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2. End of section Introduction Introduction What is the bed management tool kit for? The bed management toolkit has been designed to develop organisational wide strategic management and thinking to identify front line solutions/innovation to resolve bed management constraints identified via the rigorous diagnostics phase of the Patient Flow Collaborative. Who should use the toolkit? The tool kit will promote discussion and ideas around solutions to bed management constraints. Therefore, anyone responsible for patient flow will benefit from using this tool. • What are the aims of the toolkit? • The Patient Flow Collaborative aims to remove unnecessary constraints or delays within the patient process. For this to take place an effective bed management system which is underpinned by: • right patient, right place, right resource, right time, right clinician, • identifies patient flow and delays • the availability of innovation tools, checklists, techniques which assist continued innovation. • How should we implement the concepts in this toolkit and change to our local context? • It is essential for innovation that the people who are involved in patient flow create systems that assist patients in their local context. The toolkits and concepts should therefore be adapted to a local context and owned by all members of the clinical team. Goals of the toolkit Overview and strategy Health service team Processes Data Resources Diagnostics and tools Back to menu

3. End of section Goals of the toolkit Introduction • Introduction • The bed management toolkit is based on whole system thinking and includes a whole of hospital perspective to managing bed stock. • Goals • The specific goals of the toolkit are to: • provide possible solutions to bed constraints • build awareness of best practice for bed management • identify building blocks to good bed management • provide access to mentors/improvement leads • smooth variation in elective and emergency demand pressures. This first version of the bed management toolkit will stimulate further development of bed tools and resources developed by the patient flow teams, case studies and good news stories, lessons learnt and provide contacts. Your feedback Feedback on this first version is welcome and all Patient Flow Collaborative teams are encouraged to provide feedback for subsequent versions of the toolkit. Goals of the toolkit Overview and strategy Health service team Processes Data Resources Diagnostics and tools Back to menu

4. Overview and strategy Introduction Goals of the toolkit Whole system approach A whole system approach is needed to effectively manage the variation in capacity and demand involved in bed management. This approach can be broken down into two strands; executive strategy and frontline operational management. Overview and strategy Health service team Processes Data Resources Diagnostics and tools Click to continue Page 1 of 5 Back to menu

5. Overview and strategy Introduction Goals of the toolkit Patient Flow /Health Service Executive Team Bed management strategy Organisational executive whole of hospital strategy for bed management Effective bed usage Data and information People and processes Policy Overview and strategy Health service team Processes Patient Flow /Health Service Executive Team Bed management team Frontline implementation of policy, systems and processes Data Rigorous diagnostics Tracking systems and predicting bed stock requirements Effective length of stay management Operational procedures and whole system involvement Resources Diagnostics and tools Click to continue Page 2 of 5 Back to menu

6. Overview and strategy Introduction Organisational executive whole of hospital strategy for bed management Goals of the toolkit Data and information Overview and strategy Organisational capacity and demand projections - 12 months, 3 months, 1 month timescales. Data information to predict streams of demand; elective and emergency. Health service team People and processes Processes Agreed organisational bed management processes that integrate people's roles and responsibilities and organisational policy. Data Policy Policy that is designed to provide an effective system for bed management which includes escalation stages, data projections and bed availability per day/night. Resources Diagnostics and tools Click to continue Page 3 of 5 Back to menu

7. Overview and strategy Introduction Frontline implementation of policy, systems and processes Goals of the toolkit Rigorous diagnostics Complete a review of existing processes, roles and responsibilities, capacity, predicted and actual demand, policy and escalation routes. Overview and strategy Develop a user friendly, simple tracking process which identifies delays which have occurred in the patient process. Implement a system to predict and manage capacity and demand. These can be simple solutions/complex IT systems (see examples). Tracking systems and predicting bed stock requirements Health service team Processes The Patient Flow Collaborative has developed a toolkit for effective length of stay management which should be used in partnership with the bed management toolkit. Recognition of integrating tracking delays and effective patient processes underpin bed management roles. Effective length of stay management Data Resources Operational procedures need to be simple and user friendly to promote real time information and whole of hospital participation in managing beds.Training and enforcement of bed management procedures are essential to smooth bed management. Operational procedures and whole system involvement Diagnostics and tools Click to continue Page 4 of 5 Back to menu

8. End of section Overview and strategy Introduction Traffic light system for delays: examples Goals of the toolkit Simple process to identify any delays which occur that stop the patients treatment/discharge. Identified delay reasons may be complemented by actions that need to be taken once delay has been identified. Overview and strategy Health service team Processes Data Action to be taken Delay reason Patient Delay reason Simple A4 sheet to record delays and take action, used on the units each day, thus pulling the patient to the next stage. Resources Radiology phone radiology mgr Lee Waiting radiology on ext: 3256 Diagnostics and tools Back to menu

9. Health service team Introduction • Roles and responsibilities • Skilled, trained and dedicated bed managers • Clear role description • Empowered and given authority to manage bed stock • Bed management team • Bed management team that fits into management structure • Bed management team profile that shows leadership responsibility to manage patient flow. • Introduction • Essential components of effective bed management are skilled, trained and dedicated individuals and teams who have clear roles, responsibilities, support and reporting lines to executive, supportive, integrated communication paths to whole of hospital clinical teams. • Check list for effective bed management team • Whole of organisation strategy • Clear reporting centres • Executive available and identified daily • Bed management recognised at board level • Escalation policy that has responsibility routes is effective in prevention Goals of the toolkit Overview and strategy Health service team Processes Data Resources Diagnostics and tools Click to continue Page 1 of 4 Back to menu

10. Health service team Introduction Health service team Clear reporting to health service manager/director of operations with simple escalation policy Goals of the toolkit Overview and strategy Innovations Agreed reporting with agreed times to meet/discuss daily status Bed management seen to report to executive Develop understanding and assistance with clinical teams Train and monitor adherence to agreed escalation policy Establish clear communication between bed managers and units; book meetings, conference calls, updates throughout the day Issues/constraints Unclear reporting or no one available to report to No clear authority in role No clear senior clinical engagement Misunderstanding, lack of adherence to escalation policy Lack of communication across hospital Health service team Processes Data Resources Diagnostics and tools Click to continue Page 2 of 4 Back to menu

11. Health service team Introduction Bed management role undertaken by appropriate senior person who works to clear defined role with responsibility to challenge and influence existing practice. Goals of the toolkit Overview and strategy Innovations Thank them for trying and appoint senior person who has effective communication skills to lead this role Create and communicate proactive bed management role Manage bed management only Define and inform roles and responsibilities of bed manager Issues/constraints Junior or inexperienced de-skilled individual in wrong position Role that does not allow proactive actions Multiple roles managed by bed manager Responsibilities change from day to day with no clear recognition of responsibility to manage Health service team Processes Data Resources Diagnostics and tools Click to continue Page 3 of 4 Back to menu

12. End of section Health service team Introduction Job description for role of bed manager It is essential for patient flow that an appropriate senior person is recruited in to the role of bed manager. Job purpose Senior leader who reports to executive/director of operations, responsible for the proactive management of bed occupancy for both elective and emergency admissions through to discharge. • Key responsibilities • Establish bed management processes and systems for the organisation which are agreed by the executive team • Develop and discriminate proactive data for bed utilisation predictability • Develop whole of hospital system for bed management • Develop whole of hospital escalation procedure • Provide effective communication of bed capacity and recommendations during capacity strains Goals of the toolkit Overview and strategy Health service team Processes Data Resources Diagnostics and tools Back to menu

13. Processes Bed cleaned Bed not available Introduction Predicted emergency demand Goals of the toolkit Wait in queue Discharge for beds Cancel electives Overview and strategy Admit to bed Health service team Elective demand Processes Discharge People in beds Data Resources • Understand patient flows - smooth patient flows • Predict emergency needs for beds • Choose elective capacity following emergency prediction • Schedule elective activity • Manage delays and effective length of stay • Build a buffer (prepare patients short notice admissions) Diagnostics and tools Click to continue Page 1 of 3 Back to menu

14. Processes Introduction Reduce variation in patient flow by smoothing processes: Goals of the toolkit Innovations Identify and organise admission times Predict emergency admission beds needed per day and per night shifts Identify emergency demand bed needs and elective allocation Review 3 monthly specialty bed usage Manage length of stay from earliest point Understand constraints Admission times Not predicting emergency demand bed requirements Demand on total bed stock Mismatch of allocation per speciality of beds Length of delays not being managed Overview and strategy Health service team Processes Data Resources Diagnostics and tools Click to continue Page 2 of 3 Back to menu

15. End of section Processes Introduction Mismatch of emergency and elective bed needs Goals of the toolkit Failure to predict bed stock required for Emergency admissions Overview and strategy Health service team Impact Cancelled operations Trolley waits Complaints Low morale Processes Data Resources • Innovation • Predict emergency: smooth elective admissions by day and length of stay • Define bed pool per speciality • Use expected length of stay timescales as targets for length of stay Diagnostics and tools Back to menu

16. Data Introduction • Length of stay management •  Review Toolkit on length of stay management and change package • Establish essential daily data to be used by bed management team. • 1. Emergency and Elective arrivals • Predicted & Actual • 2. Discharge expected • Predicted & Actual Goals of the toolkit Overview and strategy Health service team Processes Example Data Resources Diagnostics and tools Click to continue Page 1 of 8 Back to menu

17. Data Introduction Long term bed management planning Goals of the toolkit Overview and strategy Health service team Processes Data Resources Diagnostics and tools Click to continue Page 2 of 8 Back to menu

18. Data Introduction Core data set Goals of the toolkit Overview and strategy Health service team Processes Data Resources Diagnostics and tools Click to continue Page 3 of 8 Back to menu

19. Data Introduction This will only work when the variation is managed Goals of the toolkit Overview and strategy Health service team Processes Data Resources Diagnostics and tools Click to continue Page 4 of 8 Back to menu

20. Why Review of historic data showed an under utilisation of open bed stock/ theatres/ clinical support services over particularly the Christmas period despite adhoc reduction in some of these services. Strategy To match service provision (beds) to demand Health Service example Stories from the Bed alignment Strategy over Christmas Data Introduction Goals of the toolkit Overview and strategy Health service team Processes Data Resources Diagnostics and tools Click to continue Page 5 of 8 Back to menu

21. Data Introduction Health Service example Stories from the Bed Alignment Strategy over Christmas Goals of the toolkit Overview and strategy Health service team Processes Data Resources Diagnostics and tools Click to continue Page 6 of 8 Back to menu

22. How Provision of baseline meaningful data to executive to enable planned system wide reduction in service to meet predicted and actual demand. Regular meeting with core senior management to plan service provision and monitor reduction over the Christmas period. Close work with Bed Managers and After Hours Administrators to ensure beds remained closed, opening only once all ward areas flexed open using the 50% rule under the Nursing EBA. Health Service example Stories from the Bed Alignment Strategy over Christmas Data Introduction Goals of the toolkit Overview and strategy Health service team Processes Data Resources Diagnostics and tools Click to continue Page 7 of 8 Back to menu

23. Success? Savings of 1.5 million over Christmas Period Where to Now Identified need to continue bed alignment process as ongoing process. Identified need to establish accurate and consistent data collection processes across the health service. Identified need to establish accurate information based on bed day utilisation rather than ward occupancy for planning. Development of appropriate meaningful reports to assist senior management in planning service provision for future. End of section Data Introduction Health Service example Stories from the Bed Alignment Strategy over Christmas Goals of the toolkit Overview and strategy Health service team Processes Data Resources Diagnostics and tools Back to menu

24. End of section Resources Introduction Implement a bed management system on screen saver, that feed live information on: - Bed occupied - Bed being cleaned - Bed available Establish ‘control room’ for bed management Use conference calls to identify bed stock (minimum daily) Implement IT system which assists with planning length of stay management and occupancy Join bed management with key daily contacts in emergency department and wards Implement escalation policy for bed management Identify the number of beds which will be needed out of hours, and allocate management responsibility to maintain stock required Identify when grand rounds with managers and clinicians are needed to problem solve delayed discharges Manage delays in discharge around public holidays or special events by boosting day surgery activity to allow time for discharge rounds Bed management team and nurse unit managers to rotate as bed manager Day case to be booked following public holidays, school holidays. Goals of the toolkit Overview and strategy Health service team Processes Data Resources Diagnostics and tools Back to menu

25. End of section Diagnostics and tools Introduction • Bed management questionnaire • Rigorous diagnostic handbook Goals of the toolkit Overview and strategy Health service team Processes Data Resources Diagnostics and tools Back to menu