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The Challenge
From bottlenecks to backlog, hospitals everywhere face the same business challenges. These problems exhaust resources, hinder improvement, and compromise customer satisfaction. But unlike other industries such as transportation, banking, and food services, many health care leaders have failed to capitalize on one powerful, fundamental notion: smarter management is not costly management.
The June 2006 Institute of Medicine (IOM) report, "Hospital-Based Emergency Care: At the Breaking Point," underscores the importance of the critical challenges faced by emergency departments in the United States, including overcrowding, ambulance diversions, and inefficient patient flow and hospital operations. Among the IOM recommendations to improve hospital emergency care are the following:
  • Hospitals should adopt system-wide operations management principles to improve the quality and efficiency of care.
  • Training in operations management for hospitals should be promoted by professional associations, accrediting organizations, and others.
  • The Joint Commission and the Centers for Medicare and Medicaid Services should develop standards to eliminate ED crowding, boarding, and diversion.
The Managing Hospital Operations Program Can Help
The Institute for Healthcare Improvement (IHI) has developed the five-month Managing Hospital Operations program for executives, managers, and clinicians that will offer the kind of rigorous, science-based operations training — made applicable to health care — that has been largely unavailable to health care professionals.
During this intensive five-month program taught by Eugene Litvak, PhD, one of the nation's leading thinkers on hospital operations redesign, participants will have a highly-individualized opportunity to address their organization's unique inefficiencies. The operational management concepts and practical tools presented during this program have already helped many hospitals to:
  • Relieve demands on the ICU unit so that, when needed, beds will be available for high-risk patients
  • Improve surgical schedules, both emergent and urgent, which can smooth patient flow from a crowded emergency department and reduce ambulance diversions
  • Determine the necessary capacity (e.g., beds, staff, equipment) needed to satisfy random patient demand
  • Dramatically improve hospital margins to achieve multimillion annual savings — participants will hear from executives of two such hospitals during this program
  • Improve the quality and safety of care
Success Stories
By applying variability methodology, developed by Dr. Eugene Litvak and his colleagues, alongside other operations management principles, Boston Medical Center transformed its operations and reduced ambulance diversions by 20%, and last-minute postponement of elective surgeries by 99.5%. [Boston Medical Center, Annual Report 2004] Read an article in The Boston Globe featuring faculty, Eugene Litvak, and some amazing results achieved by those who've worked with Dr. Litvak. Watch the interview with Dr. Litvak on NewsHour with Jim Lehrer, featuring the extraordinary story of how he helped Boston Medical Center transform their emergency department.

Watch this short video of a past participant and hear how he identified a way for his organization to potentially generate an additional $2-3 million in annual revenue.

What You'll Learn​


This intensive five-month program uses academic case studies and observation projects to guide participants through an in-depth examination of effective operational management. When applied to health care, these concepts will help participating organizations:

  • Reduce ambulance diversions

  • Avoid bottlenecks and waiting times in the ED and ICU

  • Improve staffing solutions and quality of care

  • Increase patient throughput and revenue 

  • Retain staff and reduce overtime expenditures

  • Improve financial performance

When Health Care Doesn't Work: The Role of Operations Management​


“Operating systems have a huge impact on work climate, staffing, financial results, etc., and yet we are trying to change our health care delivery system without changing its core operations. We are trying to achieve the results we want just by changing the reimbursement system, by asking different parties to collaborate, etc.


Imagine, for example, that the Ford Motor Company found that their cars could not compete in the market. They probably would do something about the engine, transmission, product lines, etc. — whatever they could do with their cars in order to compete with other manufacturers. In contrast, when our health care 'car' does not work, we try to throw more money at the system and demand additional resources.


The cost of health care delivery is inflated because we do not appropriately apply operations management methodologies. And yet we limit the price, so the quality of care is being negatively impacted. Somehow we manage to have both — waste and unsatisfactory quality of care. As long as our total cost, which is clinical cost plus delivery cost, is being limited, and as long as we do not actively employ operations management methods, we will experience this unfortunate scenario.”


— Eugene Litvak, PhD, President and CEO, Institute for Healthcare Optimization, co-founder and Director of the Program for the Management of Variability in Health Care Delivery at the Boston University (BU) Health Policy Institute, and Professor at the BU School of Management


What Past Participants Are Saying

“The operations management class was a wonderful experience. It has added rich depth to the lean thinking design principles we are using for improving flow in our hospital.”

— Sylvia Bushnell, CPHQ, Scottsdale Healthcare



“I wanted to understand queuing and apply it in health care. With Dr. Litvak’s guidance, we were able to use what we learned about queuing and develop a scientific, prospective model for bed and staffing needs in our emergency department.”

— Jeffrey S. Desmond, MD, University of Michigan Hospitals



"What I found most useful was the application of tools that have been successful in other industries and to see how they have true application in health care — critical path analysis, queuing theory. I learned a tremendous amount from observing a transactional analysis in another industry.”

— Amy Short, Six Sigma Black Belt, University Hospital of Cincinnati