Patient flow back on top of the NHS agenda in 2020
28 February 2020
Nearly 20 years ago the Milburn/Stevens scribed NHS Plan (2000) set out an ambitious journey to reduce the maximum waiting times for elective care from 18 months to 18 weeks. The result was an increase in supply side growth and an influx of new doctors and nurses along with new contractual incentives for providers to generate more activity. Less well remembered, was the fact that many doubted that these targets could even be reached. In the end it required the NHS to rely on the ‘appliance of science’, specifically in regards to the science of ‘patient flow management’.
Drawing on a combination of the skills of industrial productivity techniques, mathematics and capacity planning, and engaging clinical teams in redesign, the NHS was able to achieve this target and by the mid to late noughties 18 weeks was delivered.
Flow management, and the science of improving flow, has never been more important to the NHS management armoury than it is today. Over the last decade the NHS has systematically reduced its bed base in order to capitalise on reductions in lengths of stay so as to live within its constrained financial means. As a consequence, playing catch up on waiting times, or managing the glitches in operational capacity management from unexpected problems, challenges the systems beyond measure. This can mean long lasting patient flow problems with cancellations, outliers, delayed admissions and discharges. More problematically, the NHS has systematically reduced its flow management skills and capability leaving in house capability dangerously thin.
Tackling this is both possible and vital. Award winning North Bristol NHS Trust (NBT), for example, has made a real impact by applying our Perform methodology to work closely with clinical and management teams to change behaviours and improve teaming. The NBT leadership saw Perform as an opportunity to invest in their staff as well as to put data at the heart of decision making at all levels - ward to board. In fact, NBT had previously invested in a digital tool for patient flow management but it was only when combining it with the focus on staff behaviours that it really delivered for the Trust. Until then the site team still had to physically verify which beds were available.
The results have meant improvements in patient experience and significant bed capacity. Specifically:
- significant sustainable reductions (15%) in length of stay which have sustained 18 months on;
- improved technology infrastructure radically improving trust wide performance data, often getting user adoption and data accuracy (90%+);
- stronger governance, reporting and accountabilities around patient flow management;
Patient flow improvement capability at scale, immersing 2,000+ people in active learning, and creating a "can do" culture.
It’s great that there is likely to be more financial headroom available through the government pledge on funding but, it’s not how much we have, but how it’s spent that will count. New workforce and supply side growth is necessary but so too is better management including patient flow.
Applied well, not just in hospitals, but in whole pathways and systems, we will be able to better capitalise on new money and begin to properly deliver integrated care.