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Forecasting the number of bed days (NBD) needed within a large hospital network is extremely challenging, but it is imperative that management find a predictive model that best estimates the calculation. This estimate is used by operational managers for logistical planning purposes. Furthermore, the finance staff of a hospital would require an expected NBD as input for estimating future expenses. Some hospital reimbursement contracts are on a per diem schedule, and expected NBD is useful in forecasting future revenue.

This chapter examines two ways of estimating the NBD for a large hospital system, and it builds from previous work comparing time regression and an autoregressive integrated moving average (ARIMA). The two approaches discussed in this chapter examine whether using the total or combined NBD for all the data is a better predictor than partitioning the data by different types of services. The four partitions are medical, maternity, surgery, and psychology. The partitioned time series would then be used to forecast future NBD by each type of service, but one could also sum the partitioned predictors for an alternative total forecaster. The question is whether one of these two approaches outperforms the other with a best fit for forecasting the NBD. The approaches presented in this chapter can be applied to a variety of time series data for business forecasting when a large database of information can be partitioned into smaller segments.

Nine councils in the Innovation Forum for high‐performing local authorities voluntarily set a target of reducing hospital bed days for people aged 75+ by 20% over the three years to 2006/07. This kind of objective was new for the NHS, as much as for local government. It was motivated by a concern among the councils that hospital admission exposed residents to risks to their independence and well‐being which should be avoided wherever possible. They wished to demonstrate the value of the local authority community leadership or, as it has since become known, ‘place making’ role. Their success in meeting this target supports the new NHS White Paper's proposed transfer of functions and responsibilities from PCTs to councils. It suggests that councils can successfully adopt, in appropriate circumstances, the lead responsibility for ensuring strategic co‐ordination of place‐based commissioning in health and well‐being.

Against a background of an ageing population, rising emergency admissions and a policy direction moving towards providing care in the least intensive setting, this paper presents the dramatic results achieved in a 22‐week pilot of undivided health and social care replicating the Castlefields study and using Unique Care principles. In the context of practice‐based commissioning, where GP practices develop and commission services that represent the best model of care and use of resources for their patients, the potential for creating savings from this approach are discussed.

In 2011, community nursing services were reorganised in England in response to a national policy initiative, but little is known about the impact of these changes. A total of three dominant approaches emerged: (1) integration of community nursing services with an acute hospital provider, (2) integration with a mental health provider and (3) the establishment of a stand-alone organisation, i.e. without structural integration. The authors explored how these approaches influenced the trends in emergency hospital admissions and bed day use for older people.

The methodology was a longitudinal ecological study using panel data over a ten-year period from April 2006 to March 2016. This study’s outcome measures were (1) emergency hospital admissions and (2) emergency hospital bed use, for people aged 65+ years in 140 primary care trusts (PCTs) in England.

The authors found no statistically significant difference in the post-intervention trend in emergency hospital admissions between those PCTS that integrated community nursing services with an acute care provider and those integrated with a mental health provider (IRR 0.999, 95% CI 0.986–1.013) or those that did not structurally integrate services (IRR 0.996, 95% CI 0.982–1.010). The authors similarly found no difference in the trends for emergency hospital bed use.

PCTs were abolished in 2011 and replaced by clinical commissioning groups in 2013, but the functions remain.

The authors found no evidence that any one structural approach to the integration of community nursing services was superior in terms of reducing emergency hospital use in older people.

As far as the authors are aware, previous studies have not examined the impact of alternative approaches to integrating community nursing services on healthcare use.

Managing a large hospital network can be an extremely challenging task. Management must rely on numerous pieces of information when making business decisions. This chapter focuses on the number of bed days (NBD) which can be extremely valuable for operational managers to forecast for logistical planning purposes. In addition, the finance staff often requires an expected NBD as input for estimating future expenses. Some hospital reimbursement contracts are on a per diem schedule, and expected NBD is useful in forecasting future revenue.Two models, time regression and autoregressive integrated moving average (ARIMA), are applied to nine years of monthly counts of the NBD for the Rhode Island Hospital System. These two models are compared to see which gives the best fit for the forecasted NBD. Also, the question of summarizing the time data from monthly to quarterly time periods is addressed. The approaches presented in this chapter can be applied to a variety of time series data for business forecasting.

This paper aims to examine for the first time the impact of the intensity of hospital bed occupancy on healthcare facilities operational costs in France.

Research methodology is based on empirical data collection from 19 short‐stay care acute and long‐term care hospital facilities in Paris, France, carried out during 2008. Statistic analysis was conducted to investigate the impact of bed occupancy on operational cost of health facilities. The purpose of the analysis is to determine the best practices and provide recommendations to the decision makers for operational cost budgeting purposes.

The main findings are the relationship between bed usage and operational costs of acute hospital facilities in France. An analysis of annual O&M (operation and maintenance) cost clearly indicated that type of medical activities had a major impact on O&M cost when the influence of all other potential factors, particularly, morphology, quality of construction and age, were excluded.

Data sample is limited to hospitals in the Paris region. Hence, extrapolation from the generated results to other regions in France is limited. Other facilities operational cost drivers, such as conditional surveys of buildings, need to be considered alongside the performance measures included in this study.

The results will help in establishing best practices and benchmarking operational costs in heath care facilities in France. They will also assist in developing and planning strategic heath care operational budgets. One of the most important implications of the results is in assisting decision makers to develop facilities management improvement strategies.

The research described in this paper represents significantly advances in the understanding of the impact of medical activities on operation and maintenance costs of healthcare facilities in France.

To investigate the association between implementation of clinical governance and patient safety.

A pre-post study was conducted in an Australian health service following the implementation of clinical governance systems (CGS) in the inpatient wards in 2016. Health service audit data from 2017 on CGS implementation and the rate of adverse patient safety events (PSE) for 2015 (pre-implementation) and 2017 (post-implementation), across 45 wards in six hospitals were collected. CGS examined compliance with 108 variables, based on the Australian National Safety and Quality Health Service standards. Patient safety was measured as PSE per 100 bed days. Data were analysed using odds ratios to explore the association between patient safety and CGS percentage compliance score.

There was no change in PSE between 2015 and 2017 (MD 0.04 events/100 bed days, 95% CI -0.11 to 0.21). There were higher odds that wards with a CGS score >90% reported reduced PSE, compared to wards with lower compliance. The domains of leadership and culture, risk management and clinical practice had the strongest association with the reduction in PSE.

Given that wards with a CGS score >90% showed increased odds of reduced PSE health service boards need to put in place strategies that engage frontline managers and staff to facilitate full implementation of clinical governance systems for patient safety.

The findings provide evidence that implementation of all facets of CGS in a large public health service is associated with improved patient safety.

This article reports on the experiences and evaluations of piloting health and social care discharge co‐ordinators in acute and community hospital settings. Benefits were felt with regard to length of stay, bed day use, and patient and staff experience, and were particularly notable where a discharge co‐ordinator employed by the community trust was put into the acute hospital setting. The pilots have supported a redesign of hospital discharge processes across Torbay Care Trust and South Devon Healthcare NHS Foundation Trust, and provided the foundation for improved partnership working and integrated service provision.

The purpose of this paper is to describe the delivery of the first clinically led, inter-professional Pathway Homeless team in a mental health trust, within the King’s Health Partners hospitals in South London. The Kings Health Partners Pathway Homeless teams have been operating since January 2014 at Guy’s and St Thomas’ (GStT) and Kings College Hospital and expanded to the South London and Maudsley in 2015 as a charitable pilot, now continuing with short-term funding.

This paper outlines how the team delivered its key aim of improving health and housing outcomes for inpatients. It details the service development and integration within a mental health trust incorporating the experience of its sister teams at Kings and GStT. It goes on to show how the service works across multiple hospital sites and is embedded within the Trust’s management structures.

Innovations including the transitional arrangements for patients’ post-discharge are described. In the first three years of operation the team saw 237 patients. Improved housing status was achieved in 74 per cent of patients with reduced use of unscheduled care after discharge. Early analysis suggests a statistically significant reduction in bed days and reduced use of unscheduled care.

The paper suggests that this model serves as an example of person centred, value-based health that is focused on improving care and outcomes for homeless inpatients in mental health settings, with the potential to be rolled-out nationally to other mental health Trusts.

As policy makers seek to develop a more preventative and rehabilitative approach to older people's services, new policies and integrated initiatives have made a positive contribution. However, rebalancing the nature of the system as a whole remains elusive.