From Beer to Nosokinetics - it's all in the flow!

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

I once owned little bar that (so the marketing gumpf said) served bottled beers from “all over the world”. Apart from the sheer enjoyment of small enterprise ownership, it provided practical application of basic business principles – manage your commodities efficiently and keep the customers happy with quality and service.  Limited cellar capacity meant stock could not come in through the back door unless it was being sold at equal pace through the front. If Belgian beers for instance, were selling quicker than German beers why was that and how might the stock be managed such that the varying requirements of storage conditions be met, and the flow of beer matched to the customer demands? Also, a keen eye had to be kept on the standard of service being offered which included ensuring the customer felt at ease within the facility and environment provided.

When personal circumstance however deemed it necessary, it was with a heavy heart that time was called on those days of beer and hoses. A return to the NHS eventually followed, and an administrative role within the Patient Safety Office of a small NHS Trust provided what I thought was opportunity for the ready transfer of skills learnt as ‘mein host’.

See the patients as customers said I; customers upon whose satisfaction this business of healthcare depends. If you do, you’ll see the need to treat them with polite courtesy and a willingness to please. You’ll treat them with unenlightened self-interest and most importantly of all, you’ll treat them with the bar for their safety set as high as it possibly could be. Ultimately, it’s all about customer satisfaction says I; if they’re satisfied the business has a chance. Seeing patients as customers in the manner described however was apparently anathema to many who I concluded did not understand that healthcare was no longer a Bevan-given right and had for Thirty years been thrust under the umbrella of supposed free market principle and practice.

With a subsequent new position within Trust management, I was cheered by the prospect of all about me understanding the basic business principles associated with the status of health service manager. Treating ‘customers’ whilst seeing them move through the business with expedience appropriate to their needs, satisfaction and safety was surely bread and butter? Yes, well?

The significant problem being relentlessly faced was the patients didn’t seem to be ‘moving’ too well.

It was a problem borne of many years standing and one to which none had apparently found the solution. Escalation days were almost the norm and the effect of this disparity in quantitative dynamic was the oft calamitous cancellation of elective patient scheduling. The duality of Elective/Non-Elective service provision was disrupted and the business of healthcare service continuously undermined. Worst of all, the patients suffered both as people with treatable ills and as customers of a service they held dear with national pride. Satisfaction could only be at its lowest.

In that previous life, more Belgian beers being sold provided valuable space in the crucial but limited resource of the cellar. If German beers were not so fluid (if you pardon the pun) in their trading, the danger was stockpiling to levels that saw limited resource blocked. Whilst postponement of the order for more German beers offered temporary solution, a contract for price based on volume sales meant that the profit margins would be cut, and business profitability reduced. Continuance could escalate the harm so the issue had to be analysed, understood and addressed by appropriate action.

Not so simple in the NHS though I hear the cry. The flow of patients through the business cannot be controlled in the same way as bottles of beer! You cannot understand the NHS and how it works if you think it can!

So, understanding was sought and in so doing the science of patient flow and bed management became the Holy Grail of that understanding. In my Percivallian quest I saw many had trodden the same path but with one treading clearer and truer than most. Professor Peter Millard, recently sadly departed of this mortal coil; emeritus Professor of Geriatric Medicine at St Georges University of London, and past President of the British Geriatrics Society had invented the name Nosokinetics for ‘the mathematical study of how patients flow through health care systems’.

Nosokinetics – a great word upon which to hang the peg of my understanding and progress.  Publication of an associated bi-monthly newsletter had provided a repository of published analysis and knowledge related to the subject. Brilliant thinks I; and with glee noted all that had been written and provided to those interested up to 2010. Then the newsletter stopped and Nosokinetics apparently lost to the sands of time!

Why what happened?

A second blog will follow but if you can help answer that question, please contact me – it may even be worth a beer! You can email me on awc [dot] pcmservices [at] outlook [dot] com or tweet me @antonseloc

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