Hi Everyone! I was reading an article yesterday about the NHS Ambulance Services performance and how they failed to hit targets and people have long waiting times before an ambulance comes and picks them up. And the article was talking about how they’ve already put some investment in the ambulance service but that doesn’t seem to have made much of a difference and that they have rest assured they’re planning on putting even more investment to lower those call times.

I’m not sure that that’s the answer. If we think about why the ambulance service is taking longer to get to calls we might find that the Root Cause has nothing to do with the ambulance service at all. In fact, when I speak to the people in the NHS I find that they’ll talk about the long waiting times within A&E are being the direct contributor of ambulances not being able to clear their patients, that they’ve got at A&E so that they can respond to the next call.

If we think about that we can think about why it takes A&E so long to treat a patient and move them out of A&E and the Root Cause of that looks like, it might be because there are no beds available in the hospitals to admit them into.

The solution to that might sound like well we just need more beds and more hospitals but actually, again when you speak to doctors, they’ll talk to you about how there are patients who are well enough to leave the hospital and be discharged who aren’t being discharged at all. Because there’s no safe place for them to go to after they’ve been discharged.

So if you’re an elderly person, then you had a fall or maybe you’ve broken a leg, the local authority then liaises with that patient and the family and the local area to make sure that that person has a safe place to go back to. That might be a care home, it might be putting changes into their house to make it safe so they don’t fall again. And that’s the bit that’s not occurring so otherwise healthy patients are not being discharged. Which means they’re taking up a bed, Which means A&E cannot admit someone into that bed. Which means ambulance service can’t clear a patient at A&E. Which means ambulance is arriving late to calls.

That’s a really good example of Systems Thinking because you are looking at the entire system rather than just trying to treat a symptom over here so it illustrates the greatest strength of Systems Thinking. But it also illustrates the greatest weakness of Systems Thinking and that is, it’s really hard to do because if you think about how all these different areas work; there are a bunch of different trusts that are responsible for managing and maintaining the ambulance service.

There’s a completely different set of trusts that are responsible for maintaining and running the hospitals and then you got the local authorities who are responsible for all the adult social care as well. So trying to influence all those people to get the outcome that you need is incredibly difficult. It’s hard enough doing this in an organisation where all of those different departments are all within one organisation. It’s even harder when they’re out in multiple different organisations in multiple different trusts.

It’s really difficult to do and that’s why you see easy solutions like well we just put more money into the ambulance service. but that’s not necessarily going to fix the problem and definitely isn’t the best way to solve the problem.

Lean is a really powerful technique to address issues like this and I hope that the government starts looking at these sorts of tools and techniques more to get the outcomes that we would all like.