System-wide lessons to reduce delayed discharges from hospital

The challenge

North East London Integrated Care Board (NEL ICB) asked Kaleidoscope to conduct an After Action Review (AAR) following a deeply troubling incident. The case centred on a patient with complex needs who had remained in an acute hospital for 90 days after being declared medically fit for discharge.

The excessive delay highlighted significant gaps in coordination and communication between the multiple health and social care organisations. They needed to bring together stakeholders from across the system to explore the factors contributing to the delay, and identify recommendations for improvement.

Confusion persisted over responsibilities and funding liabilities across several local authorities, with disagreements and lack of clarity impacting the patient’s care journey.

Our approach

This was a difficult and sensitive case to explore. In order to conduct the after action review, we knew that we needed to make people feel safe and open to sharing and learning.  NEL ICB also wanted to use this opportunity to assess what happened, and deliver learning-focused discussions designed to help people agree what needed to change.

We used a combination of seven semi-structured interviews with key representatives and an online workshop with 24 participants.

The interviews and workshop focused on understanding the events that occurred, their implications and root causes, and recommendations for improvement. We then analysed the data to identify key themes and findings into a comprehensive report.

The results

Our review surfaced the key underlying issues contributing to the delayed discharge. In addition to the challenges presented by the systemic separation between health and social care. There was also a need for clearer processes, particularly around Section 117 aftercare and escalation routes.

It also surfaced the issues in coordinating care for the patient’s specific complex needs. To address these our report provided key recommendations and next steps to improve care coordination, reduce discharge delays, and prevent similar cases in the future.

1. Improving communication through clear meeting practices, roles and concise information sharing
2. Developing guiding principles to steer decision-making in complex cases
3. Investing in updated, unified care coordination processes
4. Building cross-organisational relationships and trust
5. Establishing clear internal and external escalation frameworks

Kaleidoscope enabled system-wide learning from a highly complex case. The need for more integrated, person-centred approaches across health and social care has long been recognised. This was a valuable opportunity to bring people together to work through those barriers and provide tangible actions to improve care.

Kaleidoscope’s expertise enabled us to have frank and productive conversations about an immensely complex case. The final report has given us clear recommendations for improvement that we can take forward as a system to ensure better experiences for patients in similarly challenging circumstances.

Diane Jones, North East London Integrated Care Board Lead