The Systems Flow Programme: A Journey of Innovation and Collaboration

By Sarah McAllister (Head of Improvement Programmes)

In the face of mounting pressures on adult mental health inpatient units, East London NHS Foundation Trust (ELFT) has embarked on an ambitious Quality Improvement (QI) programme for 2024/2025. This programme aims to improve patient flow across the entire system, addressing both clinical and financial challenges. The primary aims are to eliminate the use of private sector beds by October 2024 and to reduce the average length of stay to 40 days by April 2025.

A Unified Approach to System Flow

The systems flow programme is a comprehensive effort to streamline patient movement across various services, including inpatient units, community neighbourhood teams, community crisis teams, and A&E liaison. Both Bedfordshire & Luton and East London have come together to develop a shared understanding of the issues at hand. They have crafted a theory of change and are actively testing change ideas at both the system and local levels to enhance flow.  Figure 1 below shows the Trust wide programme driver diagram.

Figure 1 – Programme level driver diagram       

Early Successes and Ongoing Efforts

Significant progress has already been made in reducing out-of-area placements. The Trust has seen a decrease in private bed usage to around 15 private beds at the start of September 2024. This reduction is particularly notable in London; since the start of September 2024, private bed usage has been almost eliminated. This success is largely attributed to the increased use of stepdown beds, funded over the past few months to expand capacity with local providers. The Performance team is collaborating with directorates to capture this activity in RiO, the clinical recording system, to better understand contract utilisation, length of stay, and the purpose of stepdown bed usage.

Figure 2 – Out of Area Placements Trust wide

Figure 3 – Out of Area Placements London

Testing High-Impact Change Ideas

Across the Trust, various high-impact change ideas are being tested to improve the patient pathway. Here are some key initiatives:

• Bedfordshire & Luton: Process improvements to discharge, such as daily huddles, are showing early signs of reducing clinically ready for discharge numbers. A review of the community model has identified the need to standardise operating procedures across all localities.
• City & Hackney: The Neighbourhood Mental Health Team is addressing challenges around data quality, particularly with outcoming appointments, which currently affect missed appointment data accuracy.
• Newham: Clinical leads overseeing the care of patients in private beds have contributed to a reduction in private bed usage. An enhanced discharge coordination team is working to clarify roles and responsibilities.
• Tower Hamlets: A 30-minute daily huddle to understand patient needs has already resulted in the discharge of a long-stay patient. The “Discharge to Assess” initiative is focusing on ensuring that discharging consultants feel confident in their decisions.

 Continuous Improvement and Future Plans

Local Improvement Advisors are meeting fortnightly with directorates to support the testing of change ideas and to use data to inform decision-making. An upcoming exercise will involve Improvement Advisors helping directorates create a timeline of change ideas and annotate these onto their charts. This will help tell the story of what is working and what is not.

Through collaboration, innovation, and using improvement methods in a robust way, the Trust is making significant impact on patient flow and enhancing the quality of care. Other clinical teams can draw inspiration from these efforts, adapting and testing similar strategies to achieve their own aims.