Paul Harriman has recently published his paper ‘Timely care for frail older people referred to hospital improves efficiency and improves mortality without the need for extra resources‘ in Age and Ageing journal. Today he describes his findings on the OUP blog:
There is a truism in the world that quality costs, financially. There is a grain of truth in this statement especially if you think in a linear way. In healthcare this has become embedded thinking and any request for increasing quality is met with a counter-request for more money. In a cash-strapped system the lack of available money then results in behaviour that limits improvement. However, as an ex-colleague once said “we have plenty of money, we just choose to spend it in the wrong places”. This implies that if we were to un-spend it in the wrong place we would have plenty of spare cash.
The problem in healthcare, as in most service organisations, is that the system that delivers client value (in this case healthcare to patients) isn’t visible to those working in it. Indeed the only person that see’s the invisible system is the patient receiving that care. Our first task is to make the system visible and we can do this by producing a process map; a series of boxes describing the various activities all linked by one or more arrows. These maps can range from very high level to extremely detailed; the trick is to choose wisely and to look at the process from the patient’s perspective. Having produced your map the next step is to put some data onto it. Once you understand the process you can then start to hypothesise a different way of undertaking the work. Ask yourself;
- would pay your own money for a particular step; if not, then question why it exists
- are the steps in the right order?
- do they require roughly equal amounts of resource
- are there any bottlenecks?
Some four years ago, supported by a grant from the Health Foundation, we started to ask ourselves some of these questions in relation to the delivery of care to frail elderly patients. The answers were, in some cases, completely counter-intuitive. We found that some elderly patients stayed in hospital for many weeks after they could have left. There were many and varied reasons for this but none of them were related to acute hospital care. It was the wider disjointed system with its multiple hand-offs and traditional organisational rules that governed this. It was no-one’s fault, yet it was everyone’s problem.