Achieving Hospital-wide Patient Flow


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. This white paper guides leaders and quality improvement teams through an in-depth examination of a systems view of patient flow, and provides high-leverage strategies to improve hospital-wide patient flow.

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Ensuring timely patient care in the right location with the right clinical team amidst the COVID-19 pandemic has never been more important. Yet, while many understand the problem, they often lack the comprehensive strategies to address it. Achieving hospital-wide patient 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 2017 IHI White Paper was the culmination of approximately two decades of IHI’s research, innovation, and learning about hospital-wide patient flow. The second edition of the white paper, updated in 2020, builds on IHI’s hospital-wide patient flow framework and includes ongoing learning about improving flow. The white paper 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.

The white paper includes:

  • A framework for improving patient flow throughout the hospital: shape or reduce demand, match capacity and demand, and redesign the system
  • Specific change ideas for improving hospital-wide patient flow
  • Recommended flow measures for the overall hospital system
  • Guidance on creating an action plan to get started and for developing a portfolio of improvement projects to support hospital-wide goals for 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
  • A focus on reducing and shaping demand

  • How to Cite This Paper:

    Rutherford PA, Anderson A, Kotagal UR, Luther K, Provost LP, Ryckman FC, Taylor J. Achieving Hospital-wide Patient Flow (Second Edition). IHI White Paper. Boston, Massachusetts: Institute for Healthcare Improvement; 2020. (Available at

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