Access & Flow with Barnet, Enfield and Haringey
Barnet, Enfield and Haringey NHS Trust (BEH) are a large provider of integrated mental health services within North Central London. The trust identified several patient pathways that they wanted to focus on. One year on from graduation, we look at the progress of one of the Big Rooms at BEH, called Access and Flow.
Barnet, Enfield and Haringey NHS Trust (BEH) are a large provider of integrated mental health services within North Central London. Serving a population of 1.2 million, employing more than 3,300 staff, and operating from over 20 main sites in the community.
The team at the trust look after people’s mental and physical health in their hospitals or in the community. In 2020, the trusts Deputy Director for Quality Improvement, Alison Brandon began conversations with the Flow Coaching Academy about building local capability to Flow Coach their improvement initiatives.
The trust identified several patient pathways that they wanted to focus on, Rapid Response Service, Rehabilitation, Access to Mental Health and Child and Adolescent Mental Health Services, they sent 17 coaches to train on the first virtual online course in 2021.
One year on from graduation, we look at the progress of one of the Big Rooms at BEH, called Access and Flow.
The Access & Flow Big Room context & challenge
The Access & Flow Big Room is concerned with the service users’ journey through acute care and the significant imbalance between demand and capacity.
It launched during the Covid-19 pandemic, a time that staff were overstretched and working in unknown and changing environments. This contributed to the complexity of already convoluted processes, often making it difficult for prompt discharges from inpatient services and increasing pressure on the system.
Trust-wide Access and Flow is a very complex pathway, with multiple stakeholders across the 3 divisions, with variation in resources, demographics, and local partnership arrangements. This complexity has resulted in unwarranted variation, health inequalities and variation in service offers.
For the patients and families in the pathway, the experience can be stressful and costly for their mental well-being.
Whilst teams on the frontline were trying to react to the challenges, and doing everything they could. The QI team at BEH recognised that their actions and improvement initiatives could be more effective if they had improvement skills, tools, knowledge of using data and a methodology (how) to join up their actions into effective improvements.
The Access & Flow Big Room Journey at BEH
The Journey began with training with the Central FCA on their first ‘virtual/e-eLearning based course. After 3 months on the ‘Improving with People First course the team began using their coaching skills to create the right conditions to set up their Big Room; focusing on pathway and system stakeholders’ needs. With the participants identified and gathered in their first meeting the coaches Dr Khalid Aziz, Alison Brandon and Caroline Bete began working with the team to build a compelling vision.
The Access & Flow Big Room vision:
To minimise trauma to service users in their journey through Acute care and ensure a smoother transition into the community.
With their Flow Coaching QI methodology knowledge building and with the FCA Roadmap as a guide, they developed a deep level of understanding of their very complex system and set their aims…
The Access & Flow Big Room aims
- Develop a unified Access and Flow pathway – minimising unwarranted variation.
- Finding effective ways to prevent hospital admissions, reducing length-of-stay and facilitating early discharge – improving patient outcomes and reducing associated healthcare costs.
- Contribute to developing a culture of continuous improvement,
Through engaging with stakeholders, empowering and coaching teams with skills to do the work and verbalise their change ideas, they have created a movement of continuous improvement across their Access and Flow care pathways.
“The Big Room has enabled ‘a generation of good ideas from different professional groups“
Pathway Service Lead
The Access and Flow Big room is described by the coaches as a collaborative space to bring people together across the Acute Adult Care Pathway (Access and Flow) to build long-lasting relationships and create a better understanding of the patient pathway.
“The Big Room has enabled us to make changes across the patient pathway, and create a continuous improvement culture. We have achieved this by empowering our teams to work with a common methodology across our network, which has created a shared language for improvement and a willingness to learn from each other’s successes”.
Alison Brandon, Deputy Director for Quality Improvement
Key Achievements of the Access and Flow Big Room
- Collaboration with external stakeholders is influencing admission avoidance.
- Development of High-Intensity User project
- Development of Care of Deteriorating Patient project
- Teams working more with available data.
- Engagement with Service Users has identified issues and potential change ideas
- Increased support from the Local Authority and the provision of two Social Workers in the Division
The Impact of the Access & Flow Big Room on Patients and Staff
The Big Room has been running for 18 months and will continue to run as the pathways methodology for making improvements to the patient pathway. To date, the team, believe their impact on patients and staff has been…
Patients:
- A reduction in length-of-stay in some divisions.
- Staff are now focused on the patient experience across the whole pathway.
- Some achievements in reducing out-of-area placements.
- Increased share of voice and influence in changing their experience.
Staff:
- Staff have a better understanding of the flow of patients.
- A culture shift to everyone being responsible.
- A flattened hierarchy where everyone can suggest ideas.
Next Steps for the Access & Flow Big Room
BEH are committed to maintaining the Big Room and are exploring creating a divisional approach to maximise the learning and manage the complexity. They are currently training more coaches with the central FCA Team to support their growth ambitions.
The improvement teams are supporting the Big Rooms to create a space that can support using visual displays of the pathway work, measurements, and change ideas. They believe this will enhance cross-division working and support them to broaden their knowledge of the Big Room activity beyond the participants.
