![Page 1: Flow Cost Quality: Transforming non-elective healthcare for older people](https://reader036.vdocuments.us/reader036/viewer/2022062501/56816674550346895dda0d52/html5/thumbnails/1.jpg)
Flow Cost Quality: Transforming non-elective healthcare for older people
Tom Downes
4th March 2014
@sheffielddoc
![Page 2: Flow Cost Quality: Transforming non-elective healthcare for older people](https://reader036.vdocuments.us/reader036/viewer/2022062501/56816674550346895dda0d52/html5/thumbnails/2.jpg)
“Right First Time programme is delivering real benefits to patients and the transformation journey across the health and social care system has begun…”
![Page 3: Flow Cost Quality: Transforming non-elective healthcare for older people](https://reader036.vdocuments.us/reader036/viewer/2022062501/56816674550346895dda0d52/html5/thumbnails/3.jpg)
![Page 4: Flow Cost Quality: Transforming non-elective healthcare for older people](https://reader036.vdocuments.us/reader036/viewer/2022062501/56816674550346895dda0d52/html5/thumbnails/4.jpg)
Older, frail patients ….part of the NHS must be custom-tuned to their needs.
Roy Lilley, The Guardian 29th May 2013
![Page 5: Flow Cost Quality: Transforming non-elective healthcare for older people](https://reader036.vdocuments.us/reader036/viewer/2022062501/56816674550346895dda0d52/html5/thumbnails/5.jpg)
A complex system problem
![Page 6: Flow Cost Quality: Transforming non-elective healthcare for older people](https://reader036.vdocuments.us/reader036/viewer/2022062501/56816674550346895dda0d52/html5/thumbnails/6.jpg)
2003 Toyota Corolla
![Page 7: Flow Cost Quality: Transforming non-elective healthcare for older people](https://reader036.vdocuments.us/reader036/viewer/2022062501/56816674550346895dda0d52/html5/thumbnails/7.jpg)
Toyota Oobeya (Big Room)
How do others design complex systems?
![Page 8: Flow Cost Quality: Transforming non-elective healthcare for older people](https://reader036.vdocuments.us/reader036/viewer/2022062501/56816674550346895dda0d52/html5/thumbnails/8.jpg)
First find a room
![Page 9: Flow Cost Quality: Transforming non-elective healthcare for older people](https://reader036.vdocuments.us/reader036/viewer/2022062501/56816674550346895dda0d52/html5/thumbnails/9.jpg)
A place to meet
![Page 10: Flow Cost Quality: Transforming non-elective healthcare for older people](https://reader036.vdocuments.us/reader036/viewer/2022062501/56816674550346895dda0d52/html5/thumbnails/10.jpg)
The Big Room in Action
Physiotherapist gives an account of the test of change to get a patient home on the day theywere discharged by the GSM consultant
Senior registrar
General ManagerFor Medicine
GSMMatron
ServiceImprovement
Social ServicesManager
CommunityServicesmanagerPhysiotherapist
Secretary
DischargeLiaison
![Page 11: Flow Cost Quality: Transforming non-elective healthcare for older people](https://reader036.vdocuments.us/reader036/viewer/2022062501/56816674550346895dda0d52/html5/thumbnails/11.jpg)
Let me introduce ‘George’• 82 years old• Lives independently and wants
to continue doing so• Widowed 5 years ago• Has mild dementia• Daughter lives locally• Losing weight + poor mobility
PDSA tests of moving from ‘post take’ to ‘on take’
![Page 12: Flow Cost Quality: Transforming non-elective healthcare for older people](https://reader036.vdocuments.us/reader036/viewer/2022062501/56816674550346895dda0d52/html5/thumbnails/12.jpg)
Implementation dates:• April 2012
• Consultant geriatricians ‘on take’ 7 days per week• May 2012
• Frailty Unit process initially virtually• Frailty Unit opens mid-May
![Page 13: Flow Cost Quality: Transforming non-elective healthcare for older people](https://reader036.vdocuments.us/reader036/viewer/2022062501/56816674550346895dda0d52/html5/thumbnails/13.jpg)
Outcome measure: 34% increase in discharge within 1 day
![Page 14: Flow Cost Quality: Transforming non-elective healthcare for older people](https://reader036.vdocuments.us/reader036/viewer/2022062501/56816674550346895dda0d52/html5/thumbnails/14.jpg)
Midnight bed occupancy dropped by over 60 beds (no similar change in previous 10 years)
![Page 15: Flow Cost Quality: Transforming non-elective healthcare for older people](https://reader036.vdocuments.us/reader036/viewer/2022062501/56816674550346895dda0d52/html5/thumbnails/15.jpg)
Was reduction in bed usage due to reduced admissions? No
![Page 16: Flow Cost Quality: Transforming non-elective healthcare for older people](https://reader036.vdocuments.us/reader036/viewer/2022062501/56816674550346895dda0d52/html5/thumbnails/16.jpg)
Balance measure: No increase in readmissions
![Page 17: Flow Cost Quality: Transforming non-elective healthcare for older people](https://reader036.vdocuments.us/reader036/viewer/2022062501/56816674550346895dda0d52/html5/thumbnails/17.jpg)
The in-hospital mortality dropped by over 13%
![Page 18: Flow Cost Quality: Transforming non-elective healthcare for older people](https://reader036.vdocuments.us/reader036/viewer/2022062501/56816674550346895dda0d52/html5/thumbnails/18.jpg)
Discharge to Assess (D2A)The future hospital will support a system of ‘discharge to assess’ in physiotherapy and occupational therapy.
Section 5.20 Future Hospital Report, Royal College of Physicians (September
2013)
![Page 19: Flow Cost Quality: Transforming non-elective healthcare for older people](https://reader036.vdocuments.us/reader036/viewer/2022062501/56816674550346895dda0d52/html5/thumbnails/19.jpg)
Implementation dates:• April 2012
• Consultant geriatricians ‘on take’ 7 days per week• May 2012
• Frailty Unit process initially virtually• Frailty Unit opens mid-May
• September 2013• Testing of ‘discharge to assess’ from base wards
• October 2013• Implementation of ‘discharge to assess’ begins
![Page 20: Flow Cost Quality: Transforming non-elective healthcare for older people](https://reader036.vdocuments.us/reader036/viewer/2022062501/56816674550346895dda0d52/html5/thumbnails/20.jpg)
Time waiting per patient
D2A starts
![Page 21: Flow Cost Quality: Transforming non-elective healthcare for older people](https://reader036.vdocuments.us/reader036/viewer/2022062501/56816674550346895dda0d52/html5/thumbnails/21.jpg)
![Page 22: Flow Cost Quality: Transforming non-elective healthcare for older people](https://reader036.vdocuments.us/reader036/viewer/2022062501/56816674550346895dda0d52/html5/thumbnails/22.jpg)
• Modern health care is complex• Iterative testing and prototyping by front line staff• Our patients want timely quality care • Timely quality care is cheaper and safer• Measure• D2A – don’t worry that it’s obvious• Our journey has only just started
CONCLUSION