In order to improve health services and save money, addressing the current issues surrounding the flow of patients and the associated flow of information, data, and resources is an important consideration.

‘Whole system flow’ means the coordination of all systems and processes within the NHS, to deliver the correct and proper care to each patient. It is an important area for business and has been used to good effect in other sectors. For example, work flow in contact centres and customer journeys in online retail.

Increasing attention is being paid to this within the NHS. Recently, flow improvement programmes have been run in Scotland and Wales. Positive changes have been seen when the NHS has been able to match capacity and demand and enable better flow between departments and services.

Although there are areas of improvement, these attempts have predominately focused on a single organisation or pathway and the scale of tackling the problem in relation to a whole system is a much bigger challenge which is often not part of the scope. The issue of cultural differences between the NHS services has often slowed down positive change within the NHS and continues to be a barrier. Bringing together organisations that are funded and run in isolation is a hard task but is one that needs to happen.

Customer experience & the patient journey

We are all customers of the NHS and we expect our customer journey to be seamless. The primary focus of any flow-related initiative should be to improve the customer experience – in this case, by ensuring there is a better pathway of care through the NHS system resulting in fewer delays, effective and timely treatment, and improved health outcomes.

To make this happen, the NHS needs to focus on certain areas of change to prevent people flowing into the system unnecessarily or being diverted to the wrong secondary care pathway. 

To plan a future state, the NHS first needs to map out its current processes and patient flows. This will help them identify areas for improvement.

This cannot be done in isolation, the services need to work together to get a better overall picture; the cultural differences in the NHS will need to be overcome.

The NHS’s siloed systems need to work together to implement solutions with shared responsibility and a shared interest in the outcomes. A key point to consider is that if the NHS think holistically about use of capacity they could utilise capacity far better.

At the moment capacity (e.g. beds) are ring-fenced geographically and by speciality. Sharing capacity allows systems to run much closer to capacity without the risk of failing.

Understanding causes and identifying solutions to problems via predictive data analytics is another potential area for massive improvement throughout the NHS. Once again, this type of intuitive information gathering has been seen in small pockets of the NHS, but not yet been used to its full potential across all services.

Challenges

The NHS has to be able to identify operational, financial and workforce-related issues that are necessary to make change projects happen. Focus is now needed on an objective, new-knowledge environment in which staff, patients and service users have the ability and buoyancy to work together to investigate problems, enforce change projects and test solutions.

If NHS departments and services are able and willing to work collaboratively to design services that optimise flow, this could lead to major improvements in patient and service user experience and outcomes and ultimately a better way of working for the NHS.

The NHS needs an increased understanding of how to tackle whole system flow as the increase in efficiency and subsequent cost-benefit is hard to ignore. And policymakers need to give CCGs the time and resources they need to enforce change projects. This has the potential to significantly increase the quality of care provided to patients and service users, and to create better patient journeys.