Abstract

Hart A, , Dodds S. Improving Ambulatory Care in a Large Tertiary Emergency Department. Journal of Improvement Science 2019: 55; 1-22.

NHS unscheduled care performance has been deteriorating progressively over the last seven years. In early 2018, the Staffordshire Clinical Commissioning Group (CCG) commissioned an innovative improvement approach as part of a package of measures to support University Hospitals of North Midlands (UHNM) NHS Trust. Four front-line teams were trained in the foundation principles and practice of health care systems engineering (HCSE) as the first phase of developing embedded capability in complex adaptive system (CAS) improvement-by-design. This is the story of two of those teams: The emergency department (ED) and the transformation team (TT).

The collaborative ED microsystem design team (ED MDT) focussed their attention on the ambulatory stream of ED patients, 70% of which do not require hospital admission. An experienced HCSE practitioner facilitated the ED MDT sessions and coached the individual members of the team in the practical skills required. The outcome is a first wave of HCSE Level 1 competent NHS staff in one organisation who have learned the important lesson that when the co-ordinated, collaborative HCSE approach was used the ED ambulatory stream performance significantly improved, and when a less coordinated approach was employed the ED ambulatory stream performance significantly deteriorated.

Ambulatory; Carveout; Emergency Department (ED); Health Care Systems Engineering (HCSE); Healthcare; Training