Best Practice Case Studies
This annex of the report has been used since the first edition of SAFR in 2011 to highlight and share innovative solutions and best practice covering different aspects of managing assets and facilities services in NHSScotland.
The case studies are aimed at promoting and learning from good practice, and to provide the reader with information on actions being taken elsewhere in NHSScotland to deliver improvements in the performance, efficiency and sustainability of assets and facilities services. Two further case studies are included below on environmental improvements to the Scottish Ambulance Service’s fleet, and an evaluation of the successful introduction of a tracking system for medical devices at Forth Valley royal Hospital.
The accompanying table provides a reference summary of previously published best practice examples, with information on which SAFR report can be referenced for further details.
It is envisaged that this section will continue to be a key feature of this annual State of NHSScotland Assets and Facilities Report, aimed at helping NHSScotland to develop capability and capacity to deliver high performing, efficient and sustainable assets and facilities services.
Best Practice Case Study 1
Scottish Ambulance Service: fleet environmental improvements
The Scottish Ambulance Service vision is to move to zero emission vehicles as quickly as possible working with available technology and infrastructure, forcing innovation while ensuring patient care.
The transition from traditional fossil fuel vehicles will not be completed overnight but through adoption of existing technology now, the Service intends to significantly improve sustainability by reducing environmental impact during the transition period.
Where diesel vehicles have been specified as the most effective in a role, the early introduction and ongoing use of EU6 compliant engines (exclusively since 2016) set dramatically higher standards on NOx emissions (the oxides of nitrogen which are linked to urban air quality issues) and particulates (soot). This results in emissions from the diesel vehicles being close to similar capacity petrol engines, while still offering far lower CO2 emissions.
The priority looking forward is on alternative fuels, reducing the use and reliance on fossil fuelled vehicles. The Scottish Ambulance Service committed to trailing electric powered vehicles. It is the first UK service to bring electric powered paramedic rapid response vehicles on to its operational fleet with the introduction of converted BMW i3 response vehicles in Edinburgh, Aberdeen and Glasgow. Electric charging points are initially located at four sites to accommodate these vehicles during the evaluation period but analysis is ongoing to prioritise the planned roll out of charging points across all Scottish Ambulance Service locations.
Initial trials of the i3 in partnership with BMW arranged through the Service’s National Vehicle Design and Equipment Group were very positive and tested performance exceeded existing vehicles in this role. Following winter trails, it is hoped that this type of vehicle will be specified into this role nationally.
Where the technology is not yet in place to replace fossil fuel powered vehicles, such as the larger engine A&E vehicles operating 24/7, we are evaluating Hydrogen Fuel Cell Technology. It will not replace the fossil fuel but early indication show it can reduce emissions by up to 80% and improve fuel economy by up to 20%. This is also being evaluated in Paramedic Rapid Response Vehicles (where mileage/use and current technology prohibits charging as an effective solution).
Unfortunately hydrogen technology as a single power source is not currently a viable option for the Scottish Ambulance Service due to the limitation of two filling sites (Aberdeen and Leven) and the limited vehicle options (Toyota and left hand drive Hyundai Tucson). Discussions with vehicle manufacturers remain open and active, pressing for emerging technology that the Service can showcase.
Best Practice Case Study 2
Passive RFID Tracking of Mobile Medical Devices within
Forth Valley Royal Hospital
This is an evaluation of the use of active Radio Frequency Identification (RFID) tracking of medical devices, first introduced at Forth Valley Royal Hospital in June 2014. To date 10,000 of its 14,000 mobile medical devices have been labelled with passive tags.
The main drivers for their introduction were:
- To improve the ability to track mobile medical devices so that they could be located quickly when required for clinical use or maintenance.
- To reduce the time wasted by staff locating equipment.
- To improve equipment utilisation; in turn reducing the amount of surplus / unnecessary medical devices in circulation and wasted costs.
An evaluation of the new system has identified the following successful outcomes:
1. Increased efficiency of planned maintenance
Equipment can now be located in a much shorter time. For example, it is now possible to audit the entire Theatre Recovery Suite (30 beds) in less than 3 minutes, rather than previously taking a whole day. The system can then identify any devices requiring maintenance which reduces the impact on service delivery.
2. Accurate inventory of equipment (including location)
Internal audit reports highlight significant improvements in being able to identify the precise location of medical equipment and devices, with spot checks confirming the accuracy of this data.
3. Reduction in staff time spent locating equipment – releasing time to care
A recent staff survey asked how quick it now was to find equipment when needed; the average response was 9 out of 10 across 18 wards / departments.
4. Reduction in replacement equipment costs by reducing the numbers required
As a result of using RFID tags and using the data collected to inform decision making, an identified total of £360k has been saved. These savings, and the resale of decommissioned equipment that is no longer required, allowed the department to roll out the use of RFID tracking to more areas and to purchase equipment that was due for replacement but would not have otherwise been replaced.
Summary of other Case Studies Published in SAFR since 2011:
|NHS Board||Best Practice||Benefits||SAFR Year|
|Strategic & Service Planning|
|NHS National Services Scotland||NSS were the first NHS Board in Scotland to use scenario planning to develop a PAMS that was agile and flexible to long term change.||The process provided a valuable insight into how future change could impact on the need for property and assets, and the decisions that the organisation is likely to face in the future in relation to these assets.||SAFR 2013|
|NHS Highland||The redesign of rehabilitation services across two inpatient sites in Fort William focussed on the patient journey using LEAN methodology and the need to centralise inpatient activity at the Belford Hospital and outpatient activity at the Health Centre.||This project has resulted in a vastly improved patient experience, improved conditions for staff, and reduced bed days. It also enabled a ward facility to become surplus to needs and freed for disposal.||SAFR 2013|
|NHS Grampian||Following a thorough engagement and consultation process involving the public, the local population agreed that the existing Maud Hospital facility was no longer required, and they would be better placed with more community based services.||The service redesign ensured that people had the opportunity to remain longer at home rather than occupying local hospital beds, and it also demonstrated a community approach to integration of services.||SAFR 2012|
|NHS Greater Glasgow & Clyde||The Board’s Acute Service Review (ASR) aimed to modernise services across the City by renewing its acute healthcare facilities in tandem with a redesign of patient service delivery. The new Queen Elizabeth University Hospital was a pivotal phase of this strategy.||Enables modern healthcare to be provided in fit for purpose buildings and clinical environments, with resulting improvements to the patient experience and the working environment for staff.||SAFR 2011|
|NHS Fife||Following on from extensive public consultation, there was an identified need to change in-patient mental health services from three to two geographic locations.||This resulted in the re-provision of clinical service accommodation with modern, design award winning facilities which enabled the provision of care facilities which encourage social activity and interaction from within patient focussed, innovative and sustainable building environments.||SAFR 2011|
|NHS Board||Best Practice||Benefits||SAFR Year|
|NHS Highland||NHS Highland have introduced an Enterprise Asset Management System to control the maintenance of its estate, integrating the functions of purchasing, maintenance, asset history, and contract maintenance.||It enables information to be available which can optimise future maintenance and replacement planning and enable condition based monitoring and reliability centred maintenance to be carried out. It is also improving planned to reactive maintenance workload ratios.||SAFR 2013|
|NHS Lanarkshire||NHS Lanarkshire’s property investment and estates rationalisation plan involved a programme of replacing outdated service accommodation, centralising its corporate office function, and review all existing lease arrangements.||Better use was made of existing buildings and old facilities were replaced with more functionally suitable and better quality accommodation. The four year programme achieved a net floor space reduction of 9%, annual lease savings of circa £300k and a reduction in backlog of circa £12m.||SAFR 2012|
|NHS National Services Scotland||The refurbishment of a 1970’s office building in the centre of Glasgow was the enabler towards the relocation of 415 NSS staff from 5 leased office properties across central Glasgow to a surplus Government building at Meridian Court.||It re-used surplus office space with a long lease, transformed a tired and non-functioning 1970’s building, introduced a new working environment for staff which enable more flexible working, and reduced overall space needs.||SAFR 2012|
|NHS Lanarkshire||NHS Lanarkshire used Frameworks Scotland2 to develop a 5 year rolling programme of investment to address its backlog maintenance and statutory compliance risks.||It enabled the development of a long term arrangement to be developed to rectify its backlog issues as efficiently and effectively as possible, without the need for repeated tender processes.||SAFR 2015|
|Facilities Management Services|
|NHS Forth Valley||Automated Guided Vehicles (AGV’s) were incorporated into the new Forth Valley Royal Hospital in order to separate out staff and patient flows from visitor and FM services.||The intention was that this would reduce opportunities for cross infection, improve the hospital environment, enhance the patient experience, and promote a calmer, more therapeutic atmosphere. Also, by keeping patient flow separate from visitor and FM traffic, patients can be moved between wards or to theatre in a more controlled environment.||SAFR 2011|
|Office based Strategies|
|NHS National Services Scotland||Since 2011, NSS has embarked on a programme of further consolidating and rationalising its office estate with a specific focus on improving space utilisation, reducing recurring revenue costs, and creating agile and flexible working environments for staff.||The recurring revenue savings as a consequence of implementing the NSS programme of office consolidation and rationalisation from 2012 through to 2016 is projected to be £2.6m – a 25% saving over that period.||SAFR 2014|
|NHS National Services Scotland||NSS implemented a programme of mainly office based property rationalisation to support its strategic model of property provision since the year 2000.||Improved building performance, improved quality of working environment, flexible working spaces, shared use of accommodation, and reduced revenue costs.||SAFR 2011|
|NHS Lothian||In 2010, NHS Lothian undertook a Clinical Accommodation Release Strategy (CARS) to create additional clinical accommodation on hospital sites currently used for office accommodation purposes.||Valuable clinical accommodation was freed up with resources directed towards front line service delivery. It also enabled better efficiency, improved working environment, and reduced energy consumption.||SAFR 2011|
|NHS Board||Best Practice||Benefits||SAFR Year|
|Energy & Environmental Management|
|NHS Grampian||A new energy centre was commissioned to serve the current and future energy requirements of the Foresterhill Health Campus whilst also taking advantage of modern and more efficient CHP plant, biomass boiler and three dual fuel boilers.||This award winning project was designed to provide a 16% reduction in CO2 emissions and a 39% reduction in energy costs.||SAFR 2012|
|NHS Greater Glasgow & Clyde||Glasgow undertook a review of its central laundry facilities in 2009 with the intention of developing more efficient processes for the recycling of the trade effluent and creating a sustainable use of both water and gas energy resources.||It has managed to achieve 70% water and 95% heat recovery from introducing these new processes, with an expected pay back of less than 3 years.||SAFR 2011|
|NHS Tayside||Ninewells in Dundee implemented an ongoing programme of investment in energy efficient lighting schemes to reduce energy waste and improve the building environment.||The scheme has contributed significantly to energy, carbon and financial savings, as well as enhancing comfort levels for patients and staff. The schemes are expected to have a payback of between 7 to 10 years.||SAFR 2011|
|NHS Ayrshire & Arran||A wide range of environmental, sustainable and renewable technologies were integrated into the new Girvan Community Hospital in order to minimise its environmental impact and reduce future revenue consequences without compromising on quality or functional suitability.||It was estimated that the building performance would lead to a reduction of 3% of NHS Ayrshire & Arran’s current CO2 emissions and was also expected to receive income from the installed wind turbine.||SAFR 2011|
|NHS Lothian||Installation of electrical supply voltage optimiser technology to reduce electricity and operating costs by reducing incoming power to more accurately match the electrical loading of the equipment on site thus reducing the carbon foot print.||Savings in electrical energy consumption were expected to be between 9 – 12%.||SAFR 2011|
|NHS Board||Best Practice||Benefits||SAFR Year|
|IM&T & eHealth|
|NHS Lothian||NHS Lothian was one of the first Boards to introduce a single ‘cradle to grave’ electronic patient records system in Scotland incorporating ‘Fairwarning Privacy Surveillence Solution’. This covered approximately 850,000 patients and 1.3m records. Part of this initiative was to encrypt all 4000 laptops and USB devices in order to prevent data loss.||This was part of the drive to prevent security breaches and data loss, and thus be able to provide assurance to patients that their data was in safe hands.||SAFR 2013|
|NHS Forth Valley||NHS Forth Valley was one of the leading NHS Boards in introducing electronic bed management into the hospital ward environment through its eWard system.||It provides medicines reconciliation on admission and discharge which improves patient safety and streamlines patient discharge medication and thus minimising delays to discharge. The bed management module improves the management of hospital capacity and discharge planning, thus removing the need for ‘floor walking’.||SAFR 2012|
|NHS Lothian||NHS Lothian expanded a pilot study in 2012 to create a centralised transport hub to coordinate all inpatient transport needs.||This resulted in all transport resources being used more efficiently and there is now stricter control over the booking of private ambulances.||SAFR 2014|
|Resource Efficient Scotland and the Scottish Futures Trust (SFT)||These two organisations are jointly delivering a project to work with various public sector organisations in Scotland who are in the process of decommissioning buildings, to understand the options available for re-use and redeployment of mobile assets.||Anticipated benefits include improved data on volume, tonnage and cost of the disposal of mobile assets within the public sector, and to enable better decisions to be made on the potential for re-use or redeployment of these assets rather than disposal.||SAFR 2014|