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Hospital Flow: Pandemic Lessons Learned

By IHI Team | Tuesday, March 22, 2022
Hospital Flow Pandemic Lessons Learned

Photo by Michael | Unsplash

James Rudy would be the last person to say that dealing with the Omicron variant of COVID-19 has been easy. As Senior Director of Integrated Operations at Northwell Health (New York City, New York), he does, however, express satisfaction that he and his colleagues have taken what they have learned about improving hospital flow over the last two years of the pandemic and put those lessons to good use.  

“All this hospital flow work was happening [while Omicron started surging],” Rudy noted, “and it felt like much of the work around load balancing and staff redeployment for COVID was behind the scenes because it was running so smoothly.”

While at the epicenter of the first COVID-19 surge in the Northeast United States in early 2020, Northwell built on what they had learned as participants in the IHI Hospital Flow Professional Development Program in 2018. They worked on load balancing patients across hospitals. They addressed safe staff redeployment, clinical pathways, and PPE usage. “We learned how to do all of this while avoiding major disruptions in the typical day to day work that happens within the organization,” Rudy explained. “It’s been exciting to see how much of what we put in place before and at the beginning of COVID has helped in subsequent waves.”

In the following interview, Rudy shares his lessons learned — including those that apply to small health systems with fewer resources — and describes why a collaborative approach to learning across Northwell Health has kept teams actively engaged in improving flow even during COVID-19 surges.

On building the foundation of their work on hospital flow

Back in 2018 when I worked for Long Island Jewish (LIJ) Medical Center, which is part of Northwell Health, we sent a team made up of physician leads, nursing leads, and process improvement folks to the IHI Hospital Flow Professional Development Program. We brought a lot of knowledge and strategies, and ideas about using a learning system, back to our senior leadership team. They got very excited about using new ways of thinking about hospital flow. We started getting some great results. And then COVID hit.

On learning to be nimble

Back in early 2020, LIJ was one of the hospitals hardest hit [by COVID-19] in the region. LIJ typically has 500 to 600 inpatients. When the first wave of COVID hit, we surged to nearly 1,000 patients in the hospital. That forced us to use an all-hands-on-deck approach and be nimble. We focused on our priorities. We didn’t have the luxury of planning everything as we normally would. [Before COVID], we would have had a one- to five-year plan to go from 500 beds to 1,000 beds. [In 2020], we had one to three weeks to figure it out. But being forced to do it helped us see that we could [work quickly] while making sure we had safe processes.

On not letting perfect be the enemy of good

COVID has forced us to say, “The data and analytics may not be perfect, but are they good enough to help make decisions? Do we have enough information to offer leaders insights to make decisions?” We’ve learned that, as long as we’re not sacrificing anything from a safety or quality standpoint, we can use what we have to guide the decision-making process. One example of this was using simulation software to help identify anticipated bed, staffing, and PPE needs.

On integrating out of necessity  

We have 20+ hospitals, and we needed to figure out [during the first wave of the pandemic] how to manage [thousands of] patients in the safest, most effective way possible. Northwell has always been an integrated organization, but COVID forced at a rapid pace the further integration of that work [between hospitals and departments], and we found ourselves asking, “How can we have this kind of integration all the time? That was the start of the idea for a new department called Integrated Operations [for which I’m now Senior Director]. Our department works in partnership with the hospitals, and the starting point for our work is on hospital flow and efficiency. Our team brings skills and backgrounds in change management, process improvement, data analytics, and technology solutions. We have physicians and nurses on our team. We support the hospital’s flow and throughput goals in an ongoing and collaborative way.

LEARN MORE: IHI Hospital Flow Professional Development Program

On the key to getting buy-in

From the start, we were very aware that building trust with the teams was the number one thing. We know, if we can gain the trust and people want to work together, then the improvements are going to come. So, we spent a lot of work up front, going out to all the sites, meeting with the leadership teams, and meeting with the individual teams. We’ve said to all of them, “We’re not here to tell you what to do. That’s not our role. Our role is to support you, partner with you to meet your needs, and work together to reach the outcomes we’re trying to achieve as a health system.” We have process improvement expertise if maybe they don’t have that background. We offer data and analytics support because that is always a cumbersome challenge. We frame all of it as ways we can be helpful to their work. Doing that and demonstrating that we’re not here to tell them what to do was our way of getting our foot in the door and getting buy-in.

On learning collaboratively between hospitals

We have multiple hospitals at any given moment working on similar challenges. For example, we have five hospitals right now working on processes related to interdisciplinary rounds. They meet once a month to learn, share, collaborate, and innovate together. In the past, much of that work would’ve been done in silos. Now, we want to learn from each other in an ongoing way that’s not just seen as a project, but as a new way of improving together. We’re only about three months into it, but we’ve found that people are very engaged. They’re taking part in the meetings. They’re networking with each other.

Just the other day, we were meeting with our five tertiary hospitals. It was exciting to see their different approaches. More importantly, it was great to see how they were learning from each other. One hospital might say, “We’re working on a script for our interdisciplinary rounds.” Someone else might say, “We have a script we can share with you.” Some of these things could take six months to a year or longer to improve and optimize, but this approach means learning much more quickly. I also think we end up with better results because everyone builds off everybody else’s incremental progress.

On how any organization — large or small — can benefit from using a learning system

I have an industrial engineering background, so the concept of learning from data and information to drive process improvement is something that’s near and dear to my heart. Lots of us have been in situations where someone says, “Hey, put together a plan and figure out how to improve throughput.” And everyone gets in a room and writes down 50 things, and suddenly you have this plan with all these ideas. The challenge is how to know the right things to work on. A learning system helps guide you. You ask questions to help frame the solutions that you're going to work on. What types of flow delays are we seeing? What are the types of flow failures that we think are important to track to help prioritize our initiatives? No organization, especially a small one, has unlimited resources. So, how do you identify the things to work on that are most likely to be successful and drive results? It can be hard to know unless you have that learning system and framework in place.

Editor’s note: This interview has been edited for length and clarity.

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