Leveraging Internal Professional Standards to Optimise Patient Flow

Why this topic matters

Patient flow refers to the movement of patients through a healthcare system, from their initial presentation to discharge or transfer. Delays at any stage impact patient experience, can worsen clinical outcomes, and contribute to staff burnout. Improving flow is not just about bed management; it encompasses timely diagnostic testing, efficient ward rounds, clear communication, prompt discharge planning, and effective handover processes. While national initiatives like GIRFT (Getting It Right First Time) highlight best practices, their successful implementation often hinges on local ownership and consistent application of high standards.

Internal professional standards are the 'how-to' of your department's operations, detailing expected behaviours, processes, and communication within the confines of established clinical guidelines. By clarifying these expectations, teams can proactively address common friction points in patient flow that might otherwise persist due to undefined roles, assumptions, or variations in practice.

Practical explanation: What are Internal Professional Standards?

Internal professional standards are a set of explicit, locally agreed-upon principles and practices that guide how a clinical team or department functions. These go beyond statutory requirements or core competencies, which typically describe 'what' a clinician must do. Instead, they define 'how' professionals within a specific team or service will operate to deliver timely, high-quality, and compassionate care, especially in areas critical to patient flow.

Examples of areas where internal standards can significantly impact patient flow include:

• Timeliness of Clinical Actions: Setting clear expectations for the completion of ward rounds, review of investigations, prescribing within defined windows, or patient handover procedures.
• Communication Protocols: Defining how critical information is shared between team members, across shifts, or with other departments (e.g., agreed-upon structure for referrals, use of electronic systems, response times to urgent queries).
• Documentation Standards: Specifying the level of detail required in notes for effective handover, discharge summaries, or referrals, ensuring clarity and avoiding ambiguity.
• Multidisciplinary Team (MDT) Working: Establishing clear roles, responsibilities, and expected contributions from various disciplines within the MDT, and protocols for efficient meetings and decision-making.
• Problem-Solving and Escalation: Defining mechanisms for identifying and addressing roadblocks to patient flow, and clear pathways for escalating concerns.
• Discharge Planning: Standardising the initiation of discharge planning from admission, ensuring timely completion of TTOs, transport arrangements, and patient education.

These standards are most effective when developed collaboratively by the team members who will adhere to them, promoting ownership and practical relevance. They should be measurable, observable, and directly linked to improving specific aspects of patient care delivery and flow.

Common pitfalls

Developing and implementing internal professional standards requires careful consideration to avoid common pitfalls that can undermine their effectiveness:

• Lack of Team Buy-in: If standards are imposed top-down without consultation, clinicians may view them as an additional burden rather than a helpful framework, leading to poor adoption.
• Vague or Unmeasurable Standards: Standards that are too general ('be professional') are not actionable. They need to be specific enough to guide behaviour and allow for assessment.
• Overly Prescriptive Standards: Too much detail can stifle clinical autonomy and critical thinking. The aim is to provide a framework, not a straitjacket.
• No Mechanism for Review or Adaptation: Clinical practice and service needs evolve. Standards must be living documents that are periodically reviewed and updated to remain relevant.
• Lack of Leadership Endorsement and Modelling: If leaders do not visibly support and model adherence to the standards, the team may not take them seriously.
• Insufficient Training or Communication: Assumptions that everyone will automatically understand and apply new standards are misplaced. Ongoing communication and training are essential.
• Failure to Link to Improvement: Standards should be tied to specific improvements in patient flow or care quality. Without this link, they can feel arbitrary.

Step-by-step approach to establishing Internal Professional Standards

Implementing internal professional standards to improve patient flow can be approached systematically:

1. Identify Areas for Improvement

• Review Data: Analyse local data on patient flow metrics (e.g., length of stay, discharge delays, referral to treatment times, diagnostic turnaround). Identify specific bottlenecks or points of friction within your service.
• Team Consultation: Engage clinicians, nurses, allied health professionals, and administrative staff. Ask: "What are the common delays or frustrations in our patient pathway?" "What could we do differently to make things smoother?"
• Patient and Carer Feedback: Consider feedback from patient experience surveys or complaints related to delays or communication issues.

2. Draft Initial Standards**

• Form a Working Group: Assemble a multidisciplinary team to draft the standards. This fosters ownership.
• Focus on Specific, Actionable Behaviours: For each identified area, define clear, observable, and measurable expectations. For example, instead of "improve communication", specify "all patient handovers will utilise the SBAR (Situation, Background, Assessment, Recommendation) framework and be completed at the bedside where clinically appropriate."
• Align with Existing Guidelines: Ensure new standards complement, rather than contradict, national guidelines, local policy, and professional body advice.
• Consider Local Context: Tailor standards to your specific department's patient population, staffing, and resources.

3. Consultation and Refinement

• Wider Team Review: Share the drafted standards across the entire department or team. Seek constructive feedback from all levels of staff.
• Iterative Process: Be prepared to revise the standards based on feedback. This collaborative approach enhances buy-in.
• Formalisation: Once consensus is reached, formally document the standards. This could be a departmental policy, an addendum to job descriptions, or a clear set of guidelines.

4. Implementation and Communication

• Launch and Dissemination: Clearly communicate the new standards to all staff. Explain the 'why' behind them, linking them back to improved patient flow and outcomes.
• Training and Support: Provide any necessary training, especially for new processes or tools associated with the standards. Offer ongoing support and opportunities for clarification.
• Leadership Role Modelling: Departmental leaders must visibly adhere to and champion the standards, demonstrating their importance.

5. Monitor, Evaluate, and Adapt

• Regular Review: Schedule periodic reviews (e.g., quarterly or biannually) to assess the impact of the standards on patient flow metrics and team performance.
• Feedback Loops: Establish mechanisms for ongoing feedback from staff regarding the practicality and effectiveness of the standards.
• Celebrate Successes: Acknowledge and celebrate improvements seen as a result of adherence to the standards. This reinforces positive behaviour.
• Adaptation: Be willing to adapt or refine standards based on evaluation and evolving clinical needs. These should be living documents.

Example in clinical practice: Enhancing Discharge Efficiency

A medical ward identified that a significant proportion of their patient discharge delays were due to uncompleted TTOs (To Take Out medications) and delayed transport arrangements. While national guidance emphasised early discharge planning, the internal professional standard for the ward was vague, leading to variability.

Action Taken: The ward team, nurses, junior doctors, and consultants collaboratively developed clearer internal standards focused on discharge efficiency:

1. Ward Round Standard: For all patients identified as 'medically fit for discharge (MFD)' on the morning ward round, the consultant or registrar responsible must ensure TTOs are commenced by 11:00 on the day of MFD. If awaiting review by a specific team, this review must be escalated by 09:30.
2. Nursing Action Standard: The named nurse for an MFD patient is responsible for liaising with therapies and transport by 10:00 to confirm discharge readiness and coordinate collection.
3. Communication Standard: Any foreseen delay in TTO completion or transport must be escalated verbally to the ward sister/charge nurse by 12:00, with an action plan for resolution.

Outcome: Within six months, monitoring showed a 20% reduction in discharge delays related to TTOs and transport. Staff reported greater clarity in their roles, reduced last-minute rushing, and improved communication with pharmacy and transport teams. This enabled more predictable patient flow, reducing bed pressures and improving patient experience.

How Lazomis can help

Lazomis provides a structured platform to support the development, implementation, and monitoring of your internal professional standards, particularly those aimed at improving patient flow.

• Documentation and Dissemination: Use Lazomis's document management features to centralise your drafted standards, ensuring they are easily accessible to all team members and can be version-controlled for updates.
• Project Management for Implementation: For complex changes associated with new standards (e.g., training rollouts, new communication protocols), Lazomis's QI project management tools can help track tasks, assign responsibilities, and monitor progress.
• Data Collection and Reporting: Integrate data relevant to your standards (e.g., discharge times, handover compliance) into custom dashboards. This allows for real-time monitoring of adherence and impact on patient flow, providing objective evidence for review and adaptation.
• Feedback Mechanisms: Utilise Lazomis forms or surveys to gather anonymous feedback from staff on the effectiveness and practicality of the standards, feeding into your review cycle.
• Training and Onboarding: Incorporate the internal standards into digital onboarding packages for new staff, ensuring consistent training and understanding from day one.

This resource supports, but does not replace, clinical judgement. Local policy, formulary and specialist advice should be followed.

Key takeaways

• Internal professional standards clarify 'how' a team operates, supplementing national guidelines with local, actionable expectations.
• They are crucial for addressing specific bottlenecks and inconsistencies in patient flow within a department or service.
• Effective standards are developed collaboratively, are specific, measurable, and have visible leadership support.
• Regular review and adaptation are essential to ensure relevance and sustained positive impact on patient flow.
• Implementing internal standards can lead to significant improvements in efficiency, patient experience, and staff satisfaction.
• Lazomis can aid in documenting, disseminating, monitoring, and evaluating the impact of these standards on patient flow.