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Systems and culture

Decision-making and operational data for patient flow management


The term ‘patient flow’ refers to the movement of patients through a hospital or other healthcare service, from pre-admission to discharge. It requires the management of resources and processes to deliver effective and safe care for patients throughout the care pathway.

Improving patient flow has been shown to reduce waiting times through emergency pathways, and to improve the quality of care and experience for patients. However, as NHS trusts typically operate close to maximum capacity, there are many constraints which impact on patient flow. Clinicians and managers must make time-pressured decisions about the sequencing and scheduling of patient transfers, against the backdrop of a complex and dynamic system.

This project is studying how decisions about patient flow are made in practice on acute medical units. We are looking at how situated experience (the development of expertise in a specific context), cognitive heuristics (the rule of thumb strategies that allow people to make judgements quickly) and operational information, such as forecasts, are used to make decisions.


The project is using a case study approach to study how patient flow is managed within acute medical units in two large NHS trusts.

Our researcher is spending time in the units, observing in detail how operations managers and unit coordinators manage patient flow on a daily basis. The extended field observations are complemented by cognitive task analysis interviews with these professionals. This technique is used to uncover the tacit strategies used by experts (for example, picturing the situation a few hours ahead), that may be otherwise difficult to elicit. The research also involves quantitative analysis and applying forecasting methods to admissions data to identify trust-specific patterns to aid patient flow management.

The project report will provide a detailed analysis of how professional knowledge and experience is combined with formalised data systems to make decisions about patient flow management.

Project team

Funding and ethics

This study is funded by the Health Foundation’s grant to The Healthcare Improvement Studies Institute (THIS Institute). It is independently led by THIS Institute and the University of Bath. The study was reviewed by the University of Bath Social Sciences Research Ethics Committee and approved by the HRA.

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