This website is being retired.

Content is no longer being updated from 31 March 2026. Find out more.

Transformation Directorate

Rapid improvement guide to the FOCUSED model

The FOCUSED model provides the overarching principles for streamlining site management processes to:

  • better co-ordinate the maintenance of oversight
  • reduce variation in processes
  • ensure that all staff are aware of their role in maintaining safety and flow
  • avoid escalation as well as maintain oversight during escalation.

Who is the model for?

The FOCUSED model specifically supports senior clinical and operational managers with co-ordination roles in an acute site, although the principles of co-ordinated site management apply to all inpatient healthcare settings.

These include, but are not limited to:

  • chief operating officer (COO) and deputy COO
  • site management teams
  • emergency department (ED) consultant in charge
  • ED nurse in charge
  • ED patient flow co-ordinator
  • clinical site/flow managers
  • senior operational managers
  • ward managers and matrons
  • specialty clinical leaders.

Key principles

  • Front door. Oversight of:
    • performance
    • demand and capacity in the ED, same day emergency care (SDEC) and assessment units
    • escalation triggers
    • performance against internal professional standards (IPS)
    • patient plans in place
    • 12-hour breaches
    • senior clinical co-ordination
    • ambulance arrivals/offloads.

  • Operational oversight of the whole hospital. Oversight of:
    • outliers
    • staffing issues
    • critical care capacity
    • tertiary referrals/repats
    • infection control and COVID-19 requirements
    • diagnostics capacity
    • unresolved patient delays
    • actual versus potential discharges
    • board/ward rounds
    • continuity challenges.

  • Challenge. Consider:
    • demand and capacity for assessment
    • alternative pathways (hot clinics, day case, SDEC, virtual wards)
    • appropriate use of short stay
    • bed requests
    • IPS.

  • Understand actions and agree accountability. Ensure:
    • specific, time-bound and allocated actions from site meetings
    • demand against predicted is understood
    • actions are logged, circulated and followed up
    • agreed operational pressures escalation levels (OPELs)
    • review of service continuity challenges.

  • Site plan and reporting. Be proactive;
    • actions have owners
    • OPELs have defined triggers
    • maintain oversight of system escalation/response
    • use SBAR (situation, background, assessment, recommendation).

  • Escalation:
    • maintain normal service
    • enact system-wide OPEL escalation policy
    • maintain board oversight
    • identify roles and responsibilities
    • link triggers to action cards
    • understand interdependencies
    • analyse escalation trends and actions
    • responsive communication
    • timely de-escalation.

  • Discharge. Daily oversight:
    • prioritise failed discharges
    • identify today’s and tomorrow’s discharges
    • visibility of discharge lounge
    • monitor actual versus potential
    • demand and capacity of discharge pathways
    • monitor pathway 0 and 1
    • monitor discharges before 12:00 and 17:00
    • proactively manage repatriations
    • patients have an expected date of discharge (EDD)
    • timely board/ward rounds
    • discharge off electronic systems at the point of discharge.

Works well with

  • The SAFER patient flow bundle: this promotes a commitment to maintaining flow by reducing waste and preventing harm, complementing the principles of the FOCUSED model.
  • The FOCUSED self-assessment tool: a practical resource that enables a site to self-assess against the principles of good site management and determine priority areas for focus.

Further resources