This learning report describes the work undertaken by two NHS trusts as part of the Health Foundation’s Flow Cost Quality programme. It illustrates the problems created by poor flow that the programme was set up to address, and provides practical examples of how focusing on flow can improve quality, use available capacity effectively and save money. The report summarises key lessons from the programme and highlights important challenges for designing services and approaching change by focusing on flow.

Download Improving patient flow.

Flow Cost Quality ran in two NHS hospital trusts: South Warwickshire NHS Foundation Trust and Sheffield Teaching Hospitals NHS Foundation Trust. South Warwickshire looked at the emergency flow for all adult patients, while Sheffield focused on one clinical subspecialty – geriatric medicine. The case studies that accompany the report provide more details of the work done by each of the trusts.

Each trust brought its own context, culture, challenges and opportunities to the programme. Their experiences have provided rich learning about the relationships between flow, cost and quality, and about managing large-scale change within a complex system.

The Flow Cost Quality programme builds on, and contributes to, a growing body of work on improving flow. This report includes an appendix of other programmes that have aimed to improve flow, as well as suggestions of further reading.

Case studies

Two case studies accompany this learning report. They give more details about the work done by each of the trusts and the impact the programme has had. The case studies are:

Further reading

Flow Cost Quality

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 st...


The story of Flow, Cost, Quality in Sheffield

This video shows how a multidisciplinary team have adopted a 'big room' approach to address the relationship between patient flow, cost and the quality of care within Sheffield Teaching Hospitals N...