Developing Bed Managers The Why and The How

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Developing bed managers: The why and the how
Article in Journal of Nursing Management · February 2007

DOI: 10.1111/j.1365-2934.2006.00632.x · Source: PubMed
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Proudlove N, Boaden R and Jorgensen J (2007). "Developing bed managers : the why and the how".
Journal of Nursing Management 15:1, 34-42.
Title: Developing bed managers: the why and the how
Key words: nursing, beds, management, training, personal development
Total word count: 4,600 (excluding tables, figures and references)
Authors:
Nathan Proudlove, BSc, MSc, MPhil, PhD, Lecturer in Operational Research,

Manchester Business School, University of Manchester
Ruth Boaden, MA, MSc, PhD, Senior Lecturer in Operations Management,

Manchester Business School, University of Manchester. She is a Non-Executive
Director of Pennine Acute Hospitals NHS Trust.
Julie Jorgensen RGN, BSc, Nursing IM&T Project Manager at Stockport NHS
Foundation Trust (previously, Project Manager with the Performance
Directorate at Greater Manchester SHA).
Correspondence:
Dr Nathan Proudlove, Manchester Business School, University of Manchester,

Booth Street West, Manchester. M15 6PB.
Tel: 0161 200 3429. Fax: 0161 200 3505. Email: nathan.proudlove@mbs.ac.uk
1
Developing Bed Managers: the why and the how
Abstract
Aim:
This paper describes and analyses the role of bed managers within hospitals,
and how this can be supported through a development programme.
Background & Key Issues:
Bed management has increased in importance as access targets have
developed, and appreciation of the importance of patient flow has grown.
The bed management role is usually performed by nurse managers, and can
be particularly stressful and managerially complex. Despite calls for training
support, little has been available. In response we have developed and
delivered a training programme to over 70 staff in the past two years.
Evaluation & Conclusions:
The programme evaluation data is used to show that it has had an impact on
the knowledge and skills of the bed managers involved, but also on their
subsequent behaviours. These changes have translated into results for the
organisation and the individual, including staff retention, promotion and
fewer cancelled operations. We conclude that the programme is an
effective way to enhance the knowledge and skills of bed managers, and
that the enhanced profile of bed management raises challenges for nurse
managers in many areas of the organisation.
2
Developing Bed Managers: the why and the how
Background
Bed management is an area of nursing management which has expanded
considerably in the last decade. Day-to-day, the role can be complex and
stressful, as it involves dealing with many distinct functions which are both
internal and external to a hospital trust, as well as juggling competing
demands for resources. In the longer term, the role can play an important
part in on-going efforts to improve a organisation’s ability to admit, treat and
discharge patients appropriately. Generally, however, there is little training
available to bed managers to help them better perform and cope with day-
to-day activities, or enable them to fulfil the potential of their roles and the
bed management function in improving patient flow and experience.
There is a growing realisation that effective management of the flow of in-
patients through acute hospitals is fundamental to good quality in-patient
care and to achieving the relevant NHS Plan targets. Consequently there has
been a renewed interest in bed management, with efforts to increase
understanding and support throughout acute trusts, and to highlight the need
for training and enhanced scope for the bed management role. This paper
describes our response to this need: the Bed Managers’ Development
Programme which has been running since 2002. This has been resourced by
3
Greater Manchester SHA with the support of the NHS Modernisation Agency 1
and the Greater Manchester Workforce Development Confederation 2, and
accredited by the Royal College of Nursing.
This paper describes and analyses the role of bed managers within hospitals,
and how this can be supported through a development programme. The
material was drawn from two sources: a review of the literature on bed
management, which has been emerging since the 1990s, and the results of
the evaluation of a training programme for bed managers.
Most of the literature on bed management is “grey” literature and there are
few published academic studies in this area. It was not therefore possible to
do a systematic review (in the sense by which this term is normally
understood) of literature but all key management and medicine databases
were consulted. The literature (including the grey sources) is characterised by
a lack of “hard” data about the performance or effects of bed management
on patient flow and experience. The need for systematic evidence is
recognised as a priority area for future research (Cooke et al., 2004). Bed
management is one component of a very complex, multi-factorial system,
subject to frequent changes from within and without. It also differs in structure
and definition from one organisation to another, and these two factors make
it difficult to carry out and report research which might demonstrate causal
1 At the time of the programme being first run, although the NHS Modernisation Agency no
longer exists.
2 Subsequently absorbed into Greater Manchester Strategic Health Authority
4
links between bed management and patient care, or any other performance
measure. We suspect that this complexity is the main factor influencing the
lack of empirical quantitative evidence in this area.
Empirical data presented in this paper is drawn from the evaluation
questionnaires from the training programme, as well as data from the
participants’ assessed portfolios, which contained both quantitative and
qualitative data.
Clarifying the definition of bed management
The conceptualisation of bed management used here is drawn from work by
the Audit Commission (1992) who described the in-patient journey as a four-
stage process, with bed management involved in all stages (see Figure).
[FIGURE ABOUT HERE]
It is argued that smooth patient flow through the acute system contributes
significantly to the patient experience as well as enabling the efficient (as well
as effective and efficacious) use of the limited resources available. The
consequences of poor flow management are most visible in terms of weak
performance on emergency and elective access targets, but also result in
lengths of stay which are longer than necessary. This is often argued to be
detrimental to quality of patient care although evidence about this is not
conclusive (Clarke and Rosen, 2001).
5
In most hospitals, shortage of beds has been the most commonly cited
constraint on emergency and elective access and activity. However, the
Audit Commission (2003) point out that in many trusts this should be viewed as
a symptom of other underlying issues. As a consequence the organisation of
day-to-day in-patient flows generally focuses on bed management, which in
practice consists of identifying empty beds and allocating waiting patients to
them. There are a number of job (and function) titles for bed management,
along with a variety of roles undertaken by staff responsible for the day-to-
day placement of admissions and collating information on bed availability.
There is no one model to suit all hospitals but in recognition of the wider
importance of the role in patient flow some are now titled “Patient-Flow
Coordinator” or, reflecting additional responsibilities, “Clinical Site
Coordinator”. However, whatever the title, few of them really manage beds
(let alone patient flows) or are responsible for more than a small part of the
patient journey. The critical success factor for their role (in their view) is the
development of effective relationships with key individuals working at
different stages of the patient journey.
The importance of patient flow does not always seem to be fully appreciated
(Haraden and Resar, 2004), and consequently bed management is often
reported (by bed managers) to be undervalued and under-supported. The
role requires individuals to ‘juggle’ conflicting objectives, most prominently the
competition for beds from elective and emergency streams, and
6
unsynchronised flows of admissions and discharges (Proudlove et al., 2003).
Organisational culture and pressures on medical and managerial staff can
result in strained relationships over priorities for admission, outlying patients,
discharges and quick turnaround of beds. Although bed managers may have
responsibility for parts of the process, they rarely have actual power to control
it, but have to work co-operatively with the many groups who are each
responsible for a part of it. The job is therefore often reported to be stressful,
with staff turnover reputedly above average (although there is no formal data
collection for this group of staff). Bed managers feel isolated because there is
often relatively little opportunity for them to share experience and good
practice, either locally or nationally.
The bed management function is usually led by a senior nurse, and front-line
bed managers are overwhelmingly nurses. A clinical background is important
to enable them to inform patient placement decisions (Proudlove et al., 2003)
and to challenge current practices (Department of Health, 2004c).
Trends in bed management
The importance of performance targets has led to a focus on bed
management
The effective management of beds as a resource has always been an issue
within the NHS (Green and Armstrong, 1994) but in the early 1990s tighter
performance measures were imposed on NHS hospitals, which forced them to
attempt to improve capacity management (Laing and Shiroyama, 1995). A
7
series of well-publicised winter ‘bed crises’ in the late 1990s (The King's Fund,
2001) and the access targets of the NHS Plan (Department of Health, 2000)
resulted in further emphasis on bed availability as a key constraint on
capacity. Consequently bed management, particularly placing patients in
beds effectively, grew in prominence and the numbers of bed managers
increased (National Audit Office, 2000). More recently, Department of Health
surveys of A&E performance have highlighted waits for a specialist opinion
(from outside A&E) and waits for a bed as the major causes of breaches of
the 4-hour A&E-time target, and resulted in new syntheses of guidance
(Department of Health, 2004a, Department of Health, 2004b).
Bed availability is a symptom of something else
Bed shortages could be regarded as a symptom of a root cause; the way in
which beds are utilised, rather than the numbers available (or the numbers of
staff to support them) and this has been emphasised by a number of studies
(Audit Commission, 1992, National Audit Office, 2000, Proudlove et al., 2003,
Audit Commission, 2003, Proudlove, 2004, Proudlove and Black, 2004, Boaden
et al., 1999). Improved understanding of the effects of variation in demand
and discharge activity (e.g. Bagust et al., 1999) and international
comparisons of length of stay (Ham et al., 2003) have also contributed to this
by providing robust empirical evidence. The international focus is now on
improving patient flow (e.g. Haraden and Resar, 2004) and the role of bed
managers to deliver and facilitate such improved patient flows within
8
hospitals and in the wider health community (Department of Health, 2004c).
The (Audit Commission, 2003) has also reiterated the importance of this:
“... it is very important that, before trusts make changes, they have a
clear understanding of the very complex interactions and feedback
mechanisms that influence their bed usage. Without this, resources
may be invested inappropriately and the changes may not bring
about the expected improvement in patient outcomes.” (p.33)
Managing beds is a multi-level activity
The concept that bed management may operate on more than one level
was suggested by the Audit Commission (2000) who proposed the
classification of executive management, operational management, and
operational bed managers. This is in line with more recent calls for the
development of whole systems approaches (e.g. Bevan, 2005).
 executive management
Much guidance on bed management emphasises the importance of
executive-level understanding of, support for, and empowerment of the bed
management function in a trust (Department of Health, 2004a, Department of
Health, 2004c). This guidance recommends director-level oversight and day-
to-day control of the bed management function, and suggests that many
trusts may need to rethink their bed management functions to give them
more influence.
9
 operational management
Despite much hospital activity involving the flow of patients through a series of
process steps, the ‘operations management’ function has been weak in
hospitals (Mango and Shapiro, 2001, Walley, 2003). A number of programmes
are underway to boost the level of operations management expertise in
healthcare organisations, including Pursuing Perfection and other Institute for
Healthcare Improvement initiatives (e.g. Institute for Healthcare Improvement,
2003 and 2005). A major NHS initiative was the Improvement Partnership for
Hospitals (IPH) Clinical Systems Improvement Programme (NHS Modernisation
Agency, 2004a), which is now being developed further. These programmes
were aimed at key operational managers and change leaders and are likely
to be similarly focused when launched by the new NHS Institute for Innovation
and Improvement (Nolan, 2005). The role of nursing as a profession in this
development does not currently appear to be clear, although there are
undoubtedly impacts on nursing practice and management from an
increased emphasis on patient flow.
 operational bed managers
The NAO (2000) concluded that:
“To increase its value, the bed management function needs to
evolve into a skilled, professional activity that is able to look beyond
the immediate daily task of identifying spare beds” (National Audit
Office, 2000, p.43)
10
However, to date, there has been no training programme designed
specifically to support this “evolution”. The lack of recognition of bed
management as a formal role is also shown by its omission from national job
profiles generated under the Agenda for Change pay reforms.
Training is generally “learning by doing”
Apart from our own impressions of the lack of training, gained from working
with bed managers over a number of years, the NAO survey (National Audit
Office, 2000) also showed that over 20% of bed managers had not even
received training on routine issues such as managing patient placement and
bed availability, let alone on principles of managing flows or organisational
change. There is some good web-based training material for the discharge
co-ordinator role (Department of Health, 2003), which is allied to bed
management, but nothing specifically for bed managers. In response to this
need we set up a development programme for bed managers in adult acute
hospitals; the first such programme in the UK.
The training programme
a. History and development
A bed managers’ network group was established across Greater Manchester
in 1996. This provided a useful forum for the bed managers to share problems,
knowledge and experience, and these benefits were noted by the NAO
(2000). It also fostered a feeling of solidarity and helped reduce suspicion
between closely-situated trusts. The group realised that it also had the
11
opportunity to share good practice and encourage a consistent approach to
the role. One of the main issues raised repeatedly was the lack of any specific
training to help them cope with the demands of the job and enable them to
make better use of their skills and experience. Repeating the mistakes of
others or reinventing the wheel is not the best option. A brief study revealed
that, although there is now a wide variety of general management and
leadership training available in the NHS, only a few bed managers had
undertaken formal study in this area. We had also been involved in studying
bed management and related issues from this time through a number of
research projects funded by the Greater Manchester Chief Executive’s
Group, the (then) NW Region Executive of the NHS, the Modernisation
Agency and government research councils. Several of these projects
involved the bed managers’ network and had contributed to national
initiatives and studies, including those by the NAO and Audit Commission.
An offer of financial assistance from the Modernisation Agency’s Hospital
Operational Intelligence Project (Department of Health, 2002), and funds from
the Greater Manchester Workforce Development Confederation enabled a
senior bed manager from one of the Greater Manchester trusts to be
appointed as Project Manager to develop such training. This post was hosted
and supported by the SHA, and the project began in earnest in May 2002.
Material for the programme was developed, drawing on the team’s
knowledge and experience, informal knowledge of initiatives in trusts across
12
the UK, and studies and documents from national bodies (including the NAO,
Audit Commission, Department of Health & Modernisation Agency) and the
US. We also looked at the core elements of job descriptions for bed managers
in a range of hospitals. This showed that there were components which were
not explicit or were ambiguous in practice; for example, “maximise bed
usage” and “collect and analyse information”. An advisory group made up
of senior bed managers from Greater Manchester and beyond, together with
several Modernisation Agency staff with a special interest in bed
management was established. They contributed to the planning phase and
agreed the basic content of the programme, outlined in the next section.
The first cohort of twenty participants took part in the Development
Programme from September 2002 to April 2003. A further two cohorts ran in
parallel from September 2003 to April 2004 for fifty-two participants, including
thirteen from Wales, through an agreement with the Welsh Assembly
Government. The programme is now provided through Manchester Business
School, University of Manchester, with a further 25 participants currently
registered. Interest in taking part in the programme continues to be strong.
b. The objectives of the programme
The main aims of the development programme, which have remained
unchanged since its inception, are (Jorgensen et al., 2003):
1. To develop consistent and common approaches to the bed
management role.
13
2. To identify the challenges of the role.
3. To develop an understanding of the tools available to meet the
challenges.
4. To identify the key performance measures for the role
The usual requirement is that an applicant should be working as a bed
manager in an NHS hospital, at F Grade or above, or equivalent. So far only
one participant has not been a nurse.
The learning outcomes are that course members will be able to:
1. Identify and recommend improvements to the bed management
function in their hospital.
2. Understand the challenges of the role and in particular those relevant
to them and their organisation.
3. Understand and apply appropriate tools to meet challenge within their
own organisation.
4. Identify key national and local performance measures.
5. Create a portfolio of useful contacts and sources of help.
Participants are expected to build up a portfolio of evidence which is
submitted for assessment. Those who are successful receive a certificate from
the Royal College of Nursing Accreditation Unit and the Programme team. A
number of participants found the compilation of the portfolio and the
necessary reflection difficult. This was surprising since they were experienced
14
nurses and this skill has been encouraged in the nursing profession for a
number of years. However, all who submitted the portfolio did report
improvements to the patient experience and to the working lives of the
participants and their colleagues
c. The content of the programme
The Programme spans eight days over an eight-month period. Most of these
study days are led by lecturers from the University, with experienced health
service staff leading some of the more specialist sessions. There are two main
themes running through the programme:
 deeper understanding of in-patient flows throughout an acute hospital,
and
 personal and professional development.
Table 1 lists the topics under each of these headings.
[TABLE 1 ABOUT HERE]
The concept of patient flow is central to the whole programme, and
considerable time is spent discussing characteristics and causes of activity
patterns and components of the patient journey. Improvement initiatives and
examples from across the UK are discussed, as are practical tools such as
forecasting and anticipatory planning.
15
In addition to increasing the knowledge-base of participants, it is essential
that they are supported to develop the skills needed in a management role.
Almost all participants report a high level of job satisfaction, but at the same
time find the job frustrating and pressured, and so one of the sessions is
devoted to the symptoms and management of stress (in oneself and others).
Bringing about change and improvement can be particularly difficult in the
NHS, and so this is also covered.
The study days also provide a forum to share ideas and working methods and
to encourage reflection on practice. For example, sharing experience of who
manages the various components of the patient journey and how they could
work together more closely. Participants are also encouraged to share
experience and information about successful initiatives at their trusts and to
visit another participant’s trust to find out more about a way of working in
which they are particularly interested.
d. Evaluation of the Programme: methodology
It is possible to use the model of evaluation described by Kirkpatrick (1994) to
analyse the impact of this programme. Many programmes are only
evaluated through ‘happy sheets’ circulated at the end of individual sessions
or modules, but in addition to being evaluated in this way (reactions), this
programme is also evaluated through the knowledge gained by participants;
the workplace behaviours they exhibit during and post-programme; and the
impact of those changes on the organisation (results). This model has been
16
used for the evaluation of other programmes (Boaden, 2005). The source of
the data used for the evaluation is shown in Table 2.
At the start of the programme, participants were asked for their expectations.
These have been similar over the three cohorts we have run so far, and can
be summarised as shown in Table 3.
e. Evaluation of the programme: results
Overall the participants felt that the programme was a major success.
Feedback included general views that the programme contributed
significantly to personal development as well as knowledge, and was
delivered by people who “really understand what the subject is about”.
Kirkpatrick level 1 – Reactions
This relates to participants’ immediate satisfaction with the programme.
Participants were asked, for each session, to rate the extent to which each of
the specified learning outcomes was achieved, using a 0-5 scale where 0=not
achieved, 5=fully achieved.
Taking Cohorts 2 & 3 together, there were only two session outcomes (out of
over a hundred in total) which did not score an average of at least 4, and the
majority scored between 4.5 and 5. We have not included detail of these
17
ratings in this paper as they add little to the overall argument of the paper
and give little insight into the long-term benefits of the programme.
However, some participants noted that attending the programme made
them realise that, relative to other participants, their organisation was
performing very poorly and they were less involved in operational clinical
issues than others. Another immediate reaction was the realisation that there
was so much they should be aware of, but were not, which is common for
participants on many types of programme.
Kirkpatrick level 2 – Knowledge and skills
This relates to changes in knowledge and skills, and can be difficult to
measure unless standard measures of academic achievement are used.
However, for this programme participants were asked to report the things
they had learned, which included:
 a clearer understanding of their own role and improved knowledge
about bed management and the patient journey;
 how to apply theory to their practice;
 an increased ability to manage patient flows, leading to increased
credibility and influence in the Trust; plus increased recognition in the
Trust due to ideas put forward;
 new contacts and sources of help, and valuable networking and a
source of group support;
18
 a base of learning which they would be able to build on in the future as
they assimilate it (which was confirmed through subsequent contacts
with individuals who had completed the programme).
Line managers also reported changes they observed in their staff:
 staff having increased commitment, confidence, motivation, positive
attitude, and reduced feelings of isolation;
 increased analytical and lateral thinking, changes in the way data
were collected and used, the use of predictor tools, presentation and
implementation of ideas for change
Participants also indicated that in future programmes they would like to see
more consideration of clinical governance issues specific to bed
management. This was felt to be poorly understood by those without a
clinical background (especially managers), many of whom bed managers
interact with regularly.
Kirkpatrick level 3 - Behaviours
This relates to changes in on-the-job behaviour which was not only self-
reported but also reported by line managers. Participants reported:
 increased confidence (because of knowledge to back them up),
empowerment and decision making ability, and being more
accountable for own actions;
19
 changes in the way they work and in particular, how they deal with
others;
 implementing knowledge gained through the programme: daily bed
management meetings, predictor tools, a more proactive approach,
more focus on discharge, better management of outliers, process
mapping.
Line-managers reported:
 direct benefits to both the team and wider organisation, stemming from
sharing of the learning and better leadership.
Participants also indicated that they would like more focus on the transition
from nurse to manager in future programmes, and the behaviours needed.
Although this is addressed in part by other nursing development programmes
- the LEO programme was mentioned favourably by those who had been a
part of it – by no means all the participants had taken part in such
programmes.
Kirkpatrick level 4 - results
This relates to tangible changes in the organisation and at an individual level.
These were reported from both participants and managers. Since there are
many concurrent and inter-related initiatives underway to improve the NHS, in
particular those related to access targets, it is difficult to establish the specific
contribution of any one component. Although many participants gave
20
examples of specific improvements to patient care or experience which they
believed resulted from their own involvement in this programme, it has not
proved possible to quantify the outcomes. However, three participants
successfully applied for promotion and attributed part of their success to
participation in the programme. Line managers reported improved
performance (fewer cancellations of operations), and help from participants
on the programme in setting up a bed management team on another site.
Only 7% of line managers reported no observable benefit to the team.
The majority of the bed managers worked closely with their line managers,
but a significant number still reported difficulty implementing change due to
lack of support, interest, or financial pressures. This was surprising considering
the considerable pressure to improve in order to achieve and sustain
performance against national targets.
7 of the participants from Cohorts 2 and 3 said (at the end of the programme)
that they expected to stay in the role longer than they had before coming on
the programme. However, there were also 4 who planned to leave earlier
(other than through promotion or illness).
The programme has also had some national impact. Towards the end of the
first cohort the Project Manager organised a very well-attended bed
management conference to spread many of the messages of the
21
Programme to a wider audience. The Programme has inspired a very similar
initiative for southwest England and Wales.
Conclusions and implications
This paper aimed to describe and analyse the role of bed managers within
hospitals, and how this can be supported through a development
programme.
The role has been shown to be something carried out almost exclusively by
nurses – and reported to be stressful and frustrating. Bed managers operate
within a context of increased focus on the management of beds at all levels
of the organisation, but often with little understanding of the causes behind
the “symptoms” of poor bed utilisation. The importance of key relationships
with individuals, including senior nurses as well as other clinicians, is continually
emphasised by bed managers themselves.
The results of the evaluation demonstrate the benefit of the training
programme in achieving its objectives of increasing knowledge and
confidence, which has translated into changed behaviours, improved staff
retention and development as well as tangible reductions in cancellations of
elective work.
The aspiration of bed management evolving into a skilled, professional
activity, supported by appropriate training, is developing but still requires a lot
22
of work to be fully realised. Much of the work is about developing a
recognition of the importance of patient flow, and the role which bed
management plays in effective flow, in tandem with the development of
those in key roles.
We believe that bed management is an entirely appropriate role for senior
nurses but that they need to be adequately trained, not only in the
“technical” aspects of understanding the dynamics of patient flow, but also
in the management skills needed to operate at this level and in this type of
environment. However, there is a challenge for all nurses working with
patients – primarily within the acute environment, but not exclusively – to
better understand what bed management is, why it is important, and how
their role can support effective patient flow. Anecdotes of obstruction to the
appropriate placement of patients from nursing staff elsewhere in the hospital
were common amongst participants, and contributed to the view that good
bed management is about managing relationships rather than beds.
Relationship with ward and A&E staff were particularly important in this
regard.
The implications of our analysis of both theory and practice are that the
importance of effective bed and patient flow management is not likely to
lessen; if anything it will increase. There is therefore a need for:
 A national framework for bed/patient flow management roles and a clear
career structure.
23
 Development of greater understanding of patient flow management by
those at the top of the organisation, both in primary and secondary care.
New policy initiatives in chronic disease management will serve to highlight
the importance of this. It is not enough to train nurses as bed managers –
the system they work within has to be improved and recognition of the
issues achieved at all levels. Without this recognition, bed managers may
be perceived as failing to do their jobs, which is not our experience of
working with them.
 Effective training provision for those undertaking those roles. Such
programmes should be encouraged and funded appropriately, to better
equip nurses for this demanding role.
 Publicising the availability and content of training programmes, which
should reassure nurses who are working (or considering working) in this
area. Specialist knowledge and experience on relevant aspects of
operations and clinical management and syntheses of latest
developments in patient flow improvement are accessible.
Acknowledgements
With thanks to the project team, including many of the senior bed managers
in Greater Manchester.
24
Table 1
Day 1 - WHAT IS BED Introduction to course, overview of bed

MANAGEMENT? management function, comparison of roles
across trusts and against NAO
recommendations
Day 2 - PROCESS Introduction to process mapping and
MAPPING AND redesign; clinical governance issues in bed
REDESIGN, CLINICAL management; national and local targets
GOVERNANCE and and performance indicators
PERFORMANCE
INDICATORS
Day 3 - MEASURING Demonstrating change in performance
IMPROVEMENT (including SPC); Greater Manchester
and ADMISSION Emergency Admissions Policy, admission
pathways, receiving GP referrals, elective
versus emergency, increased use of IT, closer
management of emergencies and electives
Day 4 - WHAT SKILLS Analysis of role, identification of skills
DOES A BED MANAGER required, how to gain or improve them;
NEED? and PREDICTIVE introducing forecasting and capacity
MODELLING planning tools, utilising bed managers in
strategy and planning,
Day 5 - INFECTION Role of bed managers in reporting and
CONTROL and managing infection; the role of admissions
PLACEMENT/STAY units, managing outliers, care management
plans, factors affecting length of stay
Day 6 - CHANGE Issues and tools for personal and
MANAGEMENT and organisational change; identification of
STRESS MANAGEMENT stress (in self and others) and tools for stress
management and reduction
Day 7 - CRISIS What is a crisis? causes of crisis, Escalation
MANAGEMENT versus procedures, planning to avoid crisis, co-
ANTICIPATION AND operation with neighbours
PLANNING
Day 8 - DISCHARGE Role of Discharge Co-ordinator, discharge
planning, intermediate care, repatriation,
discharge initiatives, developing bed/flow
management
25
Table 2
Kirkpatrick Description Source of data
level
1 - Reactions Measure feedback detailed participant’s
immediate questionnaire participant evidence
satisfaction at the end of questionnaire portfolio
with the each session at the end of
programme the
2- Measure Programme
Knowledge changes in
knowledge,
skills and
attitudes
3- Measure requests for feedback from
Behaviours changes in the participant’s line-
behaviour manager at the half-way
point and at the end
4 - Results Measure continuing contact with the
the business participants after the
impact of Programme
changes
26
Table 3
Kirkpatrick level Summary of expectations
1 - Reactions  Confirmation that some of what we do already is
right!
2 - Knowledge  To gain a greater understanding and wider
knowledge of the role, targets and strategy
 To learn alternative methods and new tools
 Gain theoretical knowledge to underpin
practice and persuade others
 Understand capacity and demand
 gain an appropriate qualification
3 – Behaviours  Become less reactive, be able to plan
 To network, share ideas, reduce feelings of
isolation, and gain confidence.
4 – Results  To provide a better service to patients
 Raise the profile of the role
27
emergency
admission
placement stay discharge
elective
admission
bed availability and management
Figure: The Process of Bed Management (Audit Commission, 1992)
28
References
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32
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Developing bed managers: The why and the how

Article in Journal of Nursing Management · February 2007

Nathan Proudlove Ruth Boaden

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The user has requested enhancement of the downloaded file.

Title: Developing bed managers: the why and the how

Key words: nursing, beds, management, training, personal development

Total word count: 4,600 (excluding tables, figures and references)

Nathan Proudlove, BSc, MSc, MPhil, PhD, Lecturer in Operational Research,

Ruth Boaden, MA, MSc, PhD, Senior Lecturer in Operations Management,

Dr Nathan Proudlove, Manchester Business School, University of Manchester,

Developing Bed Managers: the why and the how

and how this can be supported through a development programme.

Background & Key Issues:

Bed management has increased in importance as access targets have

developed, and appreciation of the importance of patient flow has grown.

be particularly stressful and managerially complex. Despite calls for training

support, little has been available. In response we have developed and

delivered a training programme to over 70 staff in the past two years.

Evaluation & Conclusions:

organisation and the individual, including staff retention, promotion and

fewer cancelled operations. We conclude that the programme is an

managers in many areas of the organisation.

Developing Bed Managers: the why and the how

Bed management is an area of nursing management which has expanded

internal and external to a hospital trust, as well as juggling competing

part in on-going efforts to improve a organisation’s ability to admit, treat and

discharge patients appropriately. Generally, however, there is little training

bed management function in improving patient flow and experience.

There is a growing realisation that effective management of the flow of in-

patients through acute hospitals is fundamental to good quality in-patient

been a renewed interest in bed management, with efforts to increase

describes our response to this need: the Bed Managers’ Development

and the Greater Manchester Workforce Development Confederation 2, and

accredited by the Royal College of Nursing.

and how this can be supported through a development programme. The

the evaluation of a training programme for bed managers.

do a systematic review (in the sense by which this term is normally

understood) of literature but all key management and medicine databases

were consulted. The literature (including the grey sources) is characterised by

a lack of “hard” data about the performance or effects of bed management

on patient flow and experience. The need for systematic evidence is

management is one component of a very complex, multi-factorial system,

lack of empirical quantitative evidence in this area.

Empirical data presented in this paper is drawn from the evaluation

questionnaires from the training programme, as well as data from the

participants’ assessed portfolios, which contained both quantitative and

Clarifying the definition of bed management

The conceptualisation of bed management used here is drawn from work by

[FIGURE ABOUT HERE]

as effective and efficacious) use of the limited resources available. The

consequences of poor flow management are most visible in terms of weak

performance on emergency and elective access targets, but also result in

detrimental to quality of patient care although evidence about this is not

conclusive (Clarke and Rosen, 2001).

constraint on emergency and elective access and activity. However, the

a symptom of other underlying issues. As a consequence the organisation of

day-to-day in-patient flows generally focuses on bed management, which in

practice consists of identifying empty beds and allocating waiting patients to

day placement of admissions and collating information on bed availability.

Coordinator” or, reflecting additional responsibilities, “Clinical Site

development of effective relationships with key individuals working at