Why It Matters
In 2020, amidst the COVID-19 pandemic, ensuring timely patient care in the right location with the right clinical team has never been more important. For this reason, IHI has produced Achieving Hospital-wide Patient Flow (Second Edition) to build on the foundation of our hospital-wide patient flow framework. The following is an excerpt.
While health care systems are making progress toward more value-based, person-centric care practices, most hospitals are experiencing significant operational and financial stress. Costs continue to escalate, while reimbursements are waning.
In 2020, hospitals throughout the US and the world have been impacted by the COVID-19 pandemic, resulting in hospitals experiencing dramatic increases in costs and simultaneous decreases in revenue. Even though there is an oversupply of hospital beds in the US, emergency department and inpatient bed capacity fail to meet daily patient demand in many hospitals, particularly in large academic medical centers. In some regions, ensuring adequate nurse staffing may be of paramount importance for safely caring for hospitalized patients. Hospitals throughout the world are experiencing similar bed capacity and staffing shortages to meet regular patient demand for acute care. Diversions, long waits, and delays in the emergency department (ED) are a hospital-wide issue, not solely an ED operations issue. Delays are often the result of ED beds being occupied by patients waiting for admission to the hospital.
Larger hospital-wide issues include mismatches in bed and staff capacity and demand for various clinical services; inefficient processes for transferring patients among units and for discharging patients; long waits for transferring patients to skilled nursing and long-term care settings; and patients with mental health conditions occupying hospital beds due to inadequate mental health facilities in the community. Lack of inpatient capacity also results in delayed or canceled surgical procedures, patients being “boarded” in the post-anesthesia care unit, and patients being cared for in “off-service” units. Disparities in timely access to and progression of care for underserved patient populations is an additional issue that must be understood and addressed.
Throughout the world, the COVID-19 pandemic has exacerbated the need for hospitals to rapidly expand their capacity and capability to meet the needs of acutely ill individuals needing to be hospitalized. Dramatic expansion of emergency departments, acute care, and critical care units to meet the anticipated needs of COVID-19 positive patients has been essential to provide safe and effective care for patients in crisis. Hospitals of all sizes and in varied locations have faced unique challenges in ensuring the necessary space, supplies, equipment, and staffing to care for this patient population. Failing to achieve hospital-wide patient flow — the right care, in the right place, at the right time — puts patients at risk for suboptimal care and potential harm. It also increases the burden on clinicians and hospital staff and can accelerate burnout. Yet, while many understand the problem, they often lack the comprehensive strategies to address it.
Optimizing hospital flow, and ultimately improving outcomes and the experience of care for patients, requires an appreciation of the hospital as an interconnected, interdependent system of care. It also requires strong leadership; in fact, the role of executive leaders is critical for success. The executive oversight team committed to achieving system-wide flow must prioritize four things: carefully craft and communicate a long-term aim and its rationale; put in place structures to execute on system-wide improvement, shifting the focus from localized initiatives to hospital-wide results; be ready to resolve the tough dilemmas and surges in patient demand on a timely basis; and focus on a few important initiatives to demonstrate organizational capability, then expand the scope to hospital-wide flow initiatives.
IHI’s Achieving Hospital-wide Patient Flow (Second Edition) white paper — the culmination of two decades of the Institute for Healthcare Improvement’s research, innovation, and learning about hospital-wide patient flow — guides leaders and quality improvement teams through an in-depth examination of a systems view of patient flow, theories for improvement, and high-leverage strategies and interventions to improve hospital-wide patient flow. IHI’s recommended approach is based on these principles:
- A system-wide approach to patient flow, with a few “simple rules” — design principles that guide system-wide improvement — to govern complex systems;
- A hospital-wide learning system that utilizes the science of improvement to understand and prioritize solutions to reduce flow failures and flow delays;
- The integration of various approaches (e.g., quality improvement, Lean management, operational engineering, complex systems analysis, operations research) to achieve hospital-wide patient flow;
- The utilization of advanced data analytics to reduce artificial variation in elective surgical scheduling, forecast patient demand patterns, and match capacity and demand in routine operations; and
- A focus on reducing demand — with change ideas to reduce hospital utilization by relocating care to less costly and, in many cases, higher-quality care — and on shaping demand by expanding operating room scheduling system capabilities to predict and plan for patients who need intensive care and care in other inpatient units.
To learn more, including strategies, promising change ideas, and resources to help leaders and improvement teams, download the free white paper.
You may also be interested in:
Putting Patient Flow to the Test During Times of Uncertainty