I had a minor accident the other day. I was washing up a glass and I was forcing my hand down into the bottom to get it properly clean, the glass broke and I cut my little finger. It cut, what seemed to me, a big flap on my finger. There was a bit of blood and I stuck a dressing from my first aid kit on it. I resolved to go to Accident and Emergency to get them to check that there was no glass in the cut.
I arrived at the local A&E and had to queue for reception where I had to give my name and then fill in a basic form with name, address, my GP etc. That took five minutes. I then sat for about twenty minutes until called by a triage nurse who asked me what happened, clarified some things on my details. That took about three minutes. He then asked me to go back and wait. Which I did. For about fifty minutes. Then I was called through and was seen by a nurse practitioner who dressed the cut and gave me a tetanus shot. This took about five minutes. All done. No glass in the cut. Off you go.
Not too bad I thought. I then thought back on the steps and wondered if for my personal journey it might be better to have the nurse practitioner and the triage nurse doing the same job. So that instead of the triage nurse assessing and sending people to sit down again they could dress my wound straight away. And if you took the two people who were doing their respective triage and practitioner jobs and had them do both, lots of people with minor (and it was very minor!) injuries could be out much quicker.
Now we have to be careful here. I am a sample of one and before you redesign a flow you need to take into account the total demand on a system. The story above is one incident in an Accident and Emergency department, the system as a whole would need to be examined.
The other interesting problem is the queuing to see the receptionist. Would we want our new triage/practitioner nurse to do that job as well? I don’t know. But the clever part is that if we understood the process better and worked to understand the type and frequency of demand, the people who worked there including the receptionist and the nurses would be able to tell me better than I can tell you whether that was a good idea or not. The best thing a consultant or manager can do is give people the skills to investigate and understand for themselves how their work works so they can make improvements on their own system. So I am not worried that I don’t know, because we would together.
Also while we are adding complexity. Should we just look at A&E in isolation? What about admission to wards? What about ambulance services? How about NHS Direct who tell people to go to A&E? And not forgetting GP services. They all fit together into a wider system of which an A&E department is but a small part.
The finger is healing nicely by the way. I wouldn’t want you all to worry.