Why Integrated Care Systems Need an Integrated Approach to Patient Flow 

Integrated Care Systems (ICS) are at the core of NHS England and Improvement (NHSE/I) strategy. With management teams currently being appointed, significant strategic changes must be built into the foundation for tangible benefits to be achieved and realised.  With post-COVID waiting and staff shortages a major public and government concern, the NHS has the opportunity to implement digitally enabled improvements to make better use of existing resources whilst driving forward the objectives of wider collaboration, better resource and capacity management.

At the heart of any effective change is visibility of the patient throughout their care journey, from the community to the acute and post-acute care setting. With shared, real-time visibility of the patient journey, especially through acute settings, ICSs will have the data backed foundation to support and deliver ambitious goals, to maximise existing resources and provide a clear roadmap for provider collaboratives and accountable care partnerships, explains Neil Griffiths, Managing Director UK and Europe, TeleTracking Technologies.

Building ICS Strategy

ICSs across England are rapidly putting in place the senior leadership teams tasked with meeting the ambitious plans outlined in NHSE/I’s Integrating care: Next steps to building strong and effective integrated care systems across England

From provider collaboratives to accountable care partnerships (ACPs), the goal over the next 12 months is to devise clear strategies for improved collaboration across the wider healthcare community. With each ICS specifically focused on meeting local needs, there will be no single ‘one-size-fits-all’ model and no best practice blueprint. From local population demographics which will hugely influence demands, to the legacy primary and secondary care resources available, each ICS faces different challenges and opportunities for change.

There is, however, an underlining set of goals for every ICS: to address the backlog in diagnosis and treatment caused by the COVID-19 pandemic. Waiting list management and improvement will, without any doubt, be a far greater driver of change over the next 12 months than when the ICS concept was originally devised.  The difficulty for any ICS management team, however, is balancing immediate tactical requirements with the long-term strategic goals, something that is magnified given the current lack of coherent, trusted and up-to-date patient flow information.

Understanding Patient Flow

How are ICSs going to prioritise collaborative patient placement opportunities or drive improvements across this extended healthcare community without trusted, real-time insight into how patients are progressing through the system? 

The NHS in England has access to a previous day ‘sit-rep’ which provides an overview of what went wrong – or right – during the previous 24 hours.  More often, management is presented with a monthly review of activity, something that has little relevance given the constant changes in both demand and available capacity, especially in a COVID-19 affected environment.

Capturing real-time insight into patient flow is a vital first step in shining a light on the capacity versus demand situation amongst all healthcare providers across a system. This insight will provide ICSs with the foundation to prioritise provider collaboration. It will support informed decision making about structural change and how to best reconfigure the system to enhance capacity, improve patient management and drive down wating times.

Realising Immediate Efficiency

The process of capturing and automating patient flow will underpin changes to release vital capacity through the improvement in bed management – something that will, by default, address many of the existing bottlenecks. While 95%+ levels of bed utilisation are standard claims across the NHS, such figures are predicated on outdated bed management models: it is estimated that one ICS alone has as many as 400+ “lost” beds every day*. 

Using real-time technologies to improve patient flow and bed utilisation will release much-needed capacity and enable ICS management to focus on true strategic change rather than being dragged down by the day-to-day tactical issues associated with juggling apparently scarce resources.

This centralised model is already employed at several NHS Trusts in England where the benefits of real-time patient flow management have transformed bed utilisation by creating a centralised command, or care-coordination centre. These Centres act as the “Air-Traffic Control” for the Turst, providing oversight of the entire patient throughput and resource utilisation process. In fact, some of these trusts are now extending the single, real-time view of bed status to include community beds to provide a broader overview of the current status across a wider healthcare community.

Information Foundation

Cross-community collaboration has been encouraged for many years through NHS Shared Services initiatives, but the ICS vision is far reaching and will require unprecedented co-operation across many stakeholders. It is a model, however, that is proven elsewhere – especially in the United States. At Carilion Clinic, for example, a community that spans over millions of patients and six hospitals in both urban and rural locations in Virginia, real-time patient flow technology has been in place for over a decade. 

The healthcare provider has a complete view of the status and availability of beds across its multiple sites, as well as the status of admitted patients, upcoming discharges, beds and rooms that are being cleaned, and more.  With the ability to effectively load-balance across the system, plus better real-time insight into patient wait and hold times, Carilion can match patient needs not just to available capacity but also their location. As a result, patients can be kept close to home as long as they don’t need a higher level of care at the flagship hospital, improving satisfaction and overall patient throughput and flow efficiency.

This level of provider collaboration is only possible through the availability of trusted real-time patient flow information – and this is key. A cross-ICS pathway needs to be visualised if it is to be improved. If ICS management are to begin to build strategies for change, the way the NHS collects and uses information must change. 

Conclusion

Achieving this community-wide, effective collaboration and improved resource management is, without any doubt, a significant challenge – both technically and culturally. Data-led strategies will play a vital role in overcoming local politics and bureaucracy and supporting ICS leaders in realising the benefits of a more efficient healthcare model.

Now more than ever, it is time to think differently. Organisations must start implementing tools to support staff in capturing real-time patient flow and operations data; use it to understand current capacity opportunities and bottlenecks; and begin to create synergies that load balance the system and maximise resources to drive down waiting lists and build a platform for sustainable improvements in the future.

ENDS