Jonathan Back, Centre for Applied Resilience in Healthcare, King’s College London
The term “fog of war” refers to the difficulty of maintaining an accurate awareness of quickly evolving situations in which mistakes can be fatal. Similar uncertainty, which we term the “fog of patient flow”, is involved in managing the flow of high numbers of patients through a busy Emergency Department with multiple care pathways. Ensuring efficient flow is an important indicator of system performance. In this paper we reflect on the role of patient flow co-ordinators and the difficulties involved in maintaining awareness of a complex system. We present findings from an ethnographic study of a large NHS A&E Department (Emergency Department). The aim was to understand the department’s capacity for resilient performance from an organisational perspective. Guided by a theoretical model of resilience in system performance, our investigation focused on the ability of the system to adjust and adapt to produce good outcomes despite the misalignment of demand and capacity. Over 100 hours of observational data were collected over a period of 18 months. For the purposes of this paper we report on the role and responsibilities of Patient Flow Coordinators (FlowCo).
The specialist FlowCo role was created to facilitate the patient flow in an environment with multiple demands and competing priorities. The Flow Co acts as a ‘fire-fighter’ who monitors processes, identifies bottlenecks, and takes actions to improve flow.