The West of England AHSN aims to support improvement in our member organisations. We do this by delivering quality improvement projects and by providing staff and patient training in quality improvement science through our Improvement Academy.
The aim of the Flow Coaching Programme is to develop a group of regional flow experts and create a West of England AHSN Improvement Faculty capable of teaching and training staff in the South West.
The Royal United Hospitals Bath NHS Foundation Trust (RUH) has been selected as the first West of England member organisation to take part in this.
The focus on patient flow has received increasing traction within healthcare, especially in relation to reductions in waiting times for emergency and elective care. With pressure on A&E services and increased awareness of issues such as weekend variation, there is a growing recognition that the health care system requires better coordination and new models of provision.
The Flow methodology provides a comprehensive diagnosis of how the local system is working and where to effectively focus improvement efforts. It aligns well with aspirations in the ‘Five Year View’ as it recognises that improving systems of care is a health system-wide agenda, requiring an end-to-end patient pathway approach across departments and organisations.
The Health Foundation Flow Programme
In 2009, The Health Foundation launched a three-year programme to test the applications of quality improvement science for improving patient flow. It looked at ways in which capacity could be better matched with demand, to prevent queues and poor outcomes for patients. Patient involvement was key to this through understanding experience and mapping journeys.
The programme found that poor flow increases the likelihood of harm to patients and raises healthcare costs by failing to make the best use of skilled staff time. See www.health.org.uk for more detail.
Outcomes of the Flow Programme
The Flow Programme led to measurable improvements in the quality of care, service efficiency and reduction in mortality without requiring additional investment.
Work in Sheffield focused on the redesign of the geriatric medicine emergency pathway. The focus on patient flow has received increasing traction within healthcare, especially in relation to reductions in waiting times for emergency and elective care. With pressure on A&E services and increased awareness of issues such as weekend variation, there is a growing recognition that the health care system requires better coordination and new models of provision. This has achieved reductions in hospital bed occupancy which allowed the directorate to close two wards in 2012, delivering an estimated annual saving of £3.2 million. Average length of stay in geriatric medicine wards has also reduced by around 15%, from 11.6 days in 2006/07 to 9.9 days in 2012/13.
This work has generated widespread interest across the UK and has led to a second phase of the programme, funded by The Health Foundation and delivered by the Sheffield Microsystem Academy.
In addition to the original organisations (South Warwickshire and Sheffield Teaching Hospital Foundation Trust), the programme now includes the West of England Academy (part of the West of England AHSN), extending the reach of this work to our region.
The West of England AHSN Flow Programme
The programme is providing intensive training for six improvement coaches from the RUH to help facilitate improvements in three system-wide pathways.
The first pathways selected by the RUH for improvement are Gynaecology, Frail Elderly, and Biliary. These pathways were chosen as they involve community and hospital settings, focusing on improvement across health systems not just in single organisations. This process acknowledges the need for system collaboration to improve patient flow in order to create more efficient and ‘user friendly’ pathways for patients.
Each pathway has two expert Flow coaches. The Flow coaches have set up an improvement space at the RUH called a ‘Big Room’ for use by each care pathway. Here staff and patients meet regularly, share data and undertake facilitated tests of change.
Flow coaches facilitate teams to understand and assess the flow of their own system. Having identified areas for improvement, the teams are coached to test their ideas. This generates knowledge through iterative testing, using Plan-Do- Study-Act cycles. By undertaking repeated cycles of testing, the ideas of how to improve flow are refined
and evolved. The Flow coaches also use data to show how decisions taken in one organisation can impact on patient flow in another.
Whilst this process is not a quick fix or a ‘magic bullet’, we hope this programme has the potential to
quality improvements in two to three years, equivalent to those delivered through The Health Foundation programme, including improvements in access, length of stay, mortality rates, and cost.
“As a Flow Coach I am learning that our healthcare systems are inseparably connected with the people who operate within the system. We need to work together across the whole care pathway to improve the experience and outcomes for our patients.”
Angela Humphries, Non-elective
Surgical Flow Coach Coordinator, RUH Bath
For more information on the West of England AHSN Flow Programme, contact Anna Burhouse, Director
of Quality: firstname.lastname@example.org.