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’.

1. @theEdgeNHS | #EdgeTalks
Fixing flow
Sasha Karakusevic
Friday 4th November 2016 at 9.30am
BST

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. The Team Today
Twitter and Chat
Room Monitor
Dom Cushnan
@DomCushnan
Session Chair
Janet Wildman
@Jwildman1

4. Our Presenter
Sasha Karakusevic
@karas01

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. Are you stuck?
Wasjig “ Cone-gestion”

8. How different are the achievers?

9. Stand back to see the big picture

10. 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

11. Population change

12. Mind the gap

13. Demand and capacity aren’t
matched
Which line would you like to change?
Which line can you change?

14. Leading to congestion

15. Fixing flow
•Measure and
manage
•Transform
•Avoid

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

17. 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?

18. Queues build up rapidly if supply
and demand are not matched
Almost 2
hours
waiting
time is
added to
arrivals in
the early
evening

19. Does your bed change team look
like this?

20. 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

21. 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

22. 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

23. Re-thinking long stay
More patients appear to leave hospital to residential
and nursing care.

24. Decision making in a complex
environment
Listen very carefully to stories
Put the elements together
Adopt a structured and non-
hierarchical approach

25. 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

26. Lasted news

27. 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

28. Time to remove the
blockages

29. Next EdgeTalk Session
Empowering people to be heard and
helping leaders to listen
Creating the #AHPsMandate
Dr Joanne FillinghammDr Peter Thomond