Edge Talks November 2016: Fixing Patient Flow

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Fixing flowSasha KarakusevicFriday 4th November 2016 at 9.30am BST

@theEdgeNHS | #EdgeTalks

Joining in today and beyondPlease use the chat box to contribute continuously during the web seminar

Please tweet using hashtag #EdgeTalks and the handle @School4Radicals @theEdgeNHS

Send a request to join our Facebook group School for Health and Care Radicals and The Edge NHS

The Team TodayTwitter and Chat Room MonitorDom Cushnan@DomCushnan

Session ChairJanet Wildman@Jwildman1

Our Presenter

Sasha Karakusevic @karas01

Todays discussionKey points from my recent Nuffield Trust reportDecision making in complex environmentsWhat to do when the data doesnt fit

Are you stuck?Wasjig Cone-gestion

How different are the achievers?

Stand back to see the big picture

Flow depends onLinking: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 arent matched

Which line would you like to change?Which line can you change?

Leading to congestion

Fixing flowMeasure and manageTransformAvoid

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?

SolutionsStart 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 DirectiveDay surgeryAdmission on the day of surgery12 hour shiftsChanges in general practiceProtected meal timesPressure 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 doesnt 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 conclusionThe environment is changing rapidly with an increasingly large elderly and complex populationResources are not available to tackle this new demand on a business as usual basisThere 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 Fillinghamm

Dr Peter Thomond

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