Keeping Patients Closer to Home at Lancashire Teaching Hospitals

How a simple “Days Kept Away From Home” metric and a people‑led productivity approach helped Lancashire Teaching Hospitals reduce unnecessary hospital days and improve patient flow. 

The situation 

The Urgent and Emergency Care workstream at Lancashire Teaching Hospitals NHS Foundation Trust knew patients were spending too long in hospital when they could be safely at home. Extended stays, inconsistent escalation during periods of site pressure and limited real‑time data were all affecting patient flow and operational decision‑making. After an operational reset week focused on reducing days kept away from home, the Trust wanted to consolidate learning and turn it into sustained improvement. 

Over 70 multidisciplinary colleagues from across the Trust came together in an interactive workshop to reflect on the reset week. The aim was to strengthen connections, encourage creative collaboration and translate insight into practical action on keeping patients closer to home. 

The solution 

The team used the Modern Productive Series approach to frame this as a people‑led productivity challenge. They introduced a “Days Kept Away From Home” metric to monitor and reduce unnecessary hospital days, focusing on earlier safe discharge and preventing avoidable admissions. Site pressure meetings were redesigned to be more action‑oriented, with clearer escalation triggers, multidisciplinary participation and a shared focus on patient flow. 

A simple site pressure scorecard was developed to provide real‑time visibility of key indicators such as ED waits, bed occupancy and delayed discharges. This helped colleagues move from reactive firefighting to more proactive, data‑informed decisions. Alongside this, the Trust used the Modern Productive toolkit in a large community of practice session to build ownership and capability around the new way of working. 

Frontline leaders, working in pairs or small groups, used Connecting Conversation cards to explore the productivity factors that mattered most during the reset week and to surface themes linked to days kept away from home. This created open, psychologically safe dialogue and collective ownership of focused improvement plans, with at least 30 structured conversations taking place. 

Small multidisciplinary groups then used a crowd‑sourcing liberating structure (25/10) to generate and prioritise the best ideas to reduce days kept away from home. To turn ideas into action, teams used Stephen Covey’s three circles of control to clarify what they could control, influence or not control. Each frontline leader identified small, practical “15% solutions” they could start immediately, promoting individual ownership. 

The impact 

Early results show a reduction in the average number of days patients spend away from home in the medicine division, driven by more pathway 1 discharges and fewer pathway 2 discharges through improved discharge planning and fewer avoidable admissions. During the reset week starting 20 October, patients not meeting criteria to reside fell from 85 (479 total bed days) on Monday to 75 (298 total bed days) on Friday – a reduction of 181 days kept away from home in just one week. On one day, the team achieved 38 discharges for patients with complex needs. 

Staff report that revised site pressure meetings are more focused, with clearer accountability and faster escalation of issues. The scorecard has helped teams anticipate and respond to operational pressures earlier, reducing bottlenecks and improving flow through the hospital. 

The community of practice session created a noticeable “buzz”: music, movement and lively exchanges fuelled connection, creativity and collective ownership of the top ideas. The spread of themes from the connecting conversations showed a shared goal – reducing days kept away from home – but also highlighted the unique insight each frontline leader brought. 

The 15% solutions led to individual commitments across themes such as: 

- Early and proactive discharge planning   

- Better MDT collaboration   

- Stronger communication and information sharing   

- Preventing deconditioning and promoting function   

- Family and patient engagement   

- Clinical process and workflow improvements   

- Education and culture change   

- Quality and audit 

Rapid insight from the event was captured and shared with senior leaders to inform operational action planning and align with the Trust’s Single Improvement Plan. 

“It opened up rivers of MDT conversation on a challenging topic in a way that created hope rather than fatigue.” – Jen Carroll, Continuous Improvement Clinical Fellow 

What difference this made overall 

Using the Modern Productive Series toolkit in this way enhanced agency, safety and a sense of community among frontline leaders in a way the Trust had not previously achieved. Focusing on connection and humility helped generate concrete change ideas, not just abstract discussion, and supported more effective use of existing quality improvement methods through authentic engagement. Senior and executive leaders participated as equal partners, signalling that all contributions were valued and helping to ensure ideas were translated into practical next steps. 

The Trust now plans to build on this momentum by prioritising the approach within existing forums where frontline leaders meet and embedding it into future community of practice events. The positive “charge” in and around the room showed what is possible when real‑time data, patient‑centred measures and people‑led productivity tools are brought together to improve flow and keep patients closer to home. Find out more:

• Download case study poster. 

• Lancs Improvement Method – the local improvement framework underpinning this work, aligning Model for Improvement thinking (aims, measures, change ideas) with frontline ownership. 

What next – advice for others 

Co‑design escalation processes with frontline teams so they are practical, understood and trusted in real time

​Use real‑time, visual data to drive decisions – even a simple scorecard can change the quality and pace of operational conversations. 

Anchor improvement around patient‑centred measures, like days kept away from home, to keep everyone focused on what matters most. 

Create a community of practice where frontline and senior leaders work as equals, using tools such as connecting conversations, 25/10 and circles of control to surface ideas and turn them into practical next steps. 

Revisit progress regularly in existing forums, so learning from one reset week or workshop continues to shape how you run flow, discharge and escalation in day‑to‑day practice.