"A banana in the tailpipe": a qualitative study of patient flow in the healthcare system.

Abstract

Background: Suboptimal patient flow and impaired hospital access can lead to adverse outcomes, including lower care quality, higher mortality risk, and patient dissatisfaction. Despite awareness, optimizing patient flow remains an area requiring further development. This study aimed to comprehensively identify factors hindering patient flow in a large healthcare system and explore potential solutions, using a qualitative approach for context-specific insights.

Methods: This qualitative study followed COREQ guidelines. We conducted four focus group discussions (FGDs) involving 23 healthcare workers (HCWs) and patients selected through purposive sampling. The data were analysed using the directed content analysis method, ensuring rigor through methods such as credibility, dependability, authenticity, and transferability. The study also mapped qualitative findings to outcomes from our recent umbrella review (UR) to enhance comprehensiveness.

Results: Patient flow challenges were categorized into population (patients and providers), capacity, and process. Population challenges included community-based care, staffing issues, and inequities in access. The capacity challenges involved inefficient resource allocation, resource constraints, and patient volume growth. The process challenges included bed management, modernization struggles, private hospital issues, funding model problems, information sharing gaps, coordination challenges, transition issues, particularly delayed discharges from inpatient wards, and problems in healthcare management and patient communication. The solutions focused on human factors, infrastructure, and management, organization, and policy. FGDs identified new challenges and solutions were not covered in the recent UR.

Discussion: The participants' insights highlight the critical necessity for systemic improvements, which include enhancing infrastructure, communication, and collaboration. These improvements include early identification of discharge barriers, facilitating community discharge, addressing diverse patient needs, optimizing prehospital services, and improving patient communication. Shifting the focus from traditional emergency department processes to a system-wide approach is crucial. The comparative mapping between FGDs and the UR insights into both common and specific challenges and solutions enriches discussions on healthcare reform.