Background: Hospital 'command centres' use digital technologies to collect, analyse and present real-time information that may improve patient flow and patient safety. Bradford Royal Infirmary has trialled this approach and presents an opportunity to evaluate effectiveness to inform future adoption in the United Kingdom.
Objective: To evaluate the impact of the Bradford Command Centre on patient care and organisational processes.
Design: A comparative mixed-methods study. Operational data from a study and control site were collected and analysed. The intervention was observed, and staff at both sites were interviewed. Analysis was grounded in a literature review and the results were synthesised to form conclusions about the intervention.
Setting: The study site was Bradford Royal Infirmary, a large teaching hospital in the city of Bradford, United Kingdom. The control site was Huddersfield Royal Infirmary in the nearby city of Huddersfield.
Participants: Thirty-six staff members were interviewed and/or observed.
Intervention: The implementation of a digitally enabled hospital command centre.
Main outcome measures: Qualitative perspectives on hospital management. Quantitative metrics on patient flow, patient safety, data quality.
Data sources: Anonymised electronic health record data. Ethnographic observations including interviews with hospital staff. Cross-industry review including relevant literature and expert panel interviews.
Results: The Command Centre was implemented successfully and has improved staff confidence of better operational control. Unintended consequences included tensions between localised and centralised decision-making and variable confidence in the quality of data available. The Command Centre supported the hospital through the COVID-19 pandemic, but the direct impact of the Command Centre was difficult to measure as the pandemic forced all hospitals, including the study and control sites, to innovate rapidly. Late in the study we learnt that the control site had visited the study site and replicated some aspects of the command centre themselves; we were unable to explore this in detail. There was no significant difference between pre- and post-intervention periods for the quantitative outcome measures and no conclusive impact on patient flow and data quality. Staff and patients supported the command-centre approaches but patients expressed concern that individual needs might get lost to 'the system'.
Conclusions: Qualitative evidence suggests the Command Centre implementation was successful, but it proved challenging to link quantitative evidence to specific technology interventions. Staff were positive about the benefits and emphasised that these came from the way they adapted to and used the new technology rather than the technology per se.
Limitations: The COVID-19 pandemic disrupted care patterns and forced rapid innovation which reduced our ability to compare study and control sites and data before, during and after the intervention.
Future work: We plan to follow developments at Bradford and in command centres in the National Health Service in order to share learning. Our mixed-methods approach should be of interest to future studies attempting similar evaluation of complex digitally enabled whole-system changes.
Study registration: The study is registered as IRAS No.: 285933.
Funding: This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR129483) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 41. See the NIHR Funding and Awards website for further award information.
Keywords: COMMAND CENTRE; DATA QUALITY; ELECTRONIC HEALTH RECORDS; ETHNOGRAPHY; HEALTH SERVICES; HOSPITALS; INFORMATION TECHNOLOGY; LEARNING HEALTH SYSTEMS; MIXED METHODS; PATIENT CARE; PATIENT SAFETY; PROCESS MINING.
Safety-critical industries like airports often use ‘command centres’ to manage operations safely and efficiently. In contrast, most National Health Service hospitals have operational management that is fragmented across many departments and poorly co-ordinated. This may pose risks to the safety and care of patients and may partially explain excessive waiting times. Bradford Royal Infirmary is one of the first National Health Service hospitals to try out a command-centre approach using new digital technologies. Hospital staff at Bradford now work together in a purpose-built Command Centre room and monitor a ‘wall of analytics’ that displays real-time data from the hospital’s information systems. This study examines the implementation at Bradford in order to learn lessons that may help the National Health Service improve the way hospitals provide safe and efficient patient care. We reviewed what is known about the approach, analysed hospital data, observed teams working in the Command Centre, interviewed staff and ran workshops with patients. We also compared Bradford with a similar hospital that did not initially have a command centre. Our results showed the Bradford Command Centre does work. Staff told us the Command Centre helped them manage the hospital through the COVID-19 pandemic. Staff described how they used the new technology to improve efficiency and safety. We observed some challenges, including tension between the central team and local departments and concerns to make sure data were good quality. We could not measure the direct impact of the Command Centre on patient flow and safety using the hospital’s data because the pandemic disrupted normal operations so much. Patients expressed strong support for what they saw as modern methods but were concerned to ensure that the National Health Service tradition of personal care was preserved. Other National Health Service hospitals are interested in following a command-centre approach and our results should help them to learn from Bradford.