The Health Foundation. Evidence Scan: Improving patient flow across organisations and pathways. Dr D de Silva. November 2013

 Presented by:Alex Kennedy


Patient flow is a domain of quality within healthcare. All patient care pathways can benefit from improved flow – in terms of improved safety, financial benefits and improved patient experiences.

Design & Setting

Think tank review of over 5000 papers where analysis and changing flow methodology had been implemented.


UK and international healthcare organisations. All patient pathways, although focus on unscheduled care.


  1. Change in analysis of flow
  2. Change interventions for improving flow


  1. Improved flow
  2. Patient safety
  3. Patient satisfaction


Improved analysis techniques included:

  • Assessing service use
  • Capacity and workflow planning
  • Simulation and other forms of modelling
  • Queuing theory
  • Failure mode and effects analysis
  • Systematic feedback from staff
  • Structured observation and ethnography.

Improved flow implementation techniques included:

  • Reducing variation
    • Continuous QI approaches (Lean/ six sigma)
    • Real-time management – to assess priorities
    • Match capacity to demand
      • Adding capacity, changing skill-mix
      • New roles – patient flow co-ordinators
      • Proactively planning discharge
      • Pull not push people through the system


Analysis and improvement techniques for addressing flow can be directly transferred from other healthcare organisations  and also other industries. For example techniques to improve patient flow in A&E can be adapted to work in an NCEPOD pathway for unscheduled surgery.


Global approach to addressing flow. Particular focus on unscheduled care pathways.


Not specific to particular patient pathways (applied to all healthcare).


This paper provides a platform to implement some of the interventions described. A focus group discussion identified improvements in our local hospital’s NHFD/hip fracture pathway as a result of adapting the techniques used in this paper.

Potential for impact

Significant benefits to perioperative care pathways and all pathways in hospitals for improved efficiency, safety and cost saving.