Overview
Initiative type
Service Improvement
Status
Deliver
Published
June 2026
Summary
A practical, replicable model using guided tours that help staff see the system in motion, understand their role in flow, uncover barriers and generate insights to improve access.
Implementation sites: Cairns and Hinterland Hospital and Health Service
Dates: January 2025 - ongoing
Partnerships: Queensland Ambulance Service - Emergency Medical Dispatch (EMD)
This project was presented as a Poster at CEQ Showcase 2026 (PDF 423 KB).
Aim
To improve patient access and flow by building shared understanding of flow principles, roles, and system interdependencies across our organisation.
Outcomes
- Strengthened system-wide flow capability through a scalable, practical model that improves shared understanding, role clarity, and coordinated decision-making.
- High satisfaction: Overall satisfaction 4.67/5; 89% promoters.
- Tour expectations met/exceeded: 100%.
- Improved flow confidence: Nursing Team Leader participants demonstrated a clear shift from low/no confidence to good/high confidence in understanding of patient-flow processes.
- Cross-service engagement: Oversubscription in 2025 and a fully booked early 2026 schedule indicate sustained, high organisational demand for the program.
- Program expansion: Expanded from three to five focus areas - now incorporating Allied Health and Medical partners - and increased the number of scheduled tours in 2026.
Background
Patient flow and timely access remain persistent challenges across healthcare systems, with delays emerging from interdependent structures rather than isolated service issues (1, 2). Within Cairns and Hinterland Hospital and Health Service (CHHHS), variability in understanding core flow concepts, limited visibility of upstream and downstream impacts, and inconsistency in escalation practices contributed to fragmented decision making and avoidable delays across the patient journey'patterns that are well described in the patient flow literature internationally (1, 2).
Flow Matters ' Insights Tours was developed to address this capability and visibility gap by translating system flow theory into practical, real-world learning. The program reframes patient flow as a shared responsibility that spans services, professions, and operational layers. Participants are taken through key access and flow functions to observe real time pressures, competing demands, and system ripple effects associated with daily decisions.
Initial demand, along with informal feedback from rural and metropolitan participants, indicated a strong appetite for consistent language, clarity of roles, and opportunities to view the system as a coordinated whole. The central question guiding the initiative was:
How can CHHHS build a shared, practical, system level mental model of patient flow that strengthens coordination, consistency, and timely access?
The target cohort includes nursing Team Leaders, operational managers, rural and remote partners, and multidisciplinary staff whose decisions directly influence patient movement. The program is positioned as a repeatable, scalable approach to building flow capability across CHHHS.
Methods
The program applies an iterative continuous improvement methodology, combining systems thinking with rapid learning cycles where insights from each tour informed real time refinement of content, structure and engagement.
The initiative uses a structured learning and engagement model comprising:
1. System Flow Education: Short, targeted education on access principles, demand - capacity dynamics, escalation pathways, and role clarity.
2. Guided Walk Throughs: Observational tours of flow critical areas (e.g. Patient Flow Unit, Emergency Department (ED)/Transit Procedure Unit (TPU), CPACH), with facilitated interaction with Patient Access, Hospital Operations (after hours), IHT coordination, and Queensland Ambulance Service Emergency Medical Dispatcher (QAS EMD).
3. Facilitated Reflection: Structured group discussions to identify "unwritten rules," recurring barriers, and opportunities for improvement.
Delivery streams
The program now operates across multiple iterative and evolving participation streams, shaped by ongoing feedback from staff and leaders across the organisation:
- Nursing Leadership Development: Embedded within the CHHHS Team Leader program with protected learning time, supporting consistent foundational flow capability among frontline nursing leaders.
- Rural & Remote Services Partnership: A reciprocal model where RRS partners participate in Cairns tours and CHHHS teams visit rural sites, building shared understanding of access challenges across geographic contexts.
- Open Organisational Engagement: Broad, multidisciplinary access through whole of CHHHS invitations, with early 2026 rounds fully booked, reflecting growing system wide demand.
- Nursing Director / Emerging Director Stream (New 2026): Responding to iterative feedback identifying a capability gap, the program is expanding to include Nursing Directors and emerging directors, providing structured exposure to flow, escalation pathways, and their leadership role in system coordination.
- Allied Health System Lens Stream (New 2026): In planning with Allied Health leadership, incorporating short, structured observational sessions to strengthen visibility of system level flow, interdependencies, and their contribution to access and discharge.
- Medical Orientation Stream (New 2026): Flow fundamentals components are being incorporated into medical orientation to embed early awareness of flow impacts, escalation roles, and system interdependencies for new medical staff.
Evaluation
Mixed methods evaluation included short post tour surveys (Likert 1'5 for experience domains and 0'10 willingness to recommend) and qualitative comments. Satisfaction remained consistently high across cohorts, with universal recommendation and expectations met or exceeded. Qualitative analysis demonstrated improved understanding of operational pressures, escalation pathways, and system interdependencies.
Team Leader workshops provided additional qualitative learning data (n=55 comments sampled), revealing strengthened comprehension of patient flow processes, escalation expectations, after hours supports and bed management roles. Importantly, the Team Leader cohort also demonstrated a directional uplift in confidence, shifting from predominantly no/low confidence prior to the workshops to good/high confidence afterwards in understanding how patient flow processes operate across the broader system.
Discussion
Conditions for success
Success was enabled by visible director sponsorship, protected learning time, psychologically safe environments, and hands on exposure to real operational contexts. Positioning flow as a shared, values-based responsibility encouraged staff to view issues through a system lens rather than local pressures. Critically, the program's iterative, continuous learning approach -here participant feedback directly shaped tour content, sequencing, and engagement - allowed the model to evolve responsively, ensuring relevance, increasing buy in, and strengthening system wide capability over time.
Findings & interpretation
Evaluation demonstrated consistently high satisfaction (4.6'4.75/5) across 2025 tours, with strong engagement and universal recommendation. Participants reported clearer understanding of whole of system interdependencies, escalation pathways, and their own role in influencing patient flow across CHHHS. Observational learning was repeatedly identified as the most valuable element'guided walk throughs enabled participants to "see the system in motion," making invisible work visible and deepening comprehension of operational pressures and flow decision points.
Team Leader workshop data reinforced these findings, showing strengthened understanding of patient flow processes, escalation expectations, after hours supports, and bed management roles. Importantly, the cohort demonstrated a directional shift in confidence, progressing from predominantly no/low confidence to good/high confidence after participating'an early signal of capability uplift.
Rural and remote participants highlighted the value of witnessing metropolitan pressures first hand, deepening mutual understanding and strengthening relationships across sites. Feedback also identified practical improvement opportunities, including pacing of ED tours, sequencing of sessions, and the need for post tour action time to translate insights into specific improvement activity. These insights directly informed iterative refinements to the program's design and delivery.
Limitations
Sample sizes for formal 2025 survey data were small, and some responses required mapping from textual Likert labels to numerical scales. Team Leader pre'post confidence results represent directional trends only due to the absence of raw numerical data. Despite these limitations, qualitative convergence across multiple data sources strengthens the reliability of the themes.
Scalability and transferability
The model is low cost, repeatable, and highly adaptable. It is already expanding beyond its initial three streams into Nursing Director development, Allied Health observational sessions, and Medical orientation. Its structured-yet-flexible design allows for straightforward integration into leadership development programs, onboarding pathways, and rural outreach initiatives across Queensland Health. The capability focus - building a shared mental model of flow - positions the program as transferable to any service seeking to improve access, coordination, and flow reliability.
References
1. Nguyen Q, Wybrow M, Burstein F, Taylor D, Enticott J. Understanding the impacts of health information systems on patient flow management: A systematic review across several decades of research. PLoS One. 2022;17(9):e0274493.
2. Al Harbi S, Aljohani B, Elmasry L, Baldovino FL, Raviz KB, Altowairqi L, et al. Streamlining patient flow and enhancing operational efficiency through case management implementation. BMJ Open Qual. 2024;13(1).
Key contact
Elizabeth Evans
Healthcare Redesign Clinical Nurse Consultant
Cairns and Hinterland Hospital and Health Service
Email: lisa.evans@health.qld.gov.au