Whole system flow is the coordination of all systems and resources, across a health and social...
This report summarises the findings of the independent evaluation of the 1000 Lives Improvement Patient Flow programme. The programme was implemented between 2013 and 2015.
The report highlights the challenges of delivering a national programme aimed at improving the flow of unscheduled care of patients. Overall there were some positive results achieved but the programme activities were not implemented at the scale and pace originally envisaged.
Key findings include:
- The programme resulted in pockets of improvement across six local health boards. The most sustained improvement was achieved across one local health board. It ensured that local ownership and commitment to its pre-existing work on patient flow was maintained and used the national programme as further support.
- There was a mismatch between the programme’s ambitions and its design, timescale and resources. A two-year time scale was not sufficient to achieve change at system level and the programme didn’t have the resources required for such a large-scale initiative.
- There was significant variation in programme engagement and leadership support across local health boards. Some local health boards experienced a lack of clarity on responsibility for leading, reporting on and owning the programme and local projects.
- Many of the projects were not clearly aligned with the strategic objectives of the local health boards. This meant it was difficult to secure the necessary support from management at every level to deliver sustained results.
- For a national programme, local ownership of projects needs to be balanced with clear national programme coordination, focused on achieving the overarching goal that is aligned with national policy.
- End-to-end design is essential to avoid a series of fragmented projects that are unlikely to achieve the desired improvements along the pathways.
- There was insufficient capacity and expertise for the high quality data collection and analysis needed to interpret data and use it to design interventions to improve patient flow.
- Changes in personnel at every level in the organisations involved made implementation challenging.
The programme evaluation was commissioned by the Health Foundation and carried out by the Centre for Systems Studies at Hull University Business School. The programme was led by 1000 Lives Improvement.