Niche In-Brief Spring 2018 - Page 1

The consciousness issue - Spring 2018
Welcome to In-Brief
Welcome to our spring edition of Niche In-Brief; our subscription only collection of insights and articles from our
practitioners and partners. As NHS staff are challenged to cope with the current artic spell of weather, this edition
provides insights on areas where our clients can start to think about different approaches to the way they deliver (and
measure) services; whether that is finding better ways to measure length of stay, evaluating KPIs or rethinking the way
we deliver dementia services in the UK. 2018 will be an exciting year for us as we integrate Mental Health Strategies
under the Niche Consulting banner, making a bigger company with a much broader portfolio to offer our clients. We
hope you enjoy this edition and we will see you again in the summertime.
...Why we should all stop obsessing
about average length of stay…
In this edition
Average length of stay
Page 1-2
The well-led ward
Page 2
Rethink dementia
Page 3-4
Exec-team dysfunction
Page 5
The new interims
Page 6-7
Conscious change
Page 8-9
Troubling KPIs
Page 10
A Visyon for the future
Page 11
The average length of inpatient stay (total number of in-patient nights
divided by the total number of discharges) has become a key metric of many
services. It is, however, a metric which we would only use as a starting point,
never as the end-point, for a service analysis. There are five reasons why this
common indicator should, we suggest, be approached with much more
1. It is unclear what good is, if taken in isolation
What is a “good” average length of stay? Is it the mean? The median? Less
than the average? More? We can only have a view on this if we also
understand the outcomes of that inpatient episode, whether in terms of clinical
outcomes, or safety, or patient experience, or readmission risk. If all of those
are similar or better, a shorter length of stay can be properly argued to be
more efficient. But if some of those are worse or unknown, we cannot sensibly
comment on the “right” length of stay for a service.
2. Programmes of action need to be different for different length of stay
If we wish to improve throughput in a given ward or service, our actions will be
very different to address, for example: very short-stay admissions, who should
perhaps never have been admitted; very long-stay admissions, potentially as
delayed transfers of care; patients staying slightly above the median, with
delays in the delivery of controllable elements of care. If we only know the
average length of inpatient stay, we will not know the size of any of these
groups, nor the volume of bed-days they are using.
3. Intensity of input needs to be understood across community and
inpatient services
If a shorter length of inpatient stay leads to much more intensive and long-term
community care, is that an improvement? If a longer length of inpatient stay
permits a much shorter period of community care, is that an improvement?

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