'Ebb and flow by the moon': can we do better in hospital?

Hospitals are required to manage acutely ill patients. Optimising patient experience with regard to clinical outcomes and patient experience relies on the interaction with healthcare professionals and the manner in which patient cohorts are managed. The key to success is to keep variability to a minimum, both in terms of clinical practice and in terms of how patients are moved through the system; variability in flow increases the likelihood of queues developing, and the development of queues results in delays and has a negative impact on care. This article attempts to illuminate some of the principles which should be considered when designing whole systems. The application of relatively few principles should enable optimal flow of patient cohorts; this in turn will support optimal individual clinical management. As each site is necessarily slightly different, the figures provided are designed to simply illustrate the generic points made in the text.