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Edge Talks November 2016: Fixing Patient Flow


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Identifying the needs of any given population and creating the capacity to manage is increasingly challenging. The origins of today’s problems can be traced back to a failure to recognise the pace of change and to respond quickly enough with new ideas and processes. Creating a clear understanding of what is happening provides a basis for measuring the effectiveness of innovation and transformation.

In November’s #EdgeTalks Sasha Karakusevic, Horizons’ Project Director will offer an overview of hissasha Nuffield publication ‘Understanding patient flow in hospitals’, and a reflection on the use of data to drive change in complex systems. Sasha started his career in dentistry and maxillofacial surgery. Early in his career he became very interested in service improvement and health system design, focusing on the systems and processes that drive innovation and improvement. He has extensive interest and experience gained nationally and internationally in using information to drive improvement and make health systems work better”

This session is a must for anyone working in, or interested in health and social care. Participants will learn how to use data to better understand patient flow, manage demand – and engage people in translating data in to a meaningful narrative to drive transformation ‘on the ground’.

Published in: Healthcare
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Edge Talks November 2016: Fixing Patient Flow

  1. 1. @theEdgeNHS | #EdgeTalks Fixing flow Sasha Karakusevic Friday 4th November 2016 at 9.30am BST
  2. 2. Joining in today and beyond • Please use the chat box to contribute continuously during the web seminar • Please tweet using hashtag #EdgeTalks and the handle @School4Radicals @theEdgeNHS • Send a request to join our Facebook group School for Health and Care Radicals and The Edge NHS
  3. 3. The Team Today Twitter and Chat Room Monitor Dom Cushnan @DomCushnan Session Chair Janet Wildman @Jwildman1
  4. 4. Our Presenter Sasha Karakusevic @karas01
  5. 5. Today’s discussion • Key points from my recent Nuffield Trust report • Decision making in complex environments • What to do when the data doesn’t fit
  6. 6. Are you stuck? Wasjig “ Cone-gestion”
  7. 7. How different are the achievers?
  8. 8. Stand back to see the big picture
  9. 9. Flow depends on Linking: Defined population Appropriate capacity An efficient process Source: Sara Adi Kreindler BMJ Qual Saf 2016 doi:10.1136/bmjqs-2016- 005438
  10. 10. Population change
  11. 11. Mind the gap
  12. 12. Demand and capacity aren’t matched Which line would you like to change? Which line can you change?
  13. 13. Leading to congestion
  14. 14. Fixing flow •Measure and manage •Transform •Avoid
  15. 15. Measure Midnight is not a good time to measure operational demand in the modern hospital
  16. 16. Peak occupancy and peak flow Peak occupancy occurs in the morning but peak flow occurs between 2 and 7 pm Can your systems keep up? Where are the constraints?
  17. 17. Queues build up rapidly if supply and demand are not matched Almost 2 hours waiting time is added to arrivals in the early evening
  18. 18. Does your bed change team look like this?
  19. 19. Solutions • Start with what you have got • Actively involve support services • Is your control and command centre set up for the volume of activity? • Move to real time data
  20. 20. Managing demand 58% of patients are treated through 10% of the used space This group has grown by 17% over the 6 years to 2014/15
  21. 21. How easy is it to reverse the changes that got us here? • European Working Time Directive • Day surgery • Admission on the day of surgery • 12 hour shifts • Changes in general practice • Protected meal times • Pressure on medicine (especially) • Changes in social care
  22. 22. Re-thinking long stay More patients appear to leave hospital to residential and nursing care.
  23. 23. Decision making in a complex environment Listen very carefully to stories Put the elements together Adopt a structured and non- hierarchical approach
  24. 24. When the data doesn’t fit Check the data and the reliability of the existing system (Head) Use your intuition (Gut) Listen carefully to what people are saying Remember your values (Heart) Unless there is an error in the data it is likely there is a change in the environment that will need new thinking and new approaches to resolve
  25. 25. Lasted news
  26. 26. In conclusion • The environment is changing rapidly with an increasingly large elderly and complex population • Resources are not available to tackle this new demand on a business as usual basis • There are opportunities to manage flow better and redesign systems to expand care out of hospital
  27. 27. Time to remove the blockages
  28. 28. Next EdgeTalk Session Empowering people to be heard and helping leaders to listen Creating the #AHPsMandate Dr Joanne FillinghammDr Peter Thomond