Interrupted patient flow costs NHS time and money

6 Dec 16
Poor patient flow through the NHS wastes time and money, can hurt patients, and is deeply frustrating for people working in health and care, according to a report from the Health Foundation and the Advancing Quality Alliance.

The Challenge and Potential of Flow is designed to be a guide to help local NHS and social care leaders work together to improve productivity, patient experience and the quality of services.

‘Whole system flow’, is a coordinated approach across organisations that ensures people, information and resources are in the right place at the right time, to reduce bottlenecks, duplication and avoidable waits. It focuses on improving the pathway that patients take through different parts of the NHS and social care system.

A poorly managed flow can result in higher costs, slower patient treatment times, and duplication. The report cites several examples of poor flow, such as ambulances queuing outside hospitals, stretched emergency departments, problems getting a GP appointment and mental health patients transferred hundreds of miles for a bed.

The current health and care context offers a prime opportunity to focus seriously on fixing flow problems, the report states. Providers are under serious financial pressure, with many expected to miss financial targets, while the social care system is deemed to be nearing crisis point.

However, while the benefits of improving whole system flow are significant, in terms of improved productivity, quality of care and overall patient experience, the challenge of improving processes “shouldn’t be underestimated”, the report noted.

The report observed that, because organisations in a given area are governed, funding, inspected and regulated differently, this reinforces cultural differences. This is particularly pronounced in the case of those working in hospitals and those working in community and social services.

The authors call on local and national leaders to give frontline staff the space and time to invest in long-term improvement initiatives and to foster the right skills and culture needed to do so.

David Fillingham, chief executive of the Advancing Quality Alliance, which works to transform and improve health care, said that understanding and improving the flow of people and resources should be a major priority for NHS workers and across the wider health and social care landscape.

He said: “While the report’s findings may not offer the ‘magic bullet’ to solving flow that some may seek, it provides a framework, insight and case studies on how we can work together to tackle this complex challenge, and so secure better outcomes for patients.”

Penny Pereira, deputy director of improvement at the Health Foundation, added: “Getting flow right is critical to the delivery of new service models, improving quality of care and productivity. But it’s the impact it will have on the daily experiences of service users and staff that matters the most.”

However, she cautioned that extending work on flow went beyond quick fixes, and required time and investment. If organisations were able and willing to work together to design flow-optimised services and processes, she said, it could lead to a dramatic improvement in patient and service outcomes.

“It is for these reasons that flow should be top priority,” Pereira concluded.

The report provides a checklist of eight building blocks that need to be in place to improve whole system flow, including good IT and information, effective leadership, and a collaborative approach to redesigning processes.

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