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STRATEGIC LEVEL QUESTIONS
Organisational Issues
Can you please describe the procedures for bed management in this trust/hospital?
How do you monitor the location and number of available beds? How is this information processed and distributed, and how often? How accurate is this information?
How is the complement of beds per specialty allocated, and how often is this reviewed? What about “ownership” of beds by the specialties? Are beds organised as a
‘whole hospital’ resource, or are they seen as belonging to particular specialties/wards/consultants?
Do you know the total number of beds in the Trust and how these are divided between the various specialties? If no, where could I get this inf.?
What are the procedures for admitting a patient?
How do the various specialties organise admissions? Can you describe the receiving rotas?
Do you have placement procedures for acutely ill?
Do you have written admission procedures/protocols? (Can I have copies?) Do you have any planned investigation units, acute admission wards/beds, or observation wards/beds?
Do you have ‘fast track’ admissions for particular conditions? Are there peak days for admissions?
When a specialty’s beds are full, is there particular specialty where you prefer to place patients?
If yes, what are the reasons for this, is it set out in the bed/admissions policy?
What are the procedures for discharging a patient?
When do ward rounds take place?
Are junior staff allowed to discharge, what about ward sisters?
Any arrangements in place to deal with patients who require domiciliary support or a place in a nursing/residential home?
Do you have liaison officers/sisters who deal with local GPs and community services? Who makes arrangements for take-home medicines, transport?
Do you have pre-discharge lounges or wards? Are there any peak days for discharges?
How do you plan for seasonal variations in demand?
What are the main restrictions on planning?
Do you ever take blocks of beds from one specialty and allocate them to another? If yes, who makes this decision?
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How do you cope with short term variations in demand?
Are there beds which could not be used? beds which are ‘ring-fenced’
protected by waiting list initiatives etc.? private patient beds?
Are beds ever concealed from the bed management team?
Has the use of day surgery had any effect on your admission rates? How do the different specialties organise their operating lists?
Do you have a hospital policy on theatre mix, or is this left to the surgeons to organise?
How do you monitor the performance of bed management policies?
What data do you use to monitor the application and performance of policy? E.g. weekly/monthly summaries etc.? LOS data?
How often are your admission and discharge procedures reviewed? How useful are these reviews?
Do you know who is responsible for collecting the information on the hospital’s costs? (The inf. that is sent to ISD for inclusion in the annual Scottish Health Service Costs Report; the Blue Book)
How often is this collected?
How are boarders taken into account, are they seen as belonging to the specialty they are in at the time of recording (if yes, how long do they have to have been in specialty before they are recorded as patients), or are they counted as a patient of the specialty from which they were placed?
Who makes the decision to record boarders by specialty?
Economic Issues
The next set of questions is about what you would consider to be the consequences of increasing bed occupancy rates...
Would there be any benefits, for your trust/hospital, of increasing the number of admissions? If respondent is the Medical Director; how would you cope with a sudden rise in the number of emergency admissions?
Do you have enough discretion to raise admission criteria in A&E? Could you lower the number of admissions in any way?
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What would be the constraints of an increase in admissions?
Are staffing levels (medical and nursing) sufficient to cope? Would you need to employ bank nurses?
How would an increase in admissions affect the trust’s income and total costs?
How well do you think bed management practices would be able to cope?
Could the organisational structure of the bed management unit cope? Are the staffing levels of the bed management unit sufficient to cope? What about the information on beds, would they/you need to collect and disseminate more often?
Would you need to resort to pooling between specialties, gender pooling?
What would be the financial implications?
Is it likely that contracts with the HB or GPFHs would be prematurely fulfilled?
What would be the effect on unit costs, for example the cost per case? What about cost per day? (If cost per case rising, ask them why)
What would be the organisational effects?
How would this affect elective admissions? What would be the effect on quality of care?
Would it mean patients being inappropriately placed?
What would be the effect on length of stay?
If answer is a reduction in LOS, would a reduced LOS have any effect on cost per case or cost per day?
What about re-admission rates?
What about the effect on turnover?
Do you have a minimum turnover interval?
Could you decrease the TI, how would you do this?
What would the effect of, for example, a five per cent increase in the number of admissions to this trust/hospital? What about ten per cent...fifteen per cent...?
Another way to increase occupancy rates would be to reduce the number of beds in the trust/hospital...Is this a feasible option? (If no, why not?)
What do you think you would gain by reducing the number of beds? What would be the effects of a reduction in the number of beds?
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Are yearly contracts flexible enough to allow a reduction?
The re-deployability of resources?
Are there political risks?
Public/professional opposition? Capacity to meet waiting time targets Waiting list monies?
What would be the effect on the Trust’s total costs?
What about the unit cost - cost per case, cost per day? (If cost per case rising, ask them why)
What about spare capacity, are there any ways in which you might increase occupancy rates without reducing the number of beds?
Weekend opening?
Staff costs Total cost?
Are NHS beds used for private work at weekends?
Day case care/surgery?
More high-tech surgery, more effective drugs?
What about the use of long term contracts to increase re-deployability of resources?
Uncertainty re costs and activity
Could you co-operate with other trusts in any way? Could you sell spare capacity at marginal cost?
Pricing rules, do they allow this?
Ironing out fluctuations in demand?
How much control do you have over demand? Could you use waiting lists to increase demand? What about five day wards
How well do you think bed management policies would be able to cope?
Could the organisational structure of the bed management unit cope? Are the staffing levels of the bed management unit sufficient to cope? What about the information, would you need to collect and disseminate more often?
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What would be the financial implications?
Is it likely that contracts with the HB or GPFHs would be prematurely fulfilled?
What would be the effect on the total cost?
What about the unit cost - cost per case, cost per day? (If cost per case rising, ask them why)
What would be the organisational effects?
How would this affect elective admissions? What would be the effect on quality of care?
Would it mean patients being inappropriately placed?
What would be the effect on length of stay?
If answer is a reduction in LOS, would a reduced LOS have any effect on cost per case or cost per day? (If cost per case rising, ask them why) What about re-admission rates?
What about the effect on turnover?
Could you decrease the TI, how would you do this? Do you have a minimum turnover interval?
How do you think bed management practices could be improved on this site?
OPERATIONAL LEVEL QUESTIONS
Organisational Issues
Can you please describe the procedures you use for bed management in this Trust/specialty/ward?
How do you monitor the location and number of available beds in your trust/specialty/ward?
How is this information fed-back, and how often?
How useful do you find this information? (Bed Manager - How well is this inf. received?)
How is the/your complement of beds allocated, and how often is this reviewed? Is this/your allocation adequate for your needs?
What about “ownership” of beds by the specialties? Are beds organised as a ‘whole hospital’ resource, or are they seen as belonging to particular specialties/wards/consultants?
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How do you organise admissions? Can you describe your receiving rota(s)? Do you have placement procedures for the acutely ill?
Do you have written admission procedures/protocols (can I have copies?)
Do you have any planned investigation units, acute admission wards, or observation wards/beds?
Do you have ‘fast track’ admissions for particular conditions? Are there peak days for admissions?
When your wards are full, is there particular specialty where you prefer to place patients?
If yes, what are the reasons for this, is it set out in the bed/admissions policy? Is there a set amount of beds you can call on, or is just what is available at the time?
Who makes demands on your beds?
Is there any particular specialty/ward/consultant that will ask for beds, if so how many?
Can you describe the discharge procedures used in this Trust/specialty/ward?
Is there any delegation of authority to junior staff, or ward sisters, for discharges? Any arrangements in place to deal with patients who require domiciliary
support or a place in a nursing/residential home?
Do you have liaison officers/sisters who deal with local GPs and community services? Who makes arrangements for take-home medicines, transport?
Do you have pre-discharge lounges or wards? Are there any peak days for discharges?
How do you plan for seasonal variations in demand?
What are the main restrictions on planning?
Are blocks of beds ever taken from your specialty/ward and allocated to another? Do you ever receive beds from another specialty?
If yes, who makes this decision?
How do you cope with short term variations in demand?
Are there beds which could not be used? beds which are ‘ring-fenced’
protected by waiting list initiatives etc.? private patient beds? five day wards?
Are beds ever concealed from the bed management team? How do you organise your operating lists in this specialty/ward?
Do you have a hospital policy on theatre mix, or is this left to the surgeons to organise?
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How do you monitor the performance of bed management practices in your specialty/ward?
What data do you use to monitor performance? E.g. weekly/monthly summaries etc.? LOS data?
How often are your admission and discharge procedures reviewed? How useful are these reviews?
Do you know who is responsible for collecting the information on the hospital’s costs? (The inf. that is sent to ISD for inclusion in the annual Scottish Health Service Costs Report; the Blue Book)
How often is this collected?
How are boarders taken into account, are they seen as belonging to the specialty they are in at the time of recording?
(If yes, how long do they have to have been specialty before they are recorded as patients?)
Or, are they counted as a patient of the specialty from which they were placed?
Who makes the decision to record boarders by specialty?
Economic Issues
The next set of questions is about what you would consider to be the consequences of increasing bed occupancy rates...
What would be the benefits, in this specialty/ward, of increasing the number of admissions? If respondent is in Medical Specialty; how would you cope with a sudden rise in the number of emergency admissions?
Do you have enough discretion to raise admission criteria in A&E? Could you lower the number of admissions in any way?
What would be the constraints of an increase in admissions? How would this affect your work?
Are staffing levels (medical and nursing) sufficient to cope? Would you need to employ bank nurses?
What would be the effect on quality of care?
Would it mean patients being inappropriately placed?
How well do you think bed management practices would be able to cope?
Could the organisational structure of the bed management unit cope? Are the staffing levels of the bed management unit sufficient to cope? What about the information on beds, would you/they need to collect and disseminate more often?
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What would be the financial implications?
Is it likely that contracts with the HB or GPFHs would be prematurely fulfilled?
What would be the effect on unit costs, for example the cost per case? What about cost per day?(If cost per case rising, ask them why)
What would be the effect on length of stay?
If a reduction in LOS, would a reduced LOS have any effect on cost per case or cost per day?
What about re-admission rates?
What about the effect on turnover?
Do you have a minimum turnover interval?
Could you decrease the TI, how would you do this?
Another way to increase occupancy rates would be to reduce the number of beds in the trust/hospital...Is this a feasible option? (If no, why not?)
What would be the constraints of a reduction in the number of beds? Would you make significant savings by reducing small numbers of beds? Are yearly contracts flexible enough to allow a reduction?
The re-deployability of resources?
Are there political risks?
Public/professional opposition? Capacity to meet waiting time targets Waiting list monies?
What would be the effect on the Trust’s total costs?
What about the unit cost - cost per case, cost per day? (If cost per case rising, ask them why)
What about spare capacity, are there any ways in which you might increase occupancy rates without reducing the number of beds?
Weekend opening:
Staff costs Total cost?
Are there NHS beds which are used for private work at weekends?
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More high-tech surgery, more effective drugs?
Use of long term contracts to increase the re-deployability of resources ?
Uncertainty re costs and activity.
Could you co-operate with other trusts in any way? Could you sell spare capacity at marginal costs?
Pricing rules, would they allow this?
Ironing out fluctuations in demand?
How much control do you have over demand? Could you use waiting lists to create demand? Five day wards
How well do you think bed management practices would be able to cope?
Could the organisational structure of the bed management unit cope? Are the staffing levels of the bed management unit sufficient to cope? What about the information on beds, would you need to collect and
disseminate more often?
Would you need to resort to pooling between specialties, gender pooling?
What would be the financial implications?
Is it likely that the contract with the HB or GPFHs would be prematurely fulfilled?
What would be the effect on unit costs, for example the cost per case? What about cost per day?(If cost per case rising, ask them why)
What would be the organisational effects?
How would this affect elective admissions? What would be the effect on quality of care?
Would it mean patients being inappropriately placed?
What would be the effect on length of stay?
If a reduction in LOS, would a reduced LOS have any effect on cost per case or cost per day? (If cost per case rising, ask them why)
What about re-admission rates.
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