Friday’s launch of the ‘100 Day Discharge Challenge’ – coming less than 24 hours after most ICSs submitted bids to be ‘Discharge Integration Frontrunners’ – if nothing else, shows the current anxiety surrounding acute hospital flow and discharge outcomes among health and care executives.
The 10 best practice initiatives set out within the letter looks to build on, and codify, work which many systems have already made significant progress in delivering against.
Most system leaders would, however, say the challenge is not so much in identifying the solutions, as creating the capacity and infrastructure to deliver them. In this context, while a 10-point list will help framing action, some elements will proceed more quickly than others and systems will need to strike the right balance between putting the right infrastructure in place (e.g. demand and capacity modelling) and stepping into delivering frontline change.
IMPOWER’s Age of Intermediate Care report, co-produced with the Association of Directors of Adult Social Services (ADASS), provides a helpful structure for a cohesive approach to delivering the outcomes the challenge is looking for, that builds the change from frontline ownership and impact. We have mapped the 10 best practice initiatives against this cross-sector structure:
We must start with culture and behaviour change:
- Identify patients needing complex discharge support early
- Ensure multidisciplinary engagement in early discharge plan
- Set expected date of discharge (EDD), and discharge within 48 hours of admission
- Ensuring consistency of process, personnel and documentation in ward rounds
- Treat delayed discharge as a potential harm event
And then focus on the new forms of working / models of care required to support the best outcomes for individuals:
- Apply seven-day working to enable discharge of patients during weekends
- Streamline operation of transfer of care hubs
- Revise intermediate care strategies to optimise recovery and rehabilitation
We must then examine workforce and financial sustainability:
- Develop demand/capacity modelling for local and community systems
- Manage workforce capacity in community and social care settings to better match predicted patterns in demand for care and any surges
Taking this approach means that systems can go further, faster. In essence the ‘100 Day Challenge’ is asking systems to have a plan and infrastructure in place to deliver. That takes us to 30th September, by which point the window for innovation to pre-emptively tackle winter pressures may well have passed.
IMPOWER’s work with Somerset, Dorset and other systems has highlighted that it is possible to make immediate and substantial impact on flow and outcomes – driven by behaviour changes, improved multidisciplinary team connections and a clarity of focus on meeting patient outcomes.
Lost in the wave of initiatives is the biggest learning point that I’ve taken from the past twelve months working on integrated flow; to deliver sustainable impact, initiatives must be given time to deliver and become owned by frontline staff. The systems that hold their nerve and back themselves to do this will reap the rewards.