The Conclude Consultancy

Earlier this summer The Conclude Consultancy (TCC) completed an analysis of Day Surgery facilities in the northern region of Gothenburg, Sweden. This is now published as a Case Study. This project was typical of many that we work on, where the client wished to understand how clinical service delivery could be optimised to improve both the patient experience as well as improving the efficiency of patient flow through the surgery facilities.

In an ideal world day surgery should be a predictable and systematic process, but it must also recognise that patients come to day surgery with significantly varying needs – both from clinical wellbeing as well as emotional wellbeing perspectives. Whilst this means that the process must accommodate many variables it does not follow that it cannot be effectively managed.

On this project, TCC used their unique patient pathway method, which is one that recognises that different patients can be categorised as ‘patient types’, and as such their specific resource needs can be identified and planned for. An elderly patient with specific emotional wellbeing needs for example, should be managed differently to a younger adult patient who’s clinical and emotional needs maybe quite different. The clinical leadership team originally argued that the process was wholly unpredictable, but in analysis of the patient pathway data, TCC found that patient types could be allocated to procedure time bands, and within these time bands there was substantial predictability.

However, TCC identified that there were still significant outliers in the process where, for example,  patients displaying multiple morbidities necessitated greater complexity that often resulted in significantly longer duration in theatre, which could result in hours of delays.   Contrasting with a typical time band for the same procedure type this might only require around 90 minutes for example.  Working with the clinical leadership team we identified that these outliers could potentially be reduced by instigating an improved pre-operative assessment process, and that through this process patients displaying multiple morbidity, or other complicating factors would be treated on an inpatient pathway for surgery and not a day surgery pathway.  By this means it was determined that the incidence of significant outliers should be substantially reduce. Operational trials would seek to quantify this potential benefit.

Optimisation of Day Surgery thus analysed the whole process and sought to develop strategies with the clinical leadership team that would ensure improved predictability of it.  Simulation of alternative strategies enables the leadership team to understand ’cause and effect’ and in doing so develop new strategies focused on improving patient flow. Ultimately, it is the clinical leadership team to decide which strategies provide the best overall patient experience – TCC simply provides the data and analysis to support informed decision-making. The Case Study examines these issues.

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