Care Design 2016

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#4 Focus on flow

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Our fourth proposed redesign principle is to focus on flow by aligning the different parts of the system and the pace at which they work e.g.

  • Demand-led rather than supply-led transformation
  • Match capacity to demand on an on-going basis
  • Do today’s work today
  • Separate different types of process flow from each other
  • Segment patient flows by common needs e.g. grouping by throughput times, enabling continuity of flow and economies of repetition
  • Provide access to senior decision makers as early as possible in the process
  • Focus on interfaces, the transmission of information and standardisation of processes, equipment, communication etc.
  • Move to more seven day and extended hour working


This is what we think, how about you?

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  1. David Parker
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This is a really practical and logical principle. The only thing I would add is that I think we should be making more use of the fixed points in the system to base the sizing of our models around. For example, if we have to create an A&E department then it has to have a certain number of staff to be open for the required hours and to meet the standards required to manage the case mix it would be expected to receive, no matter how many patients flow through it. Could we create better...

Wendy Lane
by Wendy Lane
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Wendy Lane

To call out that people need access to senior decision makers implies that people are not empowered to make their own decisions. It is suggests that people need to have meetings to inform people to inform others who can then make decisions. I suspect that there are multiple layers of people who need to be informed.  The most successful teams are small, multidisciplinary where skills come together, are respected and also empowered to make decisions themselves.  This autonomy leads to a nimble...

Keith wart
by Keith wart
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Keith wart

Aside from systems and processes, a shift into a recovery/rehab mindset ensures discharge planning at the outset  will improve flow - important for those with life-long conditions who will need episodic support, but can be supported to greater levels of independent problem solving, with a greater emphasis on person-centred planning, supporting self-management, and shift away from paternalistic practices

Caroline Poole
by Caroline Poole
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Caroline Poole

flow is important, I would enhance this principle by asking people to consider that flow shouldn't be totally target driven and should pay heed to balance and the ecology of the whole system. example of where it went wrong for us is that flow was deemed important in our health economy therefore system redesigned to ensure patient flow but because of targets (A&E 4 hour wait) ended up with the crazy situation where people value flow out of the hospital above all else.....pulling teams...

Debbie Westwood
by Debbie Westwood
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Debbie Westwood

Focusing on flow changes people's whole perspectives and in my experience is a great way of aligning disparate groups across functions and silos, getting them to focus on the same thing, and an really accessible entry point to genuine whole systems thinking. People didn't know what integrated care meant - horizontally? Vertically? geographically? organisationally? who knew? But flow enables focus. Flow begs the question - what's flowing? And why? And from there means there must be a purpose...

Candy Perry
by Candy Perry
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Candy Perry
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Totally agree with this design principle.  My only comment would be that we need to look at flow from the beginning to the end of a patient journey.  Lots of departments and organisations focus on the flow within their boundaries - forgetting about the waits, delays and duplication that happens between the departments and organisations.  I'm forever hearing... "why don't they talk to each other?" "I've told them this information before"... therefore it would be great if this principle was...

Zoe Lord
by Zoe Lord
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Zoe Lord

Interfaces, communication and demand management The problem with waiting rooms in AED is that they are full of patients sitting round waiting. We can either put patients off attending AED or we can embrace the tide and redesign the system. If a patient could find out the current AED waiting times and "book themselves in" before they head off to AED, the time they wait in the waiting room could (in theory) be reduced by their travel time. It could also help departments manage demand by...

David Parker
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David Parker
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On 24.9.15, Helen Bevan visited AQuA's Leading Transformational Change Programme to lead a masterclass on 'Engagement for Transformation.' Helen asked the delegates to look at the ten draft redesign principles and give their feedback. Here is what they said about this fourth principle 'Focus on flow'... "Flow - push vs pull. Understanding interdependencies between services (including reliance)" ""Segment patient flows" - does this mean process mapping / pathways?" "Seem at...

Care Design 2016
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Care Design 2016
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Care Design 2016 (Admin)

I really like this design principle because its entirely logical and begs the thought 'why wouldn't you do this'? It's grounded in evidence and draws on the experience of successful sustainable improvements undertaken and does make a big visible impact if successfully implemented. My only query would be: 1. About matching demand to supply on an ongoing basis. This suggests quite a 'current state' approach whereas I think it's also about looking to future demand. Whilst we can never...

Hannah Wall
by Hannah Wall
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