Packed waiting rooms, delays in getting results, ambulances queuing, patients and results getting “lost” in the system: the daily frustrations facing people using and working in the NHS have become so familiar, it’s easy to start to accept them as inevitable. Or, even if these obstacles are not seen as inevitable, the effort needed to keep often ill designed systems moving is such that there’s little time to systematically dig deeper and diagnose the underlying causes.
As explored in a new guide from the Health Foundation and AQUA, many of these problems are symptoms of poor flow. Flow is about having a coordinated approach across teams and organisations to ensure people, information, and resources are in the right place at the right time. It focuses on improving the pathways that patients take through different parts of the NHS and social care system.
There are well established methods for improving flow and a growing number of examples that illustrate real benefits—not just in terms of improving patient experience and reducing hassle, but by producing better outcomes.
Sorting out the processes around flow might feel like a managerial agenda, but doctors have a critical part to play for three reasons.
Doctors know the system
It’s often said that it’s only patients who see the whole system. It’s true that our view and therefore impact will be limited unless we understand the journey from people’s front door. We also need to get further upstream to understand how to avoid people needing to flow into the health and social care system in the first place. That being said—whether they are a GP coordinating care for patients with complex needs, or a doctor in training managing hospital care at night—doctors often have a unique view and responsibility for what goes on behind the scenes, as well as what patients directly see.
They have the power to lead multidisciplinary change
Understanding flow brings into focus the many interwoven clinical and supporting processes and people that need to come together to provide care. To achieve sustainable improvement, the process of change needs to be multidisciplinary and meaningfully involve patients. Because of their power, doctors have a key role in creating the space for all those who really understand the detail of what’s happening at the frontline to come together and iteratively work out how to make it better. The “big room” process, which was pioneered in Sheffield and is spreading fast across the UK, is one example of how to do this.
And can provide the focus this needs over the long term
I’ve spent much of my career as a manager supporting process redesign in the NHS—consultants I’ve worked with would sometimes point out that they’d still be here long after I’d moved on to the next project. As the report describes, while the potential is great, the journey to improving flow at scale is long; it’s best approached as a core part of what it means to be an effective leader in the health service rather than as a separate initiative.
The report outlines what system leaders at national and health economy level need to do to enable progress: this includes building analytical and improvement capability and enabling the time, culture, and opportunity for people to work together on this, while unpicking some of the policies and incentives that lock us into siloed ways of working.
Ultimately, however, the detailed, iterative work to improve flow is best led by those who know the systems well and understand how they can be made better: doctors, working closely with other clinicians, managers, and patients, can lead the way.
Penny Pereira is the deputy director of improvement at the Health Foundation and the programme director of the Q initiative. She is responsible for scoping major new programmes.
Competing interests: None declared.