Improving whole system flow? The prize is too important to ignore

It was when I read Gerard’s story that the importance of getting flow right really hit home to me. Gerard, a patient at South Warwickshire NHS Foundation Trust a few years ago, had no complaints at all about the quality of care he got after he was admitted to hospital. What bothered him was the way in which his care was organised. He’d been in hospital for eight days but only a fraction of that time had been spent on care that genuinely added value.

It’s a story that most people who’ve been to hospital, as a patient or relative, will recognise. Great treatment, fantastic commitment from staff, but sometimes the process itself feels a bit uneven or disjointed. It’s not always clear what will happen next, when it will happen, or what you should do in the meantime. 

For South Warwickshire, and the team behind our Flow Cost Quality project, Gerard’s story proved pivotal in building the will for change within the Trust by shining a light on the human cost of poor flow. For me, his story made it clear that improving flow is about so much more than just making systems and processes more efficient and less wasteful.

South Warwickshire and our other Flow Cost Quality site, Sheffield Teaching Hospitals NHS Foundation Trust, have achieved a great deal since the programme got underway in 2010. As well delivering sustained reductions in length of stay, bed occupancy and readmissions, they’ve made a real difference to the experience of patients and service users.

But poor flow isn’t just an acute problem. It’s a challenge that affects every single service and organisation within a health and social care economy. What’s more, it’s only by working collaboratively that the biggest gains will be achieved. Despite this potential, it seems that very few projects have ever attempted to improve flow across multiple organisations or professional boundaries. The challenge of bridging the entrenched cultural differences between professions and bringing together organisations that have often been governed, funded, inspected and regulated in isolation has simply been too difficult or too daunting for most.

Yet this is exactly the kind of challenge that local health and social care economy leaders across the UK – such as those driving Sustainability and Transformation Plans (STPs) in England, and Health and Social Care Partnerships in Scotland – are now facing. Our new report, The challenge and potential of whole system flow, has been written with this in mind. It argues that a focus on improving flow within and between services can help local leaders unblock some of the infrastructural and relational barriers that may hamper the work of STPs and other efforts to drive change across health and social care economies.

In my view the starting point – and the thread that connects all flow improvement-related activities – has to be patients and service users. Not only are they well placed to identify where the waste and duplication lies in the system, but focusing squarely on their needs and aspirations is crucial in helping to get the buy in of teams working at the front line – as South Warwickshire found out.  

Our report also describes the key areas that leaders of local health and social care economies need to address collectively in order to drive change. It makes the point that an integrated approach is required; one that encompasses both the harder edged enablers of change (such as workforce, IT and financial and contractual mechanisms) and also softer (but hardly easier) enablers including leadership, culture and governance.

Bringing all of this together into a coherent whole will be an immense task. We do not underestimate the difficulties involved, even in the best equipped and most motivated of local health and social care economies. It will require vision, determination, resilience and a significant degree of both humility and curiosity. However, the prize – in terms of better quality of care, better health and better use of increasingly scarce resources – is too large, and too important, to ignore.

Bryan Jones is an Improvement Fellow at the Health Foundation