Addressing the core health and social care conflict

Every day the negative effects of this choice play out across the whole system: add more (front-line) resources and financial stability is jeopardised; reduce (front-line) resources and the provision of high-quality and timely care for all patients is jeopardised. Oscillating between the two is the worst of both situations, creating wandering bottlenecks everywhere which are a nightmare to manage and simultaneously jeopardise the quality, timeliness and affordability of care.

Any solution to this core conflict must:

• rapidly deliver a flourishing healthcare system
• rapidly improve the quality and timeliness of care
• rapidly improve the financial performance of the system
• gain the commitment of people who are already working on improving the situation
• do all this without exhausting staff or taking imprudent risks.

Diagram 1: system-wide cause-and-effect links

The QFI Pride and Joy approach

The QFI Pride and Joy approach is based on the Theory of Constraints (TOC) which asserts that in any seemingly complex system there are only a few places that have the power to affect the performance of the whole system. Focusing on these few areas will deliver a breakthrough in performance across the whole system; focusing anywhere else may deliver pockets of improvement but, more worryingly, may damage system-wide performance. It is this ability to cut through the seeming complexity of healthcare systems that enables our Pride and Joy approach to simultaneously meet all the above solution criteria.

Diagram 1 shows the cause-and-effect links between areas of a system. Dealing with the purple area (top left) is a futile exercise – there are three areas affecting its performance, each of which are ultimately driven by the orange area. It is this orange area where a change in operational practice will bring benefit to the whole system and a breakthrough in performance.

The QFI Pride and Joy whole-system solution

The QFI Pride and Joy whole-system solution is based on the following principles:

• A patient-centred, clinically led approach is an essential element of the way forward.
• Improving patient flow through all pathways simultaneously is the primary objective.
• A focused process of ongoing improvement to balance patient flow is vital.
• Removing local measures is essential when improving multiple, interacting chains of activity.

We have translated the above into the Pride and Joy software that provides staff with live, 24/7, information about what they need to do next to support timely patient care that will affect all patients across the whole system. This is the 'robust and trustworthy mechanism' described in Pride and Joy. The software provides the data necessary for AnalyTOCS to analyse what is blocking a breakthrough in performance – the operational practice in the orange area – where we investigate the true magnitude and consequences across the whole system. It is often the case that this area is itself living a conflict, which we articulate and then propose quick, practical changes in operational practice, supported by evidence of the size of the benefit to the system.

The strategy and tactics implementation plan

We have built the detailed strategy and tactics (S&T) plan for implementation. This is the full explanation of the implementation and explains to five levels – from level one (senior executives) to level five (the wards/units and central resources) – the coordinated and connected sequence of steps to be taken, who needs to take them and why the steps are necessary to achieve the strategy. The S&T plan is the vehicle through which an implementation to achieve the results is directed.

As a healthcare organisation implements the Pride and Joy approach we support by carrying out training and coaching of staff and the implementation team. This includes training in the Theory of Constraints principles, the Pride and Joy operational practices described in the book, and the use of the software. We also carry out the analysis that identifies the resource-task combination that is most often causing the most delay to the most patients across the whole system and propose simple, practical solutions that direct the organisation to simultaneously improve the performance in this area and across the whole system.  

The applications

The Pride and Joy software to support and exploit the fundamental approach has been developed in the following key health and social care areas:

• Bed-based environments – including the acute, community and mental health settings
• Community-based services
• Outpatients environments
• The elective pathway
• Emergency and assessment unit areas.