Improving flow along care pathways

Crisp, Helen; Watt, Amanda; Jones, Bryan D.; Amevenu, Daphne; Warburton, Will

doi:10.37829/hf-2020-i04

Cited by 3 publications

(5 citation statements)

References 14 publications

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“…The lack or loss of vital patient information has previously been linked to poor inter-organisational care co-ordination and continuity of care (The Health Foundation, 2013; Fillingham et al , 2016; Sheaff et al , 2017; Crisp et al , 2020). It was also was connected to patients’ involvement in decision-making and that of their family members or carers.…”

Section: Discussionmentioning

confidence: 99%

“…The need to improve the movement of patients through the health and social care systems with a focus on reducing bottlenecks, waste, delays and duplication to improve the quality of patients’ and service users’ experiences has been recognised (The Health Foundation, 2013; Fillingham et al , 2016; Crisp et al , 2020). Yet while there are guidelines and best practice principles indicating how discharges for OPLWF should be organised and co-ordinated (National Audit Office, 2016; Royal College of General Practitioners and British Geriatric Society, 2016), there are few studies addressing how these may be put into practice systematically across hospital services and little is known about the barriers to joint working for staff in different organisational settings.…”

Section: Introductionmentioning

confidence: 99%

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How latent patterns of interprofessional working may lead to delays in discharge from hospital of older people living with frailty – ‘Patient more confused than usual?’

Redwood¹,

Brant²,

Maluf³

et al. 2021

Ageing and Society

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Unnecessarily delayed discharges from hospital of older people living with frailty can have negative consequences for their health and add significant costs to health services. We report on an ethnographic study at two English hospitals and their respective health and social care systems where we followed 37 patient journeys. The study aim was to understand why delays occur. Our findings indicate that working practices in the study hospitals may have inadvertently contributed to delays. While many pieces of patients’ clinical and social information were collected, recorded and accessed in different ways by different professionals, to facilitate a discharge, these pieces needed to be re-found, integrated and re-constructed. A key component of this process was information related to patients’ social, family and functional background. This was often missing, not accessed or perceived to be of low value compared to other more readily available clinical information. Patients’ re-construction was thus often incomplete, or insufficient to reduce the clinical and prognostic uncertainty associated with frailty and to manage risks inherent in older people's discharge. Where this key component was present and integrated into decision-making in multi-disciplinary team working, uncertainty and risk were managed more constructively and sometimes avoided an escalation of care needs.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

How latent patterns of interprofessional working may lead to delays in discharge from hospital of older people living with frailty – ‘Patient more confused than usual?’

Redwood¹,

Brant²,

Maluf³

et al. 2021

Ageing and Society

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“…17 Patient voice in MDTs and broader initiatives is also often lacking, 13 yet can provide meaningful input into their development and improvement. 60 Table 1 in the Annex lists some of the factors that shape team working.…”

Section: Unrealistic Assumptions About Mdtsmentioning

confidence: 99%

Realising the potential of community-based multidisciplinary teams: insights from evidence

Lloyd¹,

Beech²,

Wolters³

et al. 2023

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Better integration between health and social care services is a longstanding policy objective in England and other countries. Recent reforms to the NHS in England established 42 area-based integrated care systems (ICSs) to lead local efforts to develop more integrated models of care. •To realise the potential of MDTs, local implementation needs to be carefully planned and supported by ongoing monitoring and evaluation. We make four recommendations:1. Develop a clear, evidence-informed 'logic model' (or 'theory of change')for how service changes are expected to lead to improvements in care. This will help identify the support needed to make MDTs work and set meaningful goals. 2.Collect data on key aspects of the logic model as part of the implementation of MDTs. This should include resource inputs, activities and outcomes that can be accessed in a timely way. 3.Monitor inputs, activities and short-and medium-term outputs. This can provide early indications of whether the MDT is working as intended and identify opportunities to learn and course-correct. 4.Undertake robust evaluation to understand what works, for whom and in which contexts. This should include measures beyond emergency hospital use and reflect outcomes that matter to patients. Robust evaluation requires careful design, reliable data and resources -and input and support from both local and national decision makers. About the Improvement Analytics UnitThe Improvement Analytics Unit (IAU) is a unique partnership between NHS England and the Health Foundation. We evaluate complex initiatives in health care in order to support learning and improvement.

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“…Another challenge for healthcare systems highlighted in the collection is how to marshal and deploy the collective improvement expertise and knowledge of those doing improvement to identify and address quality issues that require a pathway or system-wide response. One solution is to create and resource networks and platforms that bridge organisational and sectoral boundaries and give people the space to come together and share ideas and expertise, learn from each other, and tackle quality challenges collaboratively 111213. With interest in employing quality improvement approaches at population health level now on the rise,14 the need for such large scale engagement platforms, together with people who can act as “system integrators,”1516 is becoming ever more apparent.…”

mentioning

confidence: 99%

“…It is precisely for this reason that so much improvement to date has taken place within specific teams and services. Organisations such as hospitals are complex entities with “multiple” and “overlapping subgroups.”17 And while some “cultural attributes are widespread and stable,” others may be shared only in sub groups or held only tentatively.”17 Equally, many processes and pathways are not stable, but are in a constant state of flux 11…”

mentioning

confidence: 99%