Table 4

Summary of strategies for change and lessons learnt during the learning sessions

Cycle no	Strategy for change	Key learning from the cycle
First learning session	Establish hospital flow teams. Implement SAFER bundle. Emergency bed huddle.	Improvement in boarding time. Multidisciplinary team review procedure not clear. Slow referrals from inpatient to home care and long-term facilities. Emergency bed huddle procedure not clear.
Second learning session	Implement bed utilisation visual management and tracking system. Detail procedure for multidisciplinary review team and emergency bed huddle. Establish pull system for home care and long-term facilities.	Further improvement in ED boarding time. Reduction in 30-day outliers. Further improvement in boarding time. Variable fidelity between the hospitals in implementation of the change package.
Third learning session	Implement corrective action audits.	Some hospitals are still struggling with 30-day outliers.