Fri 11th December 2015 / 1:00pm to 4:15pm / Whitespace, Norloch House, 36 King's Stables Road, Edinburgh EH1 2EU

Five shades of yellow, green, blue and pink

Using colour to make length of stay visible

Flowopoly tries to make visible three aspects of patient flow, which we tend to categorise as: 1. How many? 2. How long? 3. How full? Using more specific terminology, How many? means attendances (or admissions), How long? means length of stay, and How full? means Fullness, or occupancy.

(For the arithmetically-minded, these three aspects correspond to Little's Law variables, so there is a theoretical underpinning to this—it's not just arbitrary).

The Emergency Department at Harrogate District Hospital. (Names—and other details—of patients have been anonymised to protect confidentiality)

Flowopoly is about making things visible. Specifically, it's about making visible those things that aren't ordinarily visible. One way we do this is that we create a wide-angle panoramic view of the whole healthcare system, which is a view you don't normally get (the whole hospital in one eye-sweep). Another way we improve visibility is that we speed up time (a day in the life of a hospital can be replayed in 45 minutes) so that you can see successions of patient movements in a few minutes that ordinarily would entail sitting around for hours or even days to actually witness.

But we also try to make the three Little's Law variables as visible as we can make them. How many? takes care of itself. The volumes of patients arriving, transferring and departing - all of that activity is self-evidently visible.

How full? is pretty clear, too. We have taken care to design ward boards that easily show which beds are full and which are empty, which means you can tell at a glance what the fullness is in each of the different wards and departments on show.

Three empty beds in a 23-bed ward.(Names—and other details—of patients have been anonymised to protect confidentiality)

But How long? is harder. As it is in real life, in fact. When you look with the naked eye at patients in hospital beds, you can't normally tell (not at a glance, anyway) how long all the different patients have been in for. And you certainly can't take in the length of stay experience of a whole ward in just one glance.

That has been one of the design challenges for Flowopoly. We place a lot of emphasis on using Flowopoly to enhance participants' awareness of the importance of How long? So how have we gone about making length of stay visible?

One way of doing it was to write down the length of stay on the patient cards. In fact, right from the start, we'd always made a point of recording on the cards the arrival times and departure times of patients at the various staging posts they passed through. But the trouble with this was that the cards are quite small and therefore the typeface you have to use is quite small, and also people don't really have that much time in a Flowopoly replay to start picking up cards, putting their reading glasses on and then trying to read out patients' length of stay.

So we turned instead to colour as a way of doing it.

A problem we encountered here is that we'd already used colour-coding in Flowopoly as a way of distinguishing between the staging posts. Yellow is A&E, green is assessment, blue is the acute wards, pink is post-acute. And we really didn't want to ditch this over-arching colour scheme, so our length of stay colour coding solution was going to have to live within this constraint.

So we opted for shades of the same colour. It wasn't straightforward. It took a few tweets, a few text messages and quite a lot of emails following a Flowopoly event in London in June 2015, involving references to orange non-sequiturs and ombré cakes. But we eventually arrived at a workable solution. In A&E, for example, a pale yellow card is a patient who ended up being in the department for less than an hour; whereas a deep yellow card represents a patient who ended up being in A&E for longer than four hours.

Five shades of yellow: Emergency Department length of stay

So: we made length of stay visible!

One last point. We had to grapple with the hindsight problem. This is more of an issue for wards (as opposed to A&E) but we wondered whether we should display how long patients have been in so far or do we show how long they'll eventually end up staying for?

We opted for the latter. At the heart of the Flowopoly concept is the idea that these are action replays. It's all about hindsight. So when you look at the 28 patients occupying beds in Ward 7, you are looking at a length of stay profile that reflects patients' eventual length of stay, not what it currently is.

[6 November 2015]