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Reading: A system approach to designing intermediate tier service improvements


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A system approach to designing intermediate tier service improvements


Joanne Street ,

Bolton NHS Foundation Trust, GB
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Cheryl Thompson,

Bolton NHS Foundation Trust, GB
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Sheelagh Machin,

Advancing Quality Alliance, GB
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Wendy Lewis

Advancing Quality Alliance, GB
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Background: The Intermediate Care Services in Bolton consist of health, social care, and mental health organisations, 350 staff across 7 services and 5 different bases.

In totality these services provide the step-up and step-down facilities for people at risk of hospital or long term care admission, or requiring additional support on discharge from hospital.

Bolton as a Locality system identified Intermediate Care as having significant difficulties in managing flow between its services and its transition points, thereby having a negative impact on flow within the hospital system. Whilst a number of the teams were co-located, it was recognised that integration in itself was minimal, and the opportunity to maximise efficiency and effectiveness of integration hadn’t been realised.

As a locality we applied to one of the discovery sites for AQuA’s Whole System Flow programme and undertaken a process of diagnostic, design, and implementation.

Aims and Objectives: Demonstrate how application of a Whole System Flow Programme has resulted in a re-designed and improved Intermediate Care system.

Demonstrate the system impact at the following levels in terms of effectiveness, efficiency, culture, system shift, mind-set change:

Outline the engagement and co-production process with people and their families alongside staff, managers, voluntary sector organisations, and how the inclusion of Lived Experience has shaped the phases of diagnostic, design and implementation.

Describe the challenges faced, and how these have been overcome.

Outline key measures for improvement and the data to support these.

Oral Paper

Target audience: This workshop will be of interest to people engaged in pathway redesign and  development of care systems across organisational boundaries. It will be delivered to meet the needs of patients, community representatives as well as professionals within care systems and its leaders.

Learnings/Take away: How Bolton has taken the theory of Whole System Flow, and change methodologies implementing them in practice

Practical examples for improving flow across a system

Utilising Lived Experience in a meaningful way

Challenges at a system, service, and team level and ways these have been overcome

Importance of joining up the System, Service and Team for improving service delivery

How to Cite: Street J, Thompson C, Machin S, Lewis W. A system approach to designing intermediate tier service improvements. International Journal of Integrated Care. 2019;19(4):27. DOI:
Published on 08 Aug 2019.


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