Optimizing Flow Is Everyone’s Job: How Cincinnati Children’s Improved the Efficiency of Their Hospital Operations

Why It Matters

Frederick Ryckman, MD, Senior Vice President of Medical Operations at Cincinnati Children's Hospital and Medical Center, shares the keys to his organization's success with improving the movement of patients through the acute care setting (otherwise known as “flow”).

It’s important to deliver patient care that offers great value. At Cincinnati Children’s, this means delivering exceptional outcomes with the right teams providing exactly the right care for patients in the right environment. A lot of that work is determined by having good and efficient patient flow throughout our institution.

Ten years ago, Cincinnati Children’s made some fundamental changes that have resulted in a number of favorable results, including additional capacity to care for patients. Before our flow improvement efforts, our hospital ran at about 75 percent occupancy. We’re now able to manage at about 90 to 95 percent occupancy without any disturbances in delivering the right flow and the correct patient placement. With our improvements in flow and capacity management, we have accrued the equivalent of about 75 beds. In other words, if we had stayed at our previous level of efficiency, we would have had to build more physical infrastructure to meet our growth needs. Instead, we added additional capacity without cost.

We hope that some of the lessons we learned over the last decade will be beneficial to others. Here are three ways to improve patient flow.

1. Identify Poor Flow as Failures 
   There are many keys to improving flow, but the truly transformative change we made was to classify situations in which we did not deliver great flow as failures. In the past we might have said, “Well, these were just delays,” or we would have blamed poor flow on the inevitable complexity of running a hospital system. Our culture fundamentally changed when we instead started to say, “No, this isn’t right.” If you’re waiting in our emergency room six hours for a hospital bed, that’s not a delay. That’s a failure of our ability to manage capacity and flow. Calling such situations failures was a crucial step. It made the status quo unacceptable. It compelled us to put improvement initiatives in place to specifically address those failures. 
    
2. Link Flow to Patient Safety 
   Another key change we made was to couple flow initiatives with our efforts to keep patients safe. Good flow is an essential part of delivering safe care. However, we don’t always connect managing capacity and flow with safety because — if we let it — the day-to-day process of managing flow can sometimes seem removed from the lives and well-being of patients and families. Once we made it clear that smoothing the patient journey throughout our organization helps prevent situations such as delays in care, poor handoffs, or overcrowding that can lead to patient harm, we got people’s attention and their dedication to improving flow. 
    
3. Embrace Data Analytics and Operations Management 
   The third thing we did was make the most of data analytics and operations management techniques. We identified specific streams of patients that needed unique services or required unique treatment within our system. This allowed us to better operate and manage some of the critical areas within our organization —such as operating rooms, intensive care units, and emergency rooms — where serious bottlenecks often occur.

At Cincinnati Children’s, we don’t have a specially designated flow office. No one clinician or administrator is responsible for the management of flow and capacity. We believe everyone has a part to play in being efficient and making sure we’re living up to the promise of delivering great care. It’s why we all went into health care in the first place.