A patient flow perspective of U.K. health services: exploring the case for new “intermediate care” initiatives

Abstract

This article applies system dynamics to the development of national policy guidelines for the U.K. health service. A model of total patient flow through the U.K. National Health Service is developed and used to test alternative major new structural initiatives for relieving pressure on health services and to complement health initiatives in “joint working” at the interface between health care sectors. The policies tested include the use of “intermediate care” facilities aimed at preventing patients needing hospital treatment or continuing and community care. Intermediate care, together with reductions in the overall length of stay of all patients in community care made possible by its use, is demonstrated here to have a much more profound effect on total patient wait times than more obvious wait time solutions, such as increasing acute hospital bed capacity. The results provide a clear demonstration that adjustments to “flow” (throughput) variables in a system provide significantly more leverage than adjustments to “stock” (capacity) variables. Copyright © 1999 John Wiley & Sons, Ltd.