Define the flow problem
I will agree the outcome leaders need to change, identify the cohorts creating the pressure and capture the competing explanations currently being offered.
When flow remains constrained
Patient Flow Constraint Diagnostic
Establish why the capacity and interventions already in place are not translating into the flow the system expected.
01 The situation
When this engagement is useful
Capacity has already been added, redesigned or commissioned.
Yet patients are still waiting.
Acute teams see people who could leave hospital. Community services report high utilisation. Commissioners can point to capacity already funded. Adult social care sees increasing complexity and support requirements.
Each explanation may contain part of the truth.
I will establish which explanation best accounts for the pressure across the whole pathway, and whether more capacity would actually change it.
02 Follow the constraint
What I will do
I will follow the constraint across the pathway.
I will bring together the demand, capacity, activity and operational evidence held by different partners and test it against what is actually happening to patients.
I will examine:
- who is waiting and why, rather than treating all delay as one type of demand
- where patients accumulate, divert or remain longer than expected
- whether commissioned capacity is genuinely available to the people waiting for it
- how case mix, length of stay, package intensity and turnover affect the capacity available day to day
- whether referral criteria, thresholds, operating hours, geography, workforce or pathway rules are restricting access
- whether capacity is being absorbed by a different population or purpose from the one it was intended to support
- where one organisation's response is shifting pressure or cost elsewhere in the pathway
I will then distinguish a genuine capacity shortfall from a constraint created by access, productivity, process, pathway design or the operating model.
03 The diagnostic
What the work looks like
Reconcile what the system knows
I will bring together the available pathway evidence and test where reported demand, activity and capacity agree or conflict.
Where the numbers do not reconcile, I will investigate the difference rather than average it away.
Find the constraint
I will follow the patient journey and test where capacity becomes unavailable, demand changes shape or pathway behaviour prevents the expected flow.
Where useful, I will model alternative assumptions and scenarios to show which factors materially change the result.
Test what should change
I will compare the credible responses and show leaders what additional capacity, different targeting, pathway redesign, productivity improvement or operating-model change is likely to achieve.
You retain the decision. I will make clear what the evidence supports and what each option requires you to believe.
04 A reconciled explanation
What you will have at the end
A shared account of the pressure that partners can test against the same evidence.
Depending on scope, I will provide:
- a reconciled view of demand, capacity and flow across the pathway
- segmentation of the cohorts and reasons behind the observed delay
- evidence of where commissioned, reported and usable capacity differ
- identification of the principal constraint and important dependencies
- competing explanations tested against operational evidence
- modelling or sensitivity analysis where this changes the decision
- practical options with their expected impact, risks and trade-offs
- measures that show whether the chosen intervention actually releases the constraint
- a concise executive or system briefing setting out what should happen next
The output is not another pathway map. It gives leaders a defensible explanation for why flow is constrained and what is most likely to change it.
Evidence from the work
The beds provided relief. The constraint remained.
A six-figure investment in additional bed capacity was proposed to relieve system pressure.
I modelled what the additional capacity was likely to change and identified that it could provide short-term operational relief, but would not sustain improved access while turnover and onward-flow constraints remained.
The investment proceeded.
Subsequent performance followed the pattern anticipated by the modelling: additional beds provided short-term relief, while access remained constrained by turnover and onward flow.
What did the analysis change?
It separated two questions that can easily become confused:
Question 01
Would more beds create additional capacity? Yes.
Question 02
Would that capacity resolve the constraint limiting sustainable flow? Not on its own.
Additional capacity can be useful without being the answer to the problem that justified buying it.
05 Start with what exists
What I need from you
Start with what you already have.
Typically, I will need existing demand, activity, capacity and flow information, relevant pathway definitions or service specifications, and access to a small number of people who understand how the pathway operates in practice.
I do not need every organisation to agree on the problem before we start. The disagreement is often part of the diagnostic.
You do not need a finished brief
Bring me the flow problem everyone explains differently
You do not need to decide whether the answer is more capacity, pathway redesign or operational improvement before contacting me.
That is what the diagnostic is there to establish.