@theEdgeNHS | #EdgeTalks
Fixing flow
Sasha Karakusevic
Friday 4th November 2016 at 9.30am BST
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The Team Today
Twitter and Chat Room MonitorDom Cushnan@DomCushnan
Session ChairJanet Wildman@Jwildman1
Our Presenter
Sasha Karakusevic @karas01
Today’s discussion• Key points from my recent Nuffield
Trust report• Decision making in complex
environments• What to do when the data doesn’t fit
Are you stuck?
Wasjig “ Cone-gestion”
How different are the achievers?
Stand back to see the big picture
Flow depends on
Linking:Defined populationAppropriate capacityAn efficient process
Source: Sara Adi Kreindler BMJ Qual Saf 2016 doi:10.1136/bmjqs-2016-005438
Population change
Mind the gap
Demand and capacity aren’t matched
Which line would you like to change?Which line can you change?
Leading to congestion
Fixing flow
•Measure and manage•Transform•Avoid
Measure
Midnight is not a good time to measure operational demand in the modern hospital
Peak occupancy and peak flow
Peak occupancy occurs in the morning but peak flow occurs between 2 and 7 pm
Can your systems keep up? Where are the constraints?
Queues build up rapidly if supply and demand are not matched
Almost 2 hours waiting time is added to arrivals in the early evening
Does your bed change team look like this?
Solutions• Start with what you have got
• Actively involve support services
• Is your control and command centre set up for the volume of activity?
• Move to real time data
Managing demand
58% of patients are treated through 10% of the used spaceThis group has grown by 17% over the 6 years to 2014/15
How easy is it to reverse the changes that got us here?
• European Working Time Directive• Day surgery• Admission on the day of surgery• 12 hour shifts• Changes in general practice• Protected meal times• Pressure on medicine (especially)• Changes in social care
Re-thinking long stay
More patients appear to leave hospital to residential and nursing care.
Decision making in a complex environment
Listen very carefully to storiesPut the elements togetherAdopt a structured and non-hierarchical approach
When the data doesn’t fitCheck the data and the reliability of the existing system (Head)Use your intuition (Gut)Listen carefully to what people are sayingRemember your values (Heart)
Unless there is an error in the data it is likely there is a change in the environment that will need new thinking and new approaches to resolve
Lasted news
In conclusion• The environment is changing rapidly
with an increasingly large elderly and complex population
• Resources are not available to tackle this new demand on a business as usual basis
• There are opportunities to manage flow better and redesign systems to expand care out of hospital
Time to remove the blockages
Next EdgeTalk SessionEmpowering people to be heard and helping leaders to listenCreating the #AHPsMandate
Dr Joanne FillinghammDr Peter Thomond
