What is the challenge your project is going to address and how does it connect to the theme of 'How can improvement be used to reduce delays accessing health and care services'?

Kate, 92, fell. She pressed her alarm. She stayed on the floor, cold and in pain, for 12 hours. Then the ambulance arrived.

Access to acute beds is in crisis. Over-occupancy reduces  quality, causes ambulance queuing, and exacerbates the NHS backlog by blocking scheduled-care beds.

Occupancy is largely driven by length of stay (LOS). Research shows 8% of in-patients could be safely discharged earlier (these were not awaiting social care). Freeing even a fraction of these beds would improve access significantly.

For this to happen, discharge decision makers need to prioritise  safe early discharge. This requires that new ideas and behaviours are made to spread across broad multidisciplinary clinical teams. Dissemination occurs through interpersonal social networks, and there are established evidence-based approaches for intervening in networks to facilitate and accelerate spread.

The project addresses the challenge of applying network interventions  successfully in a front-line clinical setting.

What does your project aim to achieve?

Most hospital in-patients are not waiting for social care.  Once medically stabilised patients can often complete treatment and diagnostics from home. However, the transition to being regarded as ready for discharge by clinical decision makers  is subjective and poorly defined.

The objective of this project is to encourage those involved in discharge processes and decisions to give higher priority to minimising LOS when it is safe, so as to reduce bed occupancy and improve access.

We aim to have a dual effect. First, when dealing with individual patients, clinicians will be more likely to decide on, or work to facilitate, earlier discharge. Second, they will be stimulated to take part in a range of QI activities the we will support, developing and implementing their own ideas to reduce  LOS.

How will the project be delivered?

The project will focus on one  acute  medicine team and one specialty team in one hospital.

Behaviours and opinions spread from person to person through a web of relationships known as a  social network. Workplace social networks can be mapped using simple tools, and then manipulated to facilitate and accelerate dissemination.  Evidence based network interventions include encouraging new links, adding or removing individuals, targeting subgroups (cliques)  and identifying and recruiting local influencers.

Once we have established enhanced  dissemination channels, we will  introduced ideas at  strategic network nodes with the aim that any individual in the network will be exposed to them, ideally from multiple sources and repeatedly over time.

We will develop cross discipline and cross speciality networks, with diverse membership (e.g seniority, experience, role), and will include patient leaders. We will include network members as team members in QI projects, using established tools based on the IHI/MFI model.

How is your project going to share learning?

We are working in collaboration with the London Social Network Group, a collaboration between Imperial College and the University of Greenwich. The results will be disseminated  at international meetings of Social Network academics, at and specialty society meetings .

The work will be disseminated within the Acute Medicine specialty through the QI committee and will receive prominence at their international meeting.

We will use the learning to develop a teaching package to enable others accross the NHS to use Social Network approaches to support QI.