When you work in change, it is hard enough to measure what has happened but even harder to measure what would have happened without action being taken. This is particularly important when seeking to understand complex systems. The recent paper by Wyatt and colleagues therefore makes an important contribution to the discussion in highlighting that without action admissions from ED in 47 hospitals would have been 11.9% higher than they were in 2015. This adds weight to the perception that acuity and dependency of patients in hospitals are increasing and the jobs we are asking people to do are continually evolving and our planning needs to take account of this.
It is great to see the A&E data set being used but disappointing that data quality was good enough for use in only 47 units. The lesson here is that in complex change collaborative learning is really important, The speed that this can happen depends on colleagues working together to share their experiences. Good data and analysis amplifies trust and understanding and should accelerate progress."