Mr. T, the patient, was discharged in the evening after undergoing a day procedure under general anaesthesia at the hospital. Initially, everything seemed well according to the doctors. However, overnight, as the effects of the anaesthesia diminished, Mr. T experienced severe pain and was unable to tolerate any pain relief. This led to vomiting and an inability to keep down painkillers.
When Mr. T called for an ambulance, one was not available, and the helpline 111 arranged for a taxi instead, providing guidance on how the patient could access care through the triage system.
Upon arrival at the Accident and Emergency department, Mr. T was placed in Stage One, the initial waiting area for patients undergoing triage. This area is located outside of the main health reception and is security-controlled. The typical waiting time is not factored into the stated 4-hour target.
Despite Mr. T experiencing severe pain, he had to endure approximately an hour before being attended to. During the triage process, administrative staff repeated the questionnaire already answered during the 111 call before Mr. T was directed to a nursing receptionist who asked similar questions. He was then guided to a designated area for assessment by another nurse.
Approximately two more hours passed before Mr. T was called into the nurse’s room to repeat the same questions. He was then asked to wait for an additional hour for blood samples and urine tests before eventually seeing a doctor.
Despite the severity of his pain, Mr. T waited for over 6 hours before receiving a prescription from the doctor. It took over 3 hours for the pharmacist to dispense the medications. Throughout this time, Mr. T endured over 2 hours of discomfort while receiving fluids and expressing his pain from the previous surgery.
In this case, Mr. T was finally admitted to a hospital bed for appropriate care after more than 10 hours. The following day, he was transferred to a specialised hospital for further treatment.
Feedback raised concerns about why the initial procedure was performed in a hospital with limited resources that failed to anticipate potential complications for cases like Mr. T’s. It was concluded that Mr. T should have been monitored for a longer period and provided pain relief and medications through injections rather than orally.
Analysis Using the I.M.P.I. Model
Idea
The lack of a holistic approach in the management system leads to many disconnections with reality. This can be described as the absence of a link-factor guiding the process from the “why” to the “how”.
Seven Why Principles
Using the seven why principles, we identify the negative trigger of the incoherent situation within the NHS:
- Why was the patient not receiving timely pain relief post-procedure?
Due to a lack of coordination and communication between healthcare providers, leading to delays in addressing the patient’s pain management needs. - Why was there a lack of coordination and communication among healthcare providers?
Because of a fragmented system with different departments and individuals working in silos, without a unified approach to patient care. - Why was there a fragmented system in place within the healthcare facility?
Because there was a lack of standardised protocols and guidelines for patient management, resulting in inconsistencies in care delivery. - Why were there no standardized protocols and guidelines for patient management?
Because of a failure to prioritize patient safety and experience, leading to ad-hoc decision-making processes and lack of accountability. - Why was there a failure to prioritize patient safety and experience?
Potentially due to a lack of emphasis on continuous improvement and quality assurance measures within the healthcare system, causing complacency and inefficiencies. - Why was there a lack of emphasis on continuous improvement and quality assurance measures?
Possibly due to institutional barriers or resistance to change, hindering the implementation of best practices and evidence-based guidelines. - Why were there institutional barriers or resistance to change?
There might have been a culture of hierarchy, bureaucracy, and resistance to innovation within the healthcare system, impeding progress and effective collaboration among healthcare professionals.
Proposed Solutions
Holistic Approach
An idealised holistic approach could involve several key elements:
- Integrated Communication System:
- Implement a seamless communication system between healthcare providers such as ambulance services, NHS 111, triage nurses, doctors, and pharmacists.
- Ensure efficient and accurate information sharing throughout the patient’s journey.
- Algorithmic Triage System:
- Use an algorithmic triage system to assess the urgency of a patient’s condition based on standardised criteria.
- Prioritise patients effectively to ensure those in serious pain receive timely care.
- Pre-Procedure Risk Assessment:
- Conduct comprehensive pre-procedure risk assessments for patients undergoing day procedures under general anaesthesia.
- Identify potential complications to allow for appropriate resource allocation and planning.
- Streamlined Workflow:
- Reduce waiting times and optimize patient flow in A&E departments.
- Reorganize waiting areas, optimize staff allocation, and implement efficient processes for tests and medication dispensing.
- Specialised Hospital Collaboration:
- Collaborate with specialised hospitals to ensure patients requiring specific expertise are promptly transferred to appropriate facilities.
Integration of AI in the NHS
Rationalising Processes with AI
To address arising problems and tackle institutional barriers, the integration of AI must consider technological and organisational factors:
- Collaborative Stakeholder Engagement: Gather diverse perspectives to ensure AI solutions meet stakeholder needs.
- Change Management: Build trust, enhance skills, and promote a culture of innovation among healthcare employees.
- Ethical and Regulatory Compliance: Establish governance frameworks to ensure AI complies with ethical and healthcare standards.
- Interoperability and Integration: Foster interoperability and standardisation across systems and platforms.
- Evidence-Based Decision-Making: Use AI-driven insights to inform planning and policy development.
- Continuous Monitoring and Improvement: Establish mechanisms for evaluating and optimizing AI implementations.
Step Further Solution: The I.M.P.I. Model and Third-Party AI Systems
Implementation Steps
- Conduct an in-depth analysis of the current regulatory framework.
- Develop a plan for adopting the I.M.P.I. Model alongside AI technology.
- Provide training and resources for regulatory officials.
- Collaborate with stakeholders to ensure transparency and accountability.
- Monitor the impact of AI integration and adjust strategies as needed.
Why-Key Methodology
Develop a third-party AI system governed under the “Why-Key” methodology to address root causes of problems. By integrating this system with the I.M.P.I. Model, regulatory agencies can streamline processes, enhance decision-making, and better serve NHS stakeholders.