within one month.

"The NHS Benchmarking Network supported CMFT CAMHS in the production of a high level report to the Trust Executives and commissioners, their support was invaluable and the level of expertise and data from the team ensured that the service was recommissioned."

Maria Slater - Directorate Manager, Central Manchester University Hospitals NHS Foundation Trust

Royal Manchester Childrens Hospital CAMHS is part of Central Manchester University Hospitals NHS Foundation Trust.

Service line reporting was introduced and identified that the CAMHS income was £3.5 million adrift to its budget. The CAMHS department was given 1 month by the Trust board to prove that the service was financially viable.

The review took a month and was jointly facilitated by the NHS Benchmarking Network and the Senior Management Team in CAMHS with a final recommendations paper being presented to the Trust Board.

An independent review by the NHS Benchmarking Network enabled the service, over the next 2 years to increase income by £3.4 million with no additional expenditure.  The NHS Benchmarking Network CAMHS benchmarking project provides a ‘sense check’ of what good CAMHS offer and any niches in the market for us to exploit/develop.

NHS Benchmarking Network support

The national data sourced from the Network’s benchmarking project provided assurance to the Board that CAMHS was doing the ‘right’ things and standards were high.

The national data enabled clinicians to be engaged in identifying clinical efficiencies and removed professional tensions that sometimes block clinicians engaging in a financial agenda.

Is my community hospital doing a good job?

Is my community hospital doing a good job?

Discharge destination can be used as a proxy outcome measure for community hospitals. How many patients are going home independent? How many are being returned to an acute hospital? Use this chart to compare your performance.

"The comparative data allowed us to identify areas in which there was scope for us to improve against the national average position and also to have some solid information on which to base discussions with commissioners, to help inform the setting of target trajectories for future years."

Lee Cornell, Somerset Partnership NHS Foundation Trust

As a large, rural area Somerset has 13 community hospitals which make a significant contribution to the overall capacity of, and patient flow through, the local health economy.

The provider, Somerset Partnership NHS Foundation Trust, was able to use the Community Hospitals benchmarking project to demonstrate to commissioners that, whilst the overall investment in community hospitals was 2.6 times the national average (reflecting the local geography), the number of admissions was 3.6 times the national average. The relatively high throughput was achieved through maintaining below average lengths of stay in Somerset’s community hospitals and supported the relatively low utilisation of secondary care in the area.

Somerset Partnership also used the report to identify areas for improvement. For example, although the benchmarking project showed below average DNA rates at the majority of the community hospitals, one hospital reported a rate almost double the national average. This issue was investigated and rectified using systems already in place at other sites. Review of the destination on discharge profiles for each hospital highlighted one hospital where 23% of patients were being returned to the acute trust (compared with a national average of 11%). The acuity of the patients being sent to this site was investigated in partnership with the acute trust and access criteria clarified.

For more information contact Lucy Trubacik.

Using benchmarking for workforce planning in acute therapy services

How does your physiotherapy team skill mix compare?

The physiotherapy inpatient clinical team radar chart allows you to compare your skill mix with the other participating Trusts. In this example, the trust AT066 (not Nottingham) has more staff at bands 7, 6 and 4 and less at band 5 than average.

" The acute therapy services benchmarking helped us to compare our workforce profiles with other similar Trusts and informed our future workforce plans."

Anne Cowley - Head of Therapy Services, Nottingham University Hospitals NHS Trust (2013)

Nottingham University Hospitals NHS Trust has used the NHS Benchmarking Network Acute Therapies project to support workforce planning. The new toolkit for the project enabled the Therapies management team to review the skill mix of the physiotherapy and OT teams against both national averages and their peer group of teaching hospitals. The profiling of specialist service provision provided in the toolkit allowed the context of the local service configuration to be taken into account.

The management team were also able to review the productivity of their services against comparable hospitals using benchmarking metrics including the number of contacts per WTE for the inpatient team, the number of outpatient appointments per WTE and follow up to new ratios. 

For more information contact Leigh Jenkins.