Payment for hospital discharges is wrong

Addenbrooke’s Hospital in Cambridgshire has introduced cash incentives to reduce bed blocking, says the BBC news website. From the article:

Addenbrooke’s Hospital wards will get £1,000 if they discharge two patients by 10:00 each day for a week and £5,000 if they manage it for a month.

The “Two out by 10” programme has been introduced by Dr Keith McNeil, who took over as the hospital’s chief executive this year.

This is a classic example of an arbitrary numerical target made worse by offering a monetary reward. The focus of the ward managers and staff every morning will be identifying the two patients they can ship out as fast as possible so they can get the cash. It may very well lead to some people being discharged before they should be which may cause unnecessary admissions or further treatment.

Moreover, staff will go hell for leather for the first two patients to meet the criteria and other patients will fall back into the old system. By focusing on the discharge plans of the first two patients, it may be the case that everyone else’s plans receive less effort, worsening the problem as a whole.

Dr McNeil says,

“The idea is to get everyone involved in improving patient flow in a pre-emptive way, rather than leaving it to the last minute.”

These are the right words but entirely the wrong actions.

If they want to improve discharges to free up beds, they should understand the factors that cause the current performance, understand what is important to patients about discharge and then measure the variation to see what they system is capable of. Then and only then can they start to make improvements to the whole system of care, not just the discharge procedure, so that both care and discharges are improved.



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