Action replay for healthcare systems

Flowopoly is a way of replaying patient flow reality. In a highly structured and highly participative way. It enables NHS staff to see how patient flow does and doesn't work in a complex system.

Western General Hospital, Edinburgh: 17th October 2014

It's a re-enactment of unscheduled care reality. In its pure form you take a bad day in the life of a hospital (with "bad" usually but not exclusively defined by that day's compliance with the ED four-hour target) and you replay it in a reasonably large room with A2-sized boards on tables representing wards, and with cards representing patients...

Flowopoly at NHS London HQ: 30th June 2015

...and someone gets nominated to call out the patient movements as they happen ("8:03. Arriving in A&E. Jane Smith. 8:07. Transferring from A&E to Surgical Assessment: Jack Liddle."). Each patient move takes about seven seconds to read out and execute, so you can play out a day's activity in a medium-to-large general hospital in about 45 minutes.

(You don't have to replay the full day. If the gist of it can be discerned by doing it from - say - 8:00an to 4:00pm, we'll do that. Time and attention spans and all that.)

It's not non stop. We pause for thought and reflection maybe twice or thrice. We sometimes use the pauses to swap roles. The people manning A&E get a rest from their manic.card-moving duties and the folk who hitherto have been dealing with the wards then have to give up their sedate lifestyle and get a taste of Armageddon.

Once the bad day is over, the tables are cleared and the cards get changed and it's time for the good day.

We encourage compare and contrast.

More pauses.

The good day done. Coffee.

The second half of the half day is less physically demanding on the participants but more demanding mentally.

There's a point to all this faff. There's a punchline we're trying to get to. Several punchlines actually.

Sometimes Flowopoly is about a specific post mortem. Sometimes you pick a specific day (usually a worst day in living memory type of day) and you watch what happened and it's all incredibly interesting and everyone can remember how the actual real life day went and sometimes there are arguments but this can lead to very specific actions being identified.

But Flowopoly works best when the bad day and the good day are chosen because they were typically bad and typically good. This makes it much easier to generalise from the experience. The characteristics of the bad day.

The point of Flowopoly is that it helps people see the cause and effect mechanisms in a healthcare system, and it helps people work out what the "right" performance indicators are for the system. Not the outcome indicators but the process indicators: what are the right activity levels, the right lengths of stay, the right bed occupancies that will enable the four-hour target to be met. And the reason we go to all the trouble of recreating a healthcare system in table-top format is that it helps get everyone onto the same page, it builds a shared mental model of what the healthcare system looks like. Not only that but by making the replay focus on individual patients and individual patient movements, it helps to break down the barriers between the aggregated data view of the world and the individual patient view of the world.