@theEdgeNHS | #EdgeTalks

Fixing flow

Sasha Karakusevic

Friday 4th November 2016 at 9.30am BST

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The Team Today

Twitter and Chat Room MonitorDom Cushnan@DomCushnan

Session ChairJanet Wildman@Jwildman1

Our Presenter

Sasha Karakusevic @karas01

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

Are you stuck?

Wasjig “ Cone-gestion”

How different are the achievers?

Stand back to see the big picture

Flow depends on

Linking:Defined populationAppropriate capacityAn efficient process

Source: Sara Adi Kreindler BMJ Qual Saf 2016 doi:10.1136/bmjqs-2016-005438

Population change

Mind the gap

Demand and capacity aren’t matched

Which line would you like to change?Which line can you change?

Leading to congestion

Fixing flow

•Measure and manage•Transform•Avoid

Measure

Midnight is not a good time to measure operational demand in the modern hospital

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?

Queues build up rapidly if supply and demand are not matched

Almost 2 hours waiting time is added to arrivals in the early evening

Does your bed change team look like this?

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

Managing demand

58% of patients are treated through 10% of the used spaceThis group has grown by 17% over the 6 years to 2014/15

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

Re-thinking long stay

More patients appear to leave hospital to residential and nursing care.

Decision making in a complex environment

Listen very carefully to storiesPut the elements togetherAdopt a structured and non-hierarchical approach

When the data doesn’t fitCheck the data and the reliability of the existing system (Head)Use your intuition (Gut)Listen carefully to what people are sayingRemember 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

Lasted news

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

Time to remove the blockages

Next EdgeTalk SessionEmpowering people to be heard and helping leaders to listenCreating the #AHPsMandate

Dr Joanne FillinghammDr Peter Thomond