Institute for Healthcare Improvement: Changes

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Patient Flow

Organizations must test and implement changes to existing processes in order to improve the flow of patients through the acute care setting. The organizations that have been most successful in improving patient flow have made changes in these key areas:

Use Pull Systems
Schedule the Discharge
"Extend the Chain"
Improve the Workflow
Match Capacity and Demand
Decrease and Smooth Variation
Change the Work Environment

In each of these areas, you will find detailed descriptions of several specific changes you can test. In order to achieve breakthrough results, organizations must make system-level changes, as well as changes in individual care units and processes.

Use Pull Systems
When work is being transferred through a process, instead of “pushing” it from one step to the next, have the later step “pull” it from the previous step.

Schedule the Discharge
Synchronize admissions and discharges by managing discharges efficiently.

"Extend the Chain" – Work with Resources Outside of the Hospital to Improve the Flow of Care
Working with resources beyond the hospital walls can greatly improve patient flow through the hospital.

Decrease and Smooth Variation
Decreasing and smoothing variation improves quality and reduces cost, thereby allowing for appropriate resource allocation.

Match Capacity and Demand
Appropriately matching the available capacity in the system to meet the demand for care is necessary to reduce delays, improve flow, and improve safety.

Improve the Workflow
Rather than increasing staff to handle the times of peak demand, managers can take steps to better distribute the demand and thereby improve the workflow.

Change the Work Environment
Changing the work environment can often provide leverage for improvements in worker performance.



How to Improve Testing Changes Results

Workspace on IHI.org

Track your improvement projects and data using Improvement Tracker and Projects

Use Interactive Tools such as FMEA and Trigger Tool for Measuring ADEs