• Focused on the relationship between patient flow, costs and outcomes.
  • Two hospital trusts participated: South Warwickshire NHS Foundation Trust and Sheffield Teaching Hospitals NHS Foundation Trust.
  • Work started in April 2010.

Flow Cost Quality looked at the emerging relationship between poorly managed patient flow through a hospital and the wider health care system and the outcomes of care as measured by a hospital’s standardised mortality rate (HSMR). By managing flow more effectively, the programme aimed to improve patient safety and reduce costs.

 

 

Participating teams were supported to:

  • understand the emergency care pathway and how it relates to the wider health care 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
  • test the impact of changes to capacity by reducing the capacity variations, improving productivity, and reallocating resources.

Both sites found that patient flow slows as a result of changes in capacity rather than changes in demand. A key problem was a persistent mismatch between the predictable variations in emergency demand and the availability of workforce capacity.

At one site, two-thirds of daily demand had to be ‘stored’ overnight during weekdays and reworked on subsequent days, wasting resources and causing stress to staff and patients. At weekends, two days’ worth of patients had to be ‘stored’ until Monday. Mapping a patient’s journey revealed that 83% of the resources were wasted in this way. The situation was worse during public holidays.

A further conclusion was that because current understanding of system flow is limited, problems in one department are seen as a problem in that department, so performance management measures fail to change overall system performance. For example, in one hospital the radiology department was unable to produce x-rays quickly enough, causing bottlenecks elsewhere.

The programme established that the data needed to diagnose problems with patient flow was available, but that extracting and analysing it was a problem that needed addressing.