Leeds Teaching Hospitals NHS Trust discovered a significant budget shortfall and had to act fast. The financial picture would only get worse unless they reduced spending.
The Trust mounted an unprecedented response in record time, rallying 800 staff to come up with solutions in a massive, coordinated improvement workshop.
The results were phenomenal — saving millions of pounds with a variety of updates to staffing and scheduling practices. And the Trust proved it was up to any challenge, no matter how large.
“Our people, our culture and our methods came through for us in the most impressive and inspiring ways. When you invest in those components completely, it pays off a thousandfold,”
— Professor Phil Wood, Chief Executive at the Trust.
Leeds Teaching Hospitals NHS Trust (Leeds) employs 22,000 staff across 5 locations in central England. Staff are united by a rich culture of collaboration and empowerment, known as the Leeds Way. They also utilize a single management system, called the Leeds Improvement Method, that mobilizes all staff in pursuit of daily excellence and improvement. Leeds developed and continues to evolve the system under the guidance of the Virginia Mason Institute, which has partnered with the Trust for years on building improvement capability and capacity based on the management system used at Virginia Mason Francsican Health, in the U.S.
In April 2024, executives at Leeds discovered that spending for the first month of their new fiscal year was £8M over budget. If that trend continued, the organization would end the year in dire straits, with risks to workforce, financial autonomy and its ambition for a new hospital.
Executives resolved to address it right away. Financial sustainability is entrenched among the Trust’s 7 commitments for the year, as well as its multi-year goals.
To find solutions quickly, they turned to the system that saw them through the COVID pandemic and helped them resolve countless challenges since then: the Leeds Improvement Method.
The Trust had never used their improvement method to address a challenge like their budget shortfall. Improvement workshops were typically geared toward hyperlocal clinical or operational issues, such as avoiding falls in a single recovery ward. Now they were taking on a financial challenge, which spanned the entire organization.
But executives were committed. From the beginning, the Virginia Mason Institute had insisted that Leeds fully own their improvement method, rather than duplicating the model provided by the Institute. And the method is powered by a spirit of “give it a try,” so that’s exactly what they did.
In fact, the Trust’s improvement office kicked off a workshop less than 2 weeks after executives gave them the assignment. This lead time was 3 to 4 times shorter than they take to develop standard workshops — which are much smaller and less complex.
“It was a sprint, for sure. But we understood the urgency and the need to adapt our typical approach. We couldn’t afford to wait,” says Jimmy Parvin, Professional Lead for the Leeds Improvement Method.
The workshop itself lasted one week and focused on lowering variable pay — wages for outside staff who are brought in to fill short- and long-term scheduling gaps. Variable pay was a large component of the total overspend, touching all 19 clinical service units (CSUs) in the organization. The workshop gave each CSU the chance to lower spending on variable pay by finding new ways to avoid staffing gaps and clarifying which gaps need to be covered by outside personnel.
To manage a workshop of this size, Parvin and team made two key choices:
The workshop was focused on finance, but the improvement leads made sure they kept patients in view at the same time. Each day, they reviewed safety incident reports to see whether staffing changes attempted during the workshop had an adverse effect on the delivery of care.
“In the end, financial sustainability is about patients too. We can’t deliver high-quality care if we run out of money,” says Mike Harvey, Director of Transformation at Leeds.
More than 800 staff across the 19 CSUs contributed to the effort. They included people at all levels and across a full range of clinical and non-clinical roles.
Teams meticulously studied their current variable pay spending and the processes behind how they covered shifts. Then they experimented with new processes and staffing options that reduced the dependence on variable-pay workers — whilst ensuring patient safety and quality of care were not compromised.
They found substantial room for improvement, including:
Overall, the week-long effort revealed that variable pay had been overused out of habit rather than because of formal practices. The hospital system is so large, and patient needs are so demanding, limiting this expenditure simply wasn’t a priority — until it had to be.
“We set up rules and parameters where decisions were previously ad hoc. It’s nothing too creative, but the difference is night and day,” says Keeley Townend, General Manager of the Oncology CSU.
Assembled in under 2 weeks, with 40 times as many people as the standard improvement event, this one was far from easy.
But the people of Leeds Teaching Hospitals Trust met the challenge and then some.
Leeds had never done something like this before, but their willingness to “give it a try” paid off immensely.
Mike Harvey, the Director of Transformation, says the experience reminded him of how the Trust responded to COVID:
“Everyone coming together, meeting the urgency of the moment with bravery and open-mindedness … It’s good to remember that we have that in us.”
Why train with Virginia Mason Institute?
- Immediate results — Our training programs focus on creating immediate results while supporting broader changes that systematize and sustain learning and improvement.
- Personalized coaching — 1-on-1 virtual coaching and feedback helps students apply new tools in real time.
- Intimate cohorts emphasize peer-to-peer learning — Small cohorts in a virtual setting spark group interaction and expand networking opportunities.