ArticleBMJ quality & safety2017
Six ways not to improve patient flow: a qualitative study.
Article in BMJ quality & safety, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers, 1 of them a synthesis that pooled it.
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Who cites it
20 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Patient flow in emergency departments: a comprehensive umbrella review of solutions and challenges across the health system.BMC health services research · 2024Pooled it
- Article
- Development and validation of the healthcare access barrier scale (HABS).International journal for equity in health · 2025Article
- Integration as innovation in healthcare systems.Healthcare management forum · 2025Article
- A consensus-based agreement on a definition of a process variable: findings from a New Zealand nominal group technique study.BMC health services research · 2024Article
- Transforming health care systems towards high-performance organizations: qualitative study based on learning from COVID-19 pandemic in the Basque Country (Spain).BMC health services research · 2024Article
- The impact of atypical intrahospital transfers on patient outcomes: a mixed methods study.Scientific reports · 2023Article
- How can we meet the needs of patients, their families and their communities? A qualitative study including clinicians, consumer representatives, patients, and community members.BMC health services research · 2023Article
- The Optimal Distribution of Surgery in Low- and Middle-Income Countries: A Proposed Matrix for Determining Country-Level Organization of Surgical Services - A Response to the Recent Commentaries.International journal of health policy and management · 2022Article
- What makes an effective Quality Improvement Manager? A qualitative study in the New Zealand Health System.BMC health services research · 2022Article
- Association between intrahospital transfer and hospital-acquired infection in the elderly: a retrospective case-control study in a UK hospital network.BMJ quality & safety · 2021Article
- Can facility-based transitional care improve patient flow? Lessons from four Canadian regions.Healthcare management forum · 2021Article
- Conceptualizing the Organization of Surgical Services Comment on "Decentralization and Regionalization of Surgical Care: A Review of Evidence for the Optimal Distribution of Surgical Services in Low- and Middle-Income Countries".International journal of health policy and management · 2021Article
- Long Waiting Times for Elective Hospital Care - Breaking the Vicious Circle by Abandoning Prioritisation.International journal of health policy and management · 2020Article
- "Working Against Gravity": The Uphill Task of Overcapacity Management.Health services insights · 2020Article
- How improving access times had unforeseen consequences: a case study in a Dutch hospital.BMJ open · 2019Article
- Empowering junior doctors: a qualitative study of a QI programme in South West England.Postgraduate medical journal · 2018Article
- Hospital Strategies for Reducing Emergency Department Crowding: A Mixed-Methods Study.Annals of emergency medicine · 2018Article
- The three paradoxes of patient flow: an explanatory case study.BMC health services research · 2017Article
- Improving In-Hospital Care For Older Adults: A Mixed Methods Study Protocol to Evaluate a System-Wide Sub-Acute Care Intervention in Canada.International journal of integrated careArticle
Corrections and comments
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Authors and funding
1 author.
Funding
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Abstract
backgroundAlthough well-established principles exist for improving the timeliness and efficiency of care, many organisations struggle to achieve more than small-scale, localised gains. Where care processes are complex and include segments under different groups' control, the elegant solutions promised by improvement methodologies remain elusive. This study sought to identify common design flaws that limit the impact of flow initiatives.
methodsThis qualitative study was conducted within an explanatory case study of a Canadian regional health system in which multitudinous flow initiatives had yielded no overall improvement in system performance. Interviews with 62 senior, middle and departmental managers, supplemented by ∼700 documents on flow initiatives, were analysed using the constant comparative method.
resultsFindings suggested that smooth flow depends on linking a defined
conclusionsTypically, flawed initiatives focused on too small a segment of the patient journey to properly address the impediments to flow. The proliferation of narrowly focused initiatives, in turn, reflected a decentralised system in which responsibility for flow improvement was fragmented. Thus, initiatives' specific design flaws may have their roots in a deeper problem: the lack of a coherent system-level strategy.
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