In Spring 2022, the Department of Health and Social Care asked the Academy to examine challenges related to hospital discharge. This was in light of significant challenges in enabling patients to leave hospital to a safe setting when they were well enough to be discharged. This created capacity issues in hospitals.
The complexity and fragmentation of our health and care system makes improvement, innovation, and effective change challenging. The Engineering Better Care report shows how a systems approach can unlock better health and care.
Next steps and process mapping
The Academy built on this report to undertake end-to-end process mapping of patient discharge pathways in Kettering and Cornwall. This spanned referral, admission, treatment within the hospital and, where required, discharge into community health services and adult social care. Based on this understanding, we built a map of the processes as we found them within their local context. These process maps show:
- Lack of oversight: With no single person responsible for the effective working of services across the local health and care system, and the complex patient pathways through it, there can be mismatched in capacity, resulting in bottlenecks.
- Antagonistic processes inhibit progress: The staff within the health and care system are working to their best endeavours to optimise their own processes. These local priorities can be antagonistic to the goals of other processes and to the needs of the patients, resulting in competition and conflict, often over limited resources such as community beds.
- Risk aversion causing delayed planning: Many care pathways operate as step-by-step processes with planning for the next stage only initiated when patients are already ready, leading to long delays. This risk-averse behaviour is seen as necessary by local service leaders to guard limited local resources, for example, when community care arrangements are forfeited when a patient is admitted to hospital, resulting in a wait to find a new package when they are well enough to leave.
Lessons learned from engineering systems approaches
The systems approaches used by engineers when designing and managing complex processes provide useful lessons. To be able to innovate we need to understand the system and its behaviour from the perspectives of those who use and work within it. Systems thinking can bring clarity to complexity. This shared understanding can empower staff to design and implement, effective, efficient and resilient solutions so that the patient gets the right care at the right time.
Engineering better care report 2017
A systems approach to health and care design and continuous improvement