Wasting People's Time

Short Term

THURSDAY 12TH APRIL 2018

While I’m on the topic of wasting people’s time… (from the last blog)

A few years ago I was working with a health board in Scotland on the design and communications for their “Reshaping Care for Older People” (RCOP) programme. RCOP was a Scotland-wide programme of investing in community health and social care services. It was to address the growing problem of having many older patients with complex social care needs occupying a hospital bed, when they could be receiving the care they need at home or in their community.

It was a politically-sensitive and highly-charged programme of work, because the future of the new community services they were investing in relied on them saving money by reducing the demand on hospitals. Local communities and politicians were turning it into a conversation about closing down hospitals and geriatric wards.

We looked into the figures. On average, every day about 80 people over the age of 65 arrived at one of the health board’s hospitals. A large proportion were treated and discharged on the same day, but some were admitted for at least one night. The majority of these stayed only a night or two, but many stayed on longer. We came across a stark fact. On average, of those 80 older people who came to hospital each day, 2 of them would end up remaining in a hospital bed for an average of 42 days after they were medically ready to leave. This means that around 80 beds at any one time across the hospitals in that area were occupied by people who didn’t need to be there.

This can happen when the clinical team are satisfied that a patient no longer needs the medical attention provided by the hospital, but they may need extra support to make the transition back home. For example, they might have needed new fixtures to be installed at home, or an arrangement with the local council for daily social care visits. Planning this intermediate care usually requires a number of organisations to work together, which can take time to coordinate.

Hospital beds are an expensive, and often desperately needed, resource. Imagine how much would be saved by un-occupying 80 of them each night. But for me that’s wasn’t the biggest problem - we were talking about the situation from the hospital system point of view, the financial point of view, our point of view. What about the patients?

Many of those older patients had complex and compounded health problems. They may have only had a couple of years of life remaining. And we were keeping them in hospital for an average of 42 days longer than they needed to be there. 42 extra days of limited visiting times from family and friends - 42 valuable days of missing out on what was happening at home – 42 more days of limited independence. We were busy focusing on how much the situation was costing the health system. We should have been mad as hell about what the situation was costing them.

Think about any problems in you service that you are trying to fix. You are probably aware of what it is costing you. What might it be costing your customers?

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