Overview
Poor systems deliver poor results – for patients, NHS staff and taxpayers.
The aim of this programme is to understand the relationship between patient flow, cost and quality. Until now a common assumption in the NHS has been that more cost is required to improve patient flow and healthcare quality. However it can be argued that , so far, increases in cost have not resulted in proportionate improvements in access to or quality of care.
The root cause of the delays in the existing system lies in the planning process. Capacity plans are based on average levels of past activity (ie patients seen), not on the demand (ie the requests for care). The mismatches between the daily variations in demand and staff capacity result in queues and waiting lists at every stage along the patient’s pathway of care – the very queues that managers are being asked to eliminate.
When waiting time targets are missed, managers respond by implementing short-term, expensive ‘fixes’ – overtime, agency and private sector provision. Not only are these short-term fixes expensive, they have negative knock-on effects elsewhere on quality of care. For example, opening wards to ‘store’ patients over bank holidays requires having nurses available to care for a greater number of patients. This contributes to a crisis management culture, with poor-quality care, dissatisfied patients, and staff who are ‘fire fighting’ on a daily basis.
What are we doing?
We are supporting a three-year programme (April 2009 to March 2012) to provide statistically valid evidence about improving the relationship between patient flow, quality, and costs. The participating organisations are South Warwickshire NHS Foundation Trust and Sheffield Teaching Hospitals NHS Foundation Trust.
What will the programme involve?
Kate Silvester, the programme coach, will work closely with dedicated teams at both sites, delivering structured training sessions and coaching. The teams will be supported to:
- understand the emergency care pathway and how it relates to the wider healthcare system
- understand demand being placed on every organisation and department from all sources (emergency, planned, outpatient and follow-up care)
- develop capacity plans to meet the variations in demand and prevent queues
- assess the gap between current and required capacity
- test the impact of changes to capacity by reducing the capacity variations, improving productivity, reallocating resources or recruiting more resources.
There will be measures in place to monitor improvements in patient flow, cost and quality at board level. A number of key decisions will then need to be made before embarking on permanent changes to the system.
The support provided by the Health Foundation covers:
- The programme of activities and support designed and delivered for us by Kate Silvester. This covers the running of structured training sessions and expert coaching at each site, as well as quarterly sponsors’ meetings.
- Direct funding to each participating organisation to contribute towards programme staff time for dedicated activities.