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Frontline clinical care in acute hospitals

About this project

In 2016, Chris Ham and Don Berwick shadowed a general physician on his ward round at an acute hospital to see the work under way to improve the quality of care for patients. They were both struck by the difficulties faced by clinicians in providing the best possible care for their patients, even in a well-led organisation with a deep commitment to quality improvement (the hospital was part of an NHS foundation trust rated by the Care Quality Commission as outstanding). They noted the sense of frustration among some clinical staff about their inability to diagnose and treat patients in the way they would wish.

Chris and Don held a roundtable in November with clinicians from different parts of the NHS to understand if these issues are widely felt, and if so what might be done about them. The challenges described at the roundtable included:

  • staff working under constant pressure in the face of growing demand from an ageing population with complex needs

  • difficulties for hospital staff in communicating with GPs about their patients

  • problems in communication within the hospital between acute medical staff and A&E staff as well as among different specialist teams

  • difficulties in communicating with staff in other hospitals when patients are transferred

  • delays in ordering and receiving the results of diagnostic tests, which in turn lead to delays in treatment and increase the time patients spend in hospital

  • challenges in teamworking, for example on ward rounds when consultants may not be accompanied by trainees and nurses

  • information systems that do not link data about patients held in primary and secondary care and that are often slow to use

  • patients having to repeat their histories (where they are able to) at different stages in their treatment

  • old buildings and cramped layouts that do not allow privacy and sometimes dignity for patients or space for staff to work without interruption

  • poorly organised paperwork and documents

  • inefficient organisation of supplies and workflows on hospital wards.

Some of these difficulties are the result of growing pressures on hospitals when funding is constrained, but we know that resource constraints are not the only causes.

What we're doing

As part of our work to better understand these issues, we have commissioned a series of essays to offer different perspectives, including from patients, on how clinical care is provided on general medical wards in NHS hospitals. We shall also be working with others to offer practical suggestions on how hospitals can improve care for the benefit of patients.

Key milestones

We published a series of perspectives on frontline clinical care in acute hospitals in May 2017.