From Beer to Nosokinetics - it’s all in the flow! – Part Deux.

Tony Coles is Director at Portbury Clinical Management Services Ltd. He tweets @antonseloc

Part 1 of this riveting tale of healthcare business management, as seen through the eyes of an erstwhile trader in beer, set the scene. Based on the belief that only true understanding of a problem leads to effective, longer term solutions; the quest to understand how the persistent, stifling issue of poor patient flow might be resolved was undertaken. That path of learning had led to ‘Nosokinetics’; how the word had been coined, and how energy and effort had led to its limited proliferation as both a term and associated science.……. and then the mystery?

Both word and interest in it had seemingly fallen off a cliff and, with the recent passing of the man behind it all, the solving of that mystery was dealt a blow. These blogs seek to see both the mystery resolved, and the pervading problem of poor ‘Nosokinetics’ within the modern-day NHS explored and discussed.

First the word.

In the first of bi-monthly newsletters published from 2004 to 2010, Professor Peter Millard stated that a New Year resolution was to get the word ‘Nosokinetics’ into Google. He detailed the etymology of its construct and offered definition as “how health and social care systems manage sick people”. He added that ‘Nosodynamics’ was “how the different parts of the total system interact”. Through subsequent published newsletters, many contributed to establishing the word and the science involved as a route to both understanding and addressing the many complex issues related to the management of patients through the healthcare system. And then the alarmingly sudden and (to me at least) mysterious cessation - the word was but Brownian dust in the swirling air of patient flow terminology.

Consider that in 1985 the term ‘Care Pathway’ was introduced and is still very much in use now. The concept is described as ‘a multidisciplinary healthcare management tool based on healthcare plans for a specific group of patients with a predictable clinical course, in which the different tasks or interventions by the professionals involved in the patient care (physicians, nurses, pharmacists, physical therapists, social workers etc.) are defined, optimised and sequenced either by hour (ED) or day (acute care). Outcomes are tied to specific interventions.’

Given this detailed description of the route a patient takes through a health care system, ‘the mathematical study of how patients flow’ through it leads to thinking that the word ‘Nosokinetics’ be considered not as “how health and social care systems manage sick people”; but possibly as

“the science involved in the progress of patients through a care pathway wherein the concept of multidisciplinary healthcare management is captured within the inherent Nosodynamics associated with the system.”

It may be a bit more long-winded for sure but given the extremely complex nature of the beast which it seeks to define, might not that be excusable?

And complex it surely is. In the February 2010 issue of ‘Nosokinetic News’ it was stated that ‘No longer is it good enough to compare and contrast the process of hospital in-patient care, to plan and to set targets simply in terms of numbers of beds allocated and occupied, admissions and discharges and length of stay at discharge. For the needs of an ageing population are more complex than that’.

However, there appears to be little evidence of many NHS Trusts being good at that which was no longer good enough! The issue of patient flow and ‘bed-blocking’ (when it was okay to call it that) was, and persists, as the thorn in the side of [NHS] healthcare business proficiency to this day.

But why? It can’t be stressed enough how complex the issue is but with the importance of a solution to such a long standing problem, comes reward and thus the attention of the great and good. The February 2010 publication alone, refers to the many who were doing sterling work in mathematical modelling of ‘flow of patients through health and social care systems’.

In this more up-to-date digital world of algorithms, deep learning and A.I, the pot of gold rewarded to whomever provides the solution must surely be incentive enough to seek it. And, of course, many do.

However, while much may be undertaken to investigate, analyse, interpret and theorise; most if not all NHS hospitals are struggling with the business efficiency of seeing elective and non-elective patients.

The thought thus emerging is - maybe that’s why it remains? The web constructed about the solution has become as complex as the problem itself!

If ‘Nosokinetics’ is the study of a system presenting such a complex problem, might anyone offer a word to define the complexity of the system seeking a solution?

The quest continues….


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