Using governance and patient flow strategies to improve healthcare service efficiency

The aim of this case study was to share lessons learned regarding strategies likely to increase healthcare service efficiency. Following quality assurance review of statewide Hospital in the Home (HITH) average length of stay (ALOS) and readmission data, Queensland's Department of Health observed that for some of the highest volume diagnoses seen in Queensland's HITH services in 2017, services that used a public-private partnership (PPP) model of care achieved a shorter ALOS than services using a traditional public model of care without demonstrably poorer patient outcomes. To understand the reasons for the differences in ALOS, ALOS and readmission data from 2017 for 10 high-volume diagnoses were retrospectively compared for five HITH services. Two of the services used a PPP and three used a public HITH model of care. Additional data were collected to determine similarities and points of difference regarding how the services operated in 2017. Hospitals that used a PPP HITH model of care achieved shorter ALOS for eight of the 10 diagnoses, with the difference ranging from 0.94 to 5.98 days. Differences between how the PPP and public HITH services operated in 2017 were identified. The findings suggest that the use of governance strategies, criteria-led discharge and financial incentives is likely to support safe shorter lengths of stay.