Portering efficiency and strategic patient needs

The NHS faces increasing pressures in its goals of providing effective and efficient patient care due to a combination of challenges that directly impact patient flow and hospital operations. The ageing population has significantly increased demand for healthcare services. The number of over 65-year-olds have significantly increased in the last decade, resulting in more frequent hospital admissions, longer stays, and greater post-discharge support. Additionally, there has been a surge in the number of chronic conditions such as dementia, diabetes, and cardiovascular disease, placing further strain on hospital resources. Hospital admissions for cardiovascular diseases alone have risen by 33 per cent between 2015 and 2020 (British Heart Foundation, 2021), the number of people living with diabetes rose by around 1 million between 2015 and 2022 (Diabetes UK, 2022), and the number of people diagnosed with dementia in the UK has grown from approximately 850,000 in 2015 to over 944,000 in 2023 (Alzheimer’s Society, 2023). As a result, inpatient capacity is under constant pressure, with many hospitals operating well beyond the recommended safe threshold for bed occupancy.

The Royal College of Emergency Medicine reported that emergency departments are experiencing record-breaking attendance figures, with pressures resembling those of the winter period now persisting throughout the year. This combined with the rise in ambulance handover delays and corridor care reflects a system struggling to keep up with admission demand. The challenge however does not stop there because it is not simply about getting patients into hospital, it is equally about ensuring timely discharges. With a lack of community and social care provision there is frequently a delay in transfers of care resulting in further bottlenecks within the system, leading to bed shortages and cancelled procedures.

These challenges are only further compounded with financial constraints by experienced within the NHS and persistent workforce shortages. This underscores the urgent need for organisations to embrace innovation, no matter how small, while fostering open communication to encourage fresh perspectives. By exploring, testing, and refining new ideas, we can empower hospitals to operate efficiently prioritising the well-being of our patients.

The role of portering in hospital settings

Portering, at its core, is about logistics and is responsible for the transportation of patients throughout the Hospital. However, the role of a porter isn’t limited to just patients, often being additionally accountable for the swift distribution of medical equipment, blood products, pharmaceutical items and supplies, enabling clinicians to focus on providing excellent patient care. As with many jobs in the NHS, these descriptions fail to capture the complete responsibility of the role and the impact it can have on the organisation and patient care. Although a porter’s interaction with patients is often brief, lasting between 10-15 minutes, providing comfort and kindness during transport reduces stress and anxiety in patients, creating a better overall experience and care outcome. Comparatively the role in which the Portering team’s play in patient flow, whilst seeming minor, has a significant impact on organisational outcomes. This was especially highlighted during the COVID-19 pandemic with portering teams across the country receiving greater recognition for their role in patient care and hospital operations.

Utilising equipment

Vancouver General Hospital conducted a study to identify the key factors affecting the efficient use of their CT scanners. The study aimed to optimise the utilisation of the scanners, improving timely scans and minimising wait times. The results of this study identified two main issues impacting the efficient use of its scanners. The first related to delays due to patients not being ready for their scans due to delays on the wards, resulting in porters being underutilised. The second and key area identified, was not having patients returned on time due to the unavailability of porters. Addressing these could significantly enhance the efficiency of CT scanner usage, leading to better patient care and reduced wait times. Studies such as this emphasise the important role porters play in efficient hospital processes and patient flow.

Whilst the NHS has always relied on data-driven decision-making, recent advancements have significantly enhanced our ability to leverage data insights in our management practices. The improvements in these electronic systems have revolutionised how we measure our performance, from accurately monitoring our KPI’s to providing unique visibility into operations. The benefits of leveraging technology and adopting this KPI-focused approach are clear. Embracing this means we can improve operational efficiency, patient satisfaction and utilise data to identify areas for improvement, tracking the effectiveness of changes over time. However, whilst the data for my department would suggest we are operating efficiently, I’ve witnessed instances where the adherence to this operating model doesn’t always align with the hospital’s wider need, particularly in managing patient flow during times of overcrowding. This has prompted a question that has begun to weigh heavily on my mind: Are we seeing the full picture?

Patient flow needs in the NHS

In a survey conducted by NHS Providers in May 2024, 114 trust chief executives and finance directors provided their views on various finance-related topics, including NHS productivity. The feedback was clear, one of the biggest challenges to increasing productivity within the NHS is delayed discharges and disruptions to patient flow. This inability to move patients through the hospitals prevents more people from being admitted, subsequently creating unmanageable queues. Thinking of it like a traffic jam we can explore this using queuing theory and the formation of compression waves. When the flow of traffic (patients) is disrupted, it causes a bottleneck effect, leading to a build-up of traffic waiting to get through (build-up of individuals waiting to be seen). These delays, or compression waves, compound through the system creating further delays and inefficiencies, all of which impact the overall capacity of the hospital operations.

Patient flow is complicated. When we consider the number of clinical and administrative tasks associated with a single patient visit, much of which happens at different times and in different locations, it’s easy to see how a compartmentalised approach forms. Too often, clinical teams and departments work independently of each other resulting in lower-quality service and coordination inefficiencies. However, this is understandable, very few departments have a full insight into other services, often only seeing the part of the journey in which they are involved. This is why essential teams such as the site teams or patient flow teams play such a crucial role, in maintaining a constant bird’s eye view of the journey. Porters may not have the in-depth knowledge of department functions like their clinical colleagues, they possess a unique into operations due to their movements throughout the organisation. Their perspective allows them to see how the different stages in the journey piece together, making them invaluable in identifying and addressing potential bottlenecks or inefficiencies.

Whilst we know portering will not solve all patient flow issues, finding new improved ways of working will be a step towards the greater goal of improving hospital productivity and ultimately allowing patients to receive the treatment they need as quickly as possible. By taking the time to challenge the status quo and address minor issues, we may identify practices that benefit both patients and hospital performance.

Operational efficiency vs strategic patient flow needs

In NHS portering, operational efficiency is often viewed in the principle of ‘first come first served’ basing the priorities on the order of transfer request. This approach ensures fairness in the distribution of tasks and sets clear, measurable standards that the department can use to demonstrate its effectiveness. For example, if Patient A had a transfer request made ten minutes ago and a second request has been made to move patient B, when a porter becomes available, current systems would prioritise Patient A due to the time they have been waiting. This approach, however, can sometimes conflict with the strategic patient flow needs, especially in high-pressure scenarios such as hospital overcrowding. For example, in times of overcrowding, it may be more appropriate to prioritise Patient B, who risks breaching ED wait-time targets, over Patient A, regardless of when their request was logged. Alternatively, patient B is in a speciality bed needed for another patient waiting to come up from ED. In both these instances, the logic by which the current process adhered to by the portering team would allocate jobs would not align with the greater need of the site.

This leads me to reflect on and consider potential limitations to our current approach and explore new ways of thinking. I think we would all agree that monitoring KPIs is essential in today’s business environment; however, they may not capture true visibility associated with patient flow. This raises an important question: Do the operational metrics of Portering teams truly align with the broader strategic needs of patient flow priorities in hospitals?

Joint metrics and adjusted working methodologies

Exploring this question poses an idea of new adaptive strategies during times of unpredictable demand to meet the wider organisational needs for optimal patient care. If in these times, it is deemed that the sites’ need to improve flow, whether to prevent breaches or improve care deliverance, outweighs its need to see a department as being ‘efficient’, then could an amended process be created to achieve this?

The implementation of a new process to meet these needs cannot be achieved in isolation and necessitates the need for a more collaborative approach. The site/patient flow team, working in conjunction with the portering team, provides both with a comprehensive understanding of the hospital flow, enabling reprioritisation of key tasks that enhance overall site efficiencies and, subsequently, patient care. With this oversight and decision of a singular purpose, by working together, both teams can potentially develop a more effective strategy for addressing complex healthcare challenges to reach the combined goal.

However, there is a greater question that needs to be asked in these instances: how would we evidence success? If the Portering team are to work in a way that goes against their productivity KPI metrics, then how do they evidence that the decisions made in conjunction with the site/patient flow team were, in fact, the correct decision and best for the site’s efficiencies? These questions highlight the importance and understanding, that should a new way of working be required; then there also needs to be a new set of metrics to measure and provide assurance. These however may not be as straightforward as one would like. With patient flow decisions being complex and based on several different variables, finding the right metrics to monitor will prove difficult.

When could it be implemented?

To ensure the most effective use of resources there needs to be clear guidelines allowing for understanding and providing assurance. What are the circumstances that dictate when this new process is implemented? One camp may say implementation will begin when the site reaches Internal critical incident to enable flow, releasing the pressure on the site, but could this be deemed as simply ‘firefighting’. This approach whilst being potentially beneficial in the moment, could be viewed as a more reactive approach instead of a proactive. An alternate view could be that the ideal time to implement is prior to Internal critical to provide flow prior to the congestion of the site.

Conclusion

This paper has explored the intersection between portering efficiency and strategic patient flow, challenging the assumption that an optimised digital allocation system always leads to the best hospital-wide outcomes. While task allocation technology has significantly improved fairness and productivity, its rigid adherence to predefined rules may sometimes hinder flexibility, especially during periods of high demand.

A key insight from this analysis is that efficiency alone does not equate to effectiveness. The current system excels in distributing workload evenly, ensuring porters are utilised to capacity. However, patient flow is inherently dynamic, requiring a level of situational decision-making that algorithms alone cannot provide. The findings suggest that in scenarios where patient flow becomes critical, such as emergency department bottlenecks or delayed discharges, there may be value in introducing a more integrated approach to portering decision-making.

Rather than viewing efficiency and strategic flexibility as competing priorities, hospitals might benefit from blending automated task allocation with real-time human oversight. This could involve closer collaboration between portering teams and bed management units or refining the system to allow temporary prioritisation adjustments during surge periods. The goal is not to replace efficiency metrics but to ensure they support, rather than restrict, the broader needs of patient flow.

Ultimately, this paper underscores the importance 
of contextual decision-making in hospital operations. While standardisation and digital optimisation have brought undeniable benefits, they must be 
complemented by adaptive strategies that recognise 
the complexities of hospital logistics. By fostering a culture of responsiveness and cross-team collaboration, NHS trusts can ensure that portering services are not just efficient, but truly effective in supporting patient care.