QUALITY IMPROVEMENT: Systems engineering case study: Improving patient safety and system productivity by reducing lead-times for blood tests.

Local case reports highlighted safety issues arising from the delays for inpatient blood tests. A multidisciplinary team used systems engineering techniques to understand the dynamics of the end-to-end process and how policies, which benefited the efficiency of individuals and departments, compromised the safety and effectiveness of the whole hospital system. Upstream services were synchronised so that samples arrived in the lab earlier in the day.

Introducing quality improvement as an intrinsic part of healthcare.

Healthcare systems worldwide face the challenge of recognising and improving safety, timeliness, quality and productivity. The authors describe how the COM-B model, developed by Michie et al in 2011 to explain and change criminal behaviour, is useful in identifying what skills and capabilities healthcare providers require to improve their systems. These skills include the intellectual capability to understand, design and improve healthcare processes; the opportunity to do this in their daily work; the motivation to do this - in particular recognising the reasons not to change; and finally unlearning the behaviours based on historical system beliefs that are now invalid.

Does process flow make a difference to mortality and cost? An observational study.

Purpose: The purpose of the paper is to investigate the potential relationships between emergency-care flow, patient mortality and healthcare costs using a patient-flow model.

Design/methodology/approach: The researchers used performance data from one UK NHS trust collected over three years to identify periods where patient flow was compromised. The delays' root causes in the entire emergency care system were investigated.

Timely care for frail older people referred to hospital improves efficiency and reduces mortality without the need for extra resources.

Background: hospitals are under pressure to reduce waiting times and costs. One strategy that may be effective focuses on optimising the flow of emergency patients.

Objective: we undertook a patient flow analysis of older emergency patients to identify and address delays in ensuring timely care, without additional resources.