FACILITIES MANAGEMENT
Bottlenecks in patient flow create queues that slow capacity across the hospital, increasing pressure on emergency departments, wards, and discharge pathways.
Bradley Watson
Bradley Watson is an experienced healthcare operations manager with over 14 years’ service in the NHS, currently leading Portering and Postal Services at Mid and South Essex NHS Foundation Trust. Throughout his career, Brad has managed multi- site teams of up to 200 staff across Portering, Domestic, Waste, and Grounds services, driving improvements in operational efficiency, workforce engagement, and patient flow. Passionate about continuous improvement and system thinking, he has delivered measurable cost savings, service standardisation, and accreditation achievements across diverse support services. His recent focus explores the intersection between operational performance metrics and wider organisational goals, advocating for data-driven yet people- centred approaches to improvement. Brad is currently completing a management degree, deepening his expertise in strategic and operational leadership.
(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
54 Health Estate Journal February 2026
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.
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