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How to Improve

Flow

Improving patient flow through the hospital increases patient safety, positively impacts patient and staff satisfaction, and increases revenue. Achieving breakthrough levels of improvement in patient flow requires work in three areas:

  • Within-day variability (the variation in census within each day): Reducing within-day variability allows for appropriate resource allocation throughout the hospital.
  • Between-day variability (the variation in census between days of the week): Reducing between-day variability can eliminate unnecessary bottlenecks.
  • Lengthening the chain (making connections with other community resources, such as long-term care facilities and outpatient clinics): Lengthening the chain of care ensures that patients receive the right care from the right provider in the right place.

The Model for Improvement* has been integral to the success of improvement initiatives in hundreds of health care organizations in several countries. Using the key elements of the model, especially testing changes on a small scale with Plan-Do-Study-Act (PDSA) cycles,** will allow your organization to understand the effects of changes system-wide and facilitate partnerships among various units as they participate together in finding solutions to problems of flow.

Improving flow requires multidisciplinary core team leadership with participation from staff working in the initial area of focus, as well as staff who have a cross-organizational view of the flow in your system. Forming the Team


Model for Improvement 

Setting Aims
Improvement requires setting aims. The aim should be time-specific and measurable; it should also define the specific population of patients that will be affected.

Establishing Measures
Teams use quantitative measures to determine if a specific change actually leads to an improvement.

Selecting Changes
All improvement requires making changes, but not all changes result in improvement. Organizations therefore must identify the changes that are most likely to result in improvement.

Testing Changes
The Plan-Do-Study-Act (PDSA) cycle is shorthand for testing a change in the real work setting — by planning it, trying it, observing the results, and acting on what is learned. This is the scientific method used for action-oriented learning.

 

Sources:

*Langley GL, Nolan KM, Nolan TW, Norman CL, Provost LP. The Improvement Guide: A Practical Approach to Enhancing Organizational Performance.

**The Plan-Do-Study-Act cycle was developed by W. Edwards Deming (Deming WE. The New Economics for Industry, Government, Education.).


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Optimizing Patient Flow: Moving Patients Smoothly Through Acute Care Settings


An IHI Innovation Series white paper

 

Flow White Paper