Whole System Patient Flow – The Scottish Experience

Feb 17
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Good patient flow is not about a production line with patients moving along a factory-like conveyor belt, but it does draw upon some of the same Operations Management techniques.

Instead, good patient flow places the patient on the optimal patient pathway for their needs and contributes to safe, person-centred and effective care. It also eliminates or reduces inefficiencies.

It is perhaps hard to believe that the diagram below is derived from what we refer to as ‘classic queueing theory’ developed to manage routing through early telephone exchanges.

Patient Flow Programme

Poor patient flow can mean that patients:

  • Wait for treatment – on a trolley in an ED, trying to get a GP appointment.
  • Might be on a sub-optimal pathway – boarded into an inappropriate ward where treatment is possibly not as effective or perhaps takes
  • Have incomplete treatment – discharged prematurely and requiring readmission.
  • Could be delayed once their treatment is complete – waiting for a consultant decision or a social care package in the community.

Our programme has a number of workstreams including virtual fracture clinics, enhanced recovery, criteria-led discharge and ‘Day of Care Surveys’. The rest of this article will introduce a major piece of work we have been progressing over the last three years – working with the Institute for Healthcare Optimization™ (www.ihoptimize.org) to build our local capacity to manage variability. 

The methodology considers variability to be either naturally occurring or artificially created, the latter by the way we do things.

This is illustrated in the chart below:

Daily Number of Emergent, Expedited, and Elective Cases

Jan 15 to Jun 15, Non-holiday weekdays


The hospital’s emergency and urgent work, which is largely subject to natural variation, is shown in red and blue. Although there is variability over time that variability is fairly limited. If you look at the elective activity in yellow – the activity we plan and schedule – you will see that there is a substantial amount of variability. The immediate counter argument to this chart is that on some days a hospital performs a few lengthy procedures, on other days many short ones. But if you recast the data to show theatre utilisation it shows exactly the same picture. This hospital does not operate on Fridays. Now, there may be good reason for this but if we want to provide better access to elective surgery here is one place to look.

Criterion’s series of Health conferences cover topics including Patient Flow, Emergency Departments, Infection Prevention, Hospital Safety & Security and more. View upcoming events here.

Health conferences


Submitted by Martin Hopkins

Martin Hopkins

Martin Hopkins has been working in healthcare improvement in Scotland for the last 16 years. He took up his current role in leading the Whole System Patient Flow Programme three years ago. He has been a member of two UK teams invited by the Government of Western Australia to advise on acute emergency flow.

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