Chapter 1 Executive Summary
The evolution of our healthcare systems over time has led to them becoming highly complex, with resources being shared between processes for expediency's sake to meet ever tougher patient expectations about the service they receive.
Only when we stand back from the day-to-day fire-fighting can we see that there is inherent variation in our processes and that by failing to eliminate these sources of variation we are failing to make our processes high quality, repeatable and safe. At the same time, what we also see is our teams trying to deliver services via the existing processes and systems, often through working increasingly harder and longer rather than smarter.
Consequently, our current healthcare systems often exhibit complexity and fragmentation with discreet silos of information (and treatment), controlled by separate entities with the patient left adrift feeling frustrated and dissatisfied. Organisations that are performing poorly are characterised by pushing patients through poor systems that exhibit the following characteristics:
- poorly quantified capacity and demand, often exhibiting carve out rather than planned capacity for the appropriate demand on services;
- waiting list initiatives to clear backlogs without redesign of the process;
- poor scheduling of appointments and resources with a focus on reactive counting of activity rather than proactive patient management;
- overly complex pathways and lack of consistency in systems;
- a lack of ownership and control of patients pathways;
- a lack of subsequent management of patients once they are on their pathway;
- few defined processes and/or standard working and no knowledge of pathway and/or process overlaps;
- tracking of patients on top of ineffective pathways that have not been reviewed or redesigned;
- elements of the pathway dependent upon a single person with no cross over or contingencies for absence, sometimes with the wrong person undertaking the wrong task.
The problems of delayed feedback and poor booking, administration, management and information systems, mean we often find out too late about problems in the system to take effective action. The combined effect of all these factors is poor patient flow which in turn affects quality of care, safety, patient and staff satisfaction and effective utilisation of resources.
Planned Care provision is difficult and complex. It involves community and hospital care and back again, it can cross interagency boundaries and it can also involve the independent healthcare sector. The importance of getting the flow of patients right across the whole system cannot be overstated, and whilst at times the task may seem daunting, there are certain things that we can do to make a difference.
The National Framework for Service Change outlined in "Building a Health Service Fit for the Future" published in 2005, has formed the cornerstone of subsequent plans to make sustainable improvements in the provision of healthcare to meet the changing needs of Scotland. Within that framework there are 3 key areas identified as needing clear action within Planned Care:
- Improving pre-admission processes;
- Streamlining the hospital component;
- Identifying and rolling out best practice on discharge and after care.
This document provides guidance on designing and optimising health care systems to improve Patient FLOW and subsequently focuses on three simple high impact changes that form a solid base for improvement activities across Planned Care in Scotland.
- to actively manage admissions to hospital;
- to actively manage discharge and length of stay;
- to actively manage follow-up.
The improvement of patient FLOWS can be successfully achieved by engaging local authorities and NHSScotland stakeholders, to engage fully in the patient journey and will result in:
- Improved patient outcomes and improved service quality;
- Reduced time that patients stay in hospital, improving patient experience and freeing up inpatient capacity;
- Reduced Do Not Attends, improved resource utilisation and improved overall value for money;
- Improved discharge pathways and reduced variation in length of stay;
- Improved appropriateness of care - to make sure that patients get the right treatment, from the right professional, in the right place, at the right time.