HFMA 2017: Colour scheme supports flow improvement

This was the key message to delegates attending a workshop on the opening day of the HFMA annual conference in London. Richard Brownhill, improvement manager at NHS Improvement, introduced the Red2Green programme, which aims to help providers identify wasted time for patients on inpatient wards in both acute and community settings.

Part of the improvement body’s SAFER patient flow bundle, the Red2Green process sees days marked red when a patient no longer needs acute level of care or when the next step in a patient’s care doesn’t happen. If an investigation is undertaken, the day remains red until the result of the investigation is acted upon.

The aim is to identify the constraints that prevent red days being converted to green, with ward teams reviewing the top five constraints at the end of each week.

Mr Brownhill said the process helped to reduce variance and reduce length of stay. ‘It takes a lot to be able to actually reduce costs [by reducing bed numbers] but it is possible,’ he said. But he added there were other major benefits from improving flow. Earlier discharge of patients could improve the flow in the emergency department, which could both help improve patients’ health overall as well as well as support access targets.

Jo Richardson, national therapy lead at NHS Improvement and also involved in the Red2Green programme, added that it was important not to use the approach to target blame on particular areas. ‘Red2Green is not a performance management tool,’ she said. ‘Don’t performance manage the number of red days. You want to encourage areas to declare. Red days are a learning opportunity for the system.’

David Thomas (pictured), urgent care lead for Worcestershire Health and Care NHS Trust, said the approach could lead to significant improvements and financial savings. The trust had seen a 30% reduction in occupied bed days in adult mental health acute wards over the 18 months since it started using the system. This has enabled a reduction of beds and a reinvestment of resources in the community.

‘We knew there were delays in flow and we wanted to understand the delays that affected most patients and the delay that accounted for the most number of days,’ he told the workshop. ‘This helped to get the issues out into the sunlight.’

Staff buy-in was important as their feedback helps to refine the approach. A simple collection system, built using a standard database package, also enables staff to log required dependency and safe staffing data. However he warned that the approach ‘won’t necessarily yield overnight benefits’ and trusts needed to give the approach ‘time and space’ to allow it to deliver.