As the CEO of a healthcare flow and transformation company, I am frequently asked almost a trick question by prospects and colleagues. “So you guys can improve flow with your predictive flow solutions?” I always smile and say well I don’t believe that technology on its own can deliver change in healthcare. I fundamentally believe that a marriage of technology and people supporting change on the ground makes it happen. For flow, this should include a well weaved tapestry of partnership and system working, all pulling in the same direction to discharge and manage patients out of hospitals. In some recent discussions with colleagues, I realised that not everyone knew what a Multi Agency Discharge Event (MADE) was. It’s one of these things which people have been doing for a while, but may not have applied the prescribed structure to or even realised what it was. As we kick off a new decade, with flow being a strong theme on every board report and agenda, I predict that the MADE will become a key deliverable for Chief Operating Officers (COO) and site teams across the country.
The quality and efficacy of patient flow, from admission to discharge, is truly crucial to all patients, their families and healthcare workers. It is an issue that resides at the very core of a great deal of what we do as a company, integrating our improvement strategies and advanced data solutions into the day-to-day workings of our partner organisations. It is clear to me, in addition to being a topic often raised as the greatest concern in my talks with CEOs and clinicians, that the need for high-quality data solutions goes hand in hand with a need for full involvement of the team on the ground, in order to identify issues and implement new practices that address any blockages or problems throughout the patient flow pathway. Long-term, fully integrated and standardised practices are the name of the game and ensuring that these are implemented to provide lasting improvements at our partner organisations is a goal that remains incredibly important to me.
So how do we ensure that these changes and improvements, both to healthcare technology and culture, are fully realised? In recent years, NHS Improvement has stressed the significance of ensuring that the right people and expertise within local health systems are brought together to review and tackle any roadblocks to good patient flow – and lo, the Multi Agency Discharge Event (MADE) was born. These events are designed to combat issues in patient flow by uniting the knowledge of senior clinical and operational staff from a range of areas, including Clinical Commissioning Groups (CCGs), community services, mental health services, local authority services, the voluntary sector and the Emergency Care Improvement Programme (ECIP), alongside acute trusts and primary care services. Combining this expertise with the vital voice of patients and carers through input from ‘expert patients’, carers, or individuals trained in interviewing patients, these events are consequently able to support system-wide improvements to patient flow, identifying and unblocking any delays and subsequently optimising the discharge processes.
Each MADE session works over the course of one or more days to examine progression along agreed care pathways down to an individual patient level, with each MADE team focused to a particular ward in order to observe board rounds and multi-disciplinary team meetings. Through this, these teams can highlight and tackle delays both in internal and external waits, as well as ensuring all discharges are safe and timely. Investigating the stages of a patient’s journey down to an individual level is a crucial component and requires critical reviewing for a full understanding of every step, to make sure any necessary interventions are undertaken without delay. Much of this is supported by the utilisation of patient lists and issue/action templates to allow the MADE team to collect real-time data for each of these patients, therefore providing the opportunity to proceed with an escalation if necessary and avoiding potentially harmful delays. As such, it is incredibly important that the MADE team is supported by a small central team at the hospital that provides advice in terms of accessing both acute and community-wide services.
The goal of the MADE team during these patient reviews is to document any identified challenges or delays, curating a daily source of information for the central team that focuses particularly on stranded patients – those who have been an inpatient for seven days or more – but also short stay admissions. The progress of each patient’s care, their next critical step, as well as how this step can be enabled to occur on that very same day are essential parts of the MADE team’s review, allowing wards to establish the number of ‘red’ and ‘green’ days, and ensuring clinicians are focused on implementing measures to reduce both internal and external delays.
Overall, MADE sets out to address issues that underlie blockages to good patient flow, simplifying system-wide processes, freeing up beds and reducing lengths of stay, increasing morning discharges, and increasing flow as part of an escalation process. Each event culminates in a workshop or debriefing session, during which the next steps, actions, and leads responsible for these are established to ensure lessons are learned and acted upon. With a particular focus of MADE on the delays that have contributed to patients who have become stranded in particular, it is clear to me that much of the reviewing process itself, as well as subsequent actions for improvement, will be augmented greatly by the application of technology that allows for tracking, analysis and presentation of key components to these patient pathways and overall flow.
Already we are working to combine the MADE learning sessions with our Stranded Patient modules, converting the available patient data into metrics that allow monitoring of the proportion of stranded patients alongside the actual proportion of bed days, both historically and on a live, day-to-day basis. Analysis of this data enables each organisation to track performances across all wards and specialities, putting the ability to identify outliers and review their pathway profiles to pinpoint and address the underlying issues at the fingertips of clinicians and the healthcare team. Through this, I truly believe it will be possible to ensure that the issues identified by the MADE teams can be thoroughly assessed and their expertise fully utilised, implementing long-lasting improvements within wards to ensure patient flow becomes and remains both consistent and optimised, ultimately guaranteeing that each patient’s journey is a safe and efficient one.
For organisations wishing to have some facilitated support for their two days MADE session, please feel free to reach out.