Three Panoramic Views

It's not just the wide sweep

One of the selling points of Flowopoly has always been that it enables a panoramic view of the whole system. And that this panoramic view is rarely afforded by either real life or by data that tries to describe real life.

Scene from a Flowopoly replay of Western General Hospital, Edinburgh: October 2014.

But it's taken me a while to fully realise the importance of this panoramic view. In fact, there are three separate elements to it, and it's only when these three elements combine that we get the full benefit of the Flowopoly treatment.

The sweep of the landscape
The first and most obvious (obvious because you see it as soon as you walk into the room) panoramic element is the full extent of the static image. Before the replay begins—and in fact at any subsequent time when the replay is paused—you can see at a glance what each part of the system looks like. There aren't any blind spots. If you are in the Emeregency Department (ED), you can also see what the Acute Medical Unit (AMU) looks like, and what each and all of the many downstream wards look like, and so on. And you get these views simultaneously. In one eye-sweep.

It's not easy to do this in real life. Walls, ceilings and staircases get in the way. Quite often the downstream wards are spread out amongst different buildings, even.

The way we use data to capture these static snapshots so that we can mimic a panoramic view – it's patchy. We can often get a sense of how full each part of the system is at any one time, but the drawback to this is that there can often be delays getting the information so that it's all bang up to date. Also, fullness isn't the only thing we need to look at.

The decisive moment
The second panoramic element is more specific. It's to do with moments: those moments when patients move from one part of the system to another. Flowopoly lets you see what happens in the moment. When a patient's next port-of-call is somewhere else within the system (as opposed to their next-port-of-call being home) the patient's card is coloured grey. We make the transfer moments more visible than the non-transfer moments. Moreover, we also print each patient's next port-of-call on each card so that we can see where they are bound for.

But our attention is drawn to the grey cards at very specific moments. Let's suppose for example that it's 11:43am and the patient in question arrived in the ED just over four hours earlier at 7:42am, so we've been alerted to this patient's predicament because breach moments get called out in Flowopoly. This means when we look at the card to see what the problem might be, we can look at how full the ED is at 11:43, how full their next port-of-call is at 11:43, and also we can see that the medical wards beyond AMU are also all full at 11:43. Flowopoly alerts us to the fact that the panoramic view is more important at the moments of dysfunction and the moments of transfer. We don't just need to look at the whole system at any old point in time; we need to look at it more closely at these specific moments in time.

The history prior to the moment
The third panoramic aspect is that Flowopoly adds in a 'history' element to the panoramic in-the-moment view. A few months ago I was trying to get my head around what happens in those patient flow moments when a patient leaves the AMU and gets transferred onwards into a downstream medical award. I figured there were two separate viewpoints of these transfer events. One was the perspective of the AMU, where the main thing that is 'visible' was the patient's length of stay in AMU prior to transfer (and how much of that length of stay was 'surplus to requirements' since they were only there because they were waiting for a bed to become available). And the other viewpoint was that of the downstream ward, where the main thing was how many empty beds they had at the time the transfer took place.

(I have spent quite a lot of time since then theorising about whether patients who are transferred to downstream wards in times of plenty (and by 'plenty' I means empty beds being in plentiful supply) get there more quickly than patients who are transferred when beds are tight.)

But the panoramic observation is that what we are adding to the transfer moment is some historic information. In the case of the AMU it's how long had the patient spent in the AMU already, prior to moving out. And in the case of the downstream wards, the historic infomation was what was the occupancy in the minutes and hours preceding the transfer.

So this third element is to do with freezing the moment and then taking the opportunity to look at what was happening in the run-up to that moment. And this historical view also needs to be panoramic because there are two sides to every transfer story: what had been happening to the patient in the run-up to the transfer, and what had been happening to the ward capacity in the run-up to the transfer.

[24 February 2020]