Perform: Delivering a step change improvement in patient flow

With demand and acuity continuing to outstrip capacity, NHS trusts need to think differently about how they manage patient flow and clinical care. We have been supporting trusts and health systems to make a sustainable step change improvement in patient flow through investing in their staff and technology. Using our Perform methodology we work closely with clinical and management teams to change behaviours and improve teaming which are sustained by digital adoption and effective governance.

This results in improvements in patient experience and creates significant bed capacity which can be used to increase activity, redesign services and reduce costs.

The impact we have made

Our approach delivers tangible and sustainable improvement by focusing on the patient flow through four lenses

Operational & behavioural change

We work alongside your clinical teams to improve ways of working - embedding a culture of empowerment and continuous improvement.

Digitally enabled

We co-design & embed digital solutions to provide real-time insight - enabling teams understand and take responsibility for performance, make timely data-driven decisions and fundamentally revolutionalise care.


Sustainable solutions

We co-delivery with your teams to co-design and upskill your teams - delivering a tailored, sustainable and continually evolving solution.

How we do it

Emergency department

Digitally enabled

Our digital tool uses historical data and predictive analytics to forecast demand into the Emergency Department and admissions by specialty areas. This is then combined with real-time data feeds to enable proactive management of Emergency Department performance and data-driven decision making.

Operational and behavioural Change

We work alongside clinicians and management to establish a daily rhythm of regular touchpoints to operationally manage the department. This enables them to proactively manage flow through the emergency quadrant.

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Site management

Digitally enabled

We work with site management teams to implement or optimise digital bed management systems. Together with the team, we co-design and embed effective systems and an operational rhythm which integrates with systems in other areas of the hospital.

Behavioural change

Working alongside teams we upskill staff to proactively manage flow through using live bed management tools, introducing capacity meetings with clear accountability and supporting teams in how they interface with clinical areas.

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Acute assessment units

Digitally enabled

Optimising or introducing digital whiteboards we empower teams with the right metrics to proactively manage the flow of patients through the hospital. We introduce and implement digital solutions to improve handover to and from other areas of the hospital.

Operational and behavioural Change

We work with trust teams to introduce a balanced approach to flow and other areas of the hospital (imaging, diagnostics) to create new, efficient pathways and processes.

We increase collaboration and cohesion to ensure the flow of patients from ED and onto wards.

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Inpatient wards

Digitally enabled

We introduce and upskills teams in the use of a range of tools and solutions, from digital whiteboards, to our Perfect Ward app, to manage the flow of patients, as well as other quality metrics such as safety and care.

Operational and behavioural change

We provide coaching to teams so that they can recognise and solve their own problems and change the way they operate. This includes having quality MDT board rounds and improved collaboration, along with a proactive approach to managing care and discharge planning.

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Discharge and community teams

Digitally enabled

We have a discharge predictor tools that takes into account a patients expected discharge date as well as other data source tools which enable greater coordination leading to increased productivity and consistency.

Operational and behavioural change

We work with in-house and external community teams to provide a joined-up approach to help deliver the best care to patients. We help introduce better ways of working to reduce DToCs, unnecessary delays to discharge and leverage technology to increase productivity and engagement, even amongst decentralised teams.

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Where we’ve done it

North Bristol NHS Trust

For all trusts winter is an extremely challenging time. North Bristol NHS Trust (NBT) wanted to find a way to meet their 12.2% increase in demand but wanted something different that put their people at the heart of the solution. PwC partnered with  to introduce and embed Perform. A joint PwC-NBT team of over 30 people, aligned to each of the 26 wards, site and discharge teams supported staff at all levels and helped them understand the key role they each play in patient flow, the digital tools they have to help them and worked with them to redefine roles and responsibilities to ensure impact across the whole site.

Results achieved:

  • reducing Length of Stay by 13%
  • releasing 50 beds
  • enabling a 10.2% increase in 4hr performance
  • 6.1% increase in elective activity
  • improving patient experience and valuing patient time.
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Winner of Best Clinical Service and Treatment Pathway Transformation Project at the 2019 HSJ Partnership Awards.

Contact us

James Macpherson

Director, Health provider transformation, PwC United Kingdom

Tel: +44 (0)7815 188213

Kathryn Lodge

Director, Health provider transformation, PwC United Kingdom

Tel: +44 (0)7793 020565

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