The challenge and potential of whole system flow

The challenge and potential of whole system flow: Improving the flow of people, information and resources across whole health and social care economies. David Fillingham, Bryan Jones, Penny Pereira. The Health Foundation 2016

In all parts of the UK there is an increased emphasis on health and social care organisations working together to tackle the quality and productivity challenges that all systems are facing, and to ensure that care is ‘genuinely coordinated around what people need and want’.

Improving the flow of patients, service users, information and resources within and between health and social care organisations can have a crucial role to play in coordinating care around the needs of patients and service users, and driving up service quality and productivity.

Poor flow is not only a source of significant waste and delay, but it can also be devastating for patients and service users and deeply frustrating for people working in health and social care.Most flow-related initiatives to date have focused on a small segment of the patient or service user journey, usually within hospitals. There is a need to look beyond the hospital and to give attention to every team, service and organisation that patients and service users encounter.

The challenge and potential of whole system flow outlines an organising framework and tested methods that local health and social care leaders can use to improve whole system flow. It draws on case studies and other examples of work in this area from across the UK and internationally.

The report also describes the steps that policymakers and regulators at a national level need to take to create an environment that is conducive to change at this scale.

Frontline pharmacists: making a difference for people with long-term conditions

Royal Pharmaceutical Society, November 2016

Royal Pharmaceutical Society

This report argues the case for community pharmacists being able to routinely prescribe medicines for people with long-term conditions and refer them directly to other health care professionals to ease the overwhelming demand facing the NHS. Currently, the care of people with long term conditions accounts for half of all GP appointments, 64 per cent of outpatient appointments and 70 per cent of all health and social care spending. The report estimates that up to £500 million of extra value could be generated if medicines were used in a more optimal manner in five therapeutic areas: asthma, diabetes, high blood pressure, vascular disease and schizophrenia.

Extended hours in primary care linked to reductions in minor A&E attendances

National Institute for Health Research Signal
Published: Associations between Extending Access to Primary Care and Emergency Department Visits: A Difference-In-Differences Analysis, Whittaker, W.,Anselmi, L.,Kristensen, S. R. PLoS One Volume 13 Issue 9 , 2016

Practices which offered additional appointments showed a reduction in the number of their patients attending emergency departments (also known as A&E) for minor conditions. There was no overall reduction in emergency visits. Costs were reduced for emergency departments but by less than the cost of the additional appointments. The study did not evaluate whether or not this is cost saving to the health service as a whole nor if health outcomes were improved.

Emergency departments are increasingly busy and patients are waiting longer to be treated. Commissioners and providers have been interested in interventions which may help to reduce these hospital pressures.

This NIHR-funded study funded 56 general practices in Manchester to offer extra appointments during evenings and weekends as part of a larger programme to improve primary care. There was a 26.4% relative reduction in “minor” A&E visits (10,933 fewer visits), compared to 469 practices which did not offer additional appointments.

Nationally, policy-makers aim to encourage patients with minor conditions to attend alternative services, including primary care. These findings suggest additional appointments may help reduce minor A&E visits but may be more costly overall.

Shaping healthy cities and economies: the role of clinical commissioning

NHS Clinical Commissioners, December 2016

NHS Clinical Commissioners

This report showcases how clinical leaders in England’s core cities – the eight largest cities outside of London – are looking at how the services they commission can improve not only the health but social and economic wellbeing of their populations. The report finds that in these areas, clinical commissioners are working with a wide range of partners to go beyond traditional boundaries to combat health inequalities and social exclusion, increase skills and employment and to attract inward investment to help realise the potential of their local economies.

 

Using patient experience to improve outcomes after cancer treatment

Proven, D. & Rennie, C. (2016) Cancer Nursing Practice. 15(10) pp. 19-22.

The Transforming Care After Treatment (TCAT) programme aims to improve care for people living with and beyond cancer in Scotland. The direct involvement of people affected by cancer is integral to the programme’s design and its overall success. Under the TCAT programme a project team in NHS Ayrshire and Arran has worked with people affected by cancer to review and redesign its breast and colorectal cancer pathways. The outcomes of the project have demonstrated the value of ongoing user involvement in the development of an intervention. This allows for rapid feedback and insight into experiences, and services have become more efficient, effective and person-centred.

Read the abstract here

Smartphone text message service to foster hand hygiene compliance in health care workers

Kerbaj, J. et al. American Journal of Infection Control. Published online 9 December 2016

Background: Health care-associated infections are a major worldwide public health issue. Hand hygiene is a major component in the prevention of pathogen transmission in hospitals, and hand hygiene adherence by health care workers is low in many studies. We report an intervention using text messages as reminders and feedback to improve hand hygiene adherence.

Conclusions: Text message feedback should be incorporated into multimodal approaches for improving hand hygiene compliance.

Read the full abstract here

Patient reported outcome of adult perioperative anaesthesia

Walker, E.M.K. et al. (2016) British Journal of Anaesthesia. 117(6) pp. 758-766.

Background. Understanding the patient perspective on healthcare is central to the evaluation of quality. This study measured selected patient-reported outcomes after anaesthesia in order to identify targets for research and quality improvement.

Conclusions. Anxiety and discomfort after surgery are common; despite this, satisfaction with anaesthesia care in the UK is high. The inconsistent relationship between patient-reported outcome, patient experience and patient satisfaction supports using all three of these domains to provide a comprehensive assessment of the quality of anaesthesia care.

Read the full abstract here

Pharmacists based in general practice

The Patient’s Association, in partnership with the Primary Care Pharmacy Association, has published A survey of patients and carers views of pharmacists based in GP practices. 

The survey found nearly 80% of patients both welcomed the addition of a pharmacist to the general practice team and said that they would welcome a review of their medicines by the pharmacist.

Nearly 80% of respondents also stated that they had better access to services with a GP based pharmacist. 70% felt that they did not need to make an appointment to see their GP after speaking to their pharmacist.

Read the full survey here

The effects of a high-intensity functional exercise group on clinical outcomes in hospitalised older adults

Raymond, M.J.M. et al. Age Ageing. Published online: December 7 2016

Objective: to investigate a high-intensity functional exercise (HIFE) group in hospitalised older adults.

Conclusion the results suggest that a HIFE group programme combined with individual physiotherapy may improve mobility to a similar extent to individual physiotherapy alone in hospitalised older adults. Providing physiotherapy in a group setting resulted in increased therapist efficiency. A high-intensity exercise group with individual physiotherapy may be an effective and efficient method to provide care to older inpatients.

Read the full abstract here

New NHS leadership framework

New NHS leadership framework – Developing people improving care | NHS England

NHS England and NHS Improvement have been working with the other health Arms Length Bodies (ALBs) to develop the new NHS leadership framework – Developing people improving care.

This is an evidence-based national framework to guide action on improvement skill-building, leadership development and talent management for people in NHS-funded roles.

The framework focuses on helping NHS and social care staff to develop four critical capabilities:

• systems leadership for staff who are working with partners in other local services on ‘joining up’ local health and care systems for their communities

• established quality improvement methods that draw on staff and service users’ knowledge and experience to improve service quality and efficiency

• inclusive and compassionate leadership, so that all staff are listened to, understood and supported, and that leaders at every level of the health system truly reflect the talents and diversity of people working in the system and the communities they serve

• talent management to support NHS-funded services to fill senior current vacancies and future leadership pipelines with the right numbers of diverse, appropriately developed people

Read more about the framework on the NHS Improvement website.