Get all on board to devise your A&E solutions

The very first step to improve operational performance in the emergency pathway should involve building true alignment among hospital and partners (primary care, social care, and commissioners) by highlighting, quantifying, and most importantly, agreeing the root causes of poor performance.

‘The next step should involve developing transformation initiatives addressing the root causes’

It involves extensive discussions across the entire system based on analytical insights that “attach” accurate numbers to specific bottlenecks that everyone in the system agrees. It focuses on building consensus and agreeing priorities which provides the basis for a “change story” or narrative that the whole system aspires to.

Building on the consensus and commitment generated by this shared narrative, the next step should involve developing transformation initiatives addressing the root causes.

What is important?

Often there will be numerous initiatives happening across the system. It is essential to prioritise the key actions within a structured improvement programme to which all the partners commit and contribute to.

Maintaining a focus on quality and safety is key.

Processes, systems and behaviours all need to be addressed in a joined up way, in areas beyond the acute provider such as community, and social care.

Specifically, a structured improvement programme could address each of these areas.

‘Regular reporting is needed to support the appropriate dialogues’

It is imperative that the system establishes performance dialogues supported by the appropriate metrics along the whole of the emergency pathway.

This would include agreeing the appropriate metrics and pulling together existing data sets from all partner organisations into an appropriate format – for example, a dashboard – which can be easily understood and lends itself to action.

For robust “real time management” of the pathway, regular reporting is needed to support the appropriate dialogues. They can be implemented in various ways:

• Real time reports are generated multiple times per day to facilitate proactive management of the pathway and are used in bed meetings and in executive short discussions.
• Daily performance reports enable teams to track and understand “yesterday’s” performance across the hospital.
• A weekly dashboard provides an overview of “the week that was” so that appropriate action at the system level can be taken.

Andreas Hadjitheoris is associate principal at McKinsey

These presentations were given at the Emergency Care summit held by HSJ and the McKinsey Hospital Institute on 12 February. The event was held under Chatham house rules but presentation speakers have given permission on being identified.