Patient flow is affected by numerous factors, including available supply, patient volume, efficient practices and staffing. Therefore, patient flow issues at hospitals can arise in many forms, such as excessive demand, inefficient, costly processes and long wait times. Russ Richmond, MD, CEO of Objective Health, a specialized group within McKinsey & Co. that serves healthcare providers, takes a three-pronged approach to patient flow that can address the issue in all of its forms.
1. Operating system. A hospital's operating system — how patients and staff move in the organization — plays a large role in patient flow. Hospitals need to ensure that each area of the hospital is staffed according to demand; they can do this by using analytic models. "So many hospitals don't think their demand is predictable, but it actually is within a relatively tight standard deviation," Dr. Richmond says. Analytic models can map out hospitals' demand by area, time of day and day of the week to prevent overstaffing or understaffing departments.
In addition to staffing by demand, tracking patients with visual displays can help improve patient flow. "There often is confusion around where any one patient is at any one time, which leads to delays and clogging up [of] the system," according to Dr. Richmond. Hospitals can use either technology to monitor patients' location or boards that physicians and staff can use to keep patients moving through the system. For example, operating room processes are very complex and rely on the coordination of several departments. Being aware of what step a patient has completed, such as receiving anesthesia, can allow staff to advance patients through the OR more efficiently. "A simple whiteboard that shows patients where they are in the perioperative process gives everyone — transporters, the director, nurses — a common source of truth that they can use to efficiently move patients through operating rooms and theaters," Dr. Richmond says.
2. Management infrastructure. Management infrastructure is how responsibilities are divided among staff and physicians. "Frequently we see role confusion around who does what when," Dr. Richmond says. One way to ensure everyone understands their role is to establish a daily huddle: a time when key staff members discuss the problems that occurred the previous day and what to do to prevent a recurrence of these problems. Communicating with each other every day helps staff understand their responsibilities and how to work with others to achieve their goals.
"By looking at the environment, clarifying roles and actually breaking down some barriers around typical roles, we can find dramatic opportunity," Dr. Richmond says. For example, having an emergency room physician do triage with the nurse, which is atypical of the current process, can actually eliminate some steps and speed decision-making, he says.
Another part of management infrastructure is measuring performance for different roles appropriately. Dr. Richmond says hospitals often do not assess staff using the correct performance indicators. "Because staff are measured on different criteria or not precisely enough, [hospitals are] incentivizing the wrong behavior instead of the right behavior for patient flow."
3. Monitor behavior. Hospitals also need to maintain the organization's focus on patient flow so it doesn't revert back to inefficient processes. Communicating patient flow efforts to employees raises everyone's awareness of how the hospital is working towards optimal patient flow and why it's important. Dr. Richmond says the hospital needs to market these efforts within the hospital through policies and clear communication to keep employees and physicians engaged in the initiative. He suggests "frequent reminders and policy announcement and visual displays so [appropriate] behavior becomes ingrained in the way work happens."
For instance, Dr. Richmond says a policy to improve patient flow could be requiring the attending physician to estimate a discharge date for patients and to discharge the patient before noon. Providing a patient with an expected date of discharge "alleviates some anxiety and gives everyone goals they can work towards." In addition, discharging patients early in the day frees up space for patients coming through the emergency department, which is typically most busy in the early morning and late at night, according to Dr. Richmond.
Learn more about Objective Health.
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1. Operating system. A hospital's operating system — how patients and staff move in the organization — plays a large role in patient flow. Hospitals need to ensure that each area of the hospital is staffed according to demand; they can do this by using analytic models. "So many hospitals don't think their demand is predictable, but it actually is within a relatively tight standard deviation," Dr. Richmond says. Analytic models can map out hospitals' demand by area, time of day and day of the week to prevent overstaffing or understaffing departments.
In addition to staffing by demand, tracking patients with visual displays can help improve patient flow. "There often is confusion around where any one patient is at any one time, which leads to delays and clogging up [of] the system," according to Dr. Richmond. Hospitals can use either technology to monitor patients' location or boards that physicians and staff can use to keep patients moving through the system. For example, operating room processes are very complex and rely on the coordination of several departments. Being aware of what step a patient has completed, such as receiving anesthesia, can allow staff to advance patients through the OR more efficiently. "A simple whiteboard that shows patients where they are in the perioperative process gives everyone — transporters, the director, nurses — a common source of truth that they can use to efficiently move patients through operating rooms and theaters," Dr. Richmond says.
2. Management infrastructure. Management infrastructure is how responsibilities are divided among staff and physicians. "Frequently we see role confusion around who does what when," Dr. Richmond says. One way to ensure everyone understands their role is to establish a daily huddle: a time when key staff members discuss the problems that occurred the previous day and what to do to prevent a recurrence of these problems. Communicating with each other every day helps staff understand their responsibilities and how to work with others to achieve their goals.
"By looking at the environment, clarifying roles and actually breaking down some barriers around typical roles, we can find dramatic opportunity," Dr. Richmond says. For example, having an emergency room physician do triage with the nurse, which is atypical of the current process, can actually eliminate some steps and speed decision-making, he says.
Another part of management infrastructure is measuring performance for different roles appropriately. Dr. Richmond says hospitals often do not assess staff using the correct performance indicators. "Because staff are measured on different criteria or not precisely enough, [hospitals are] incentivizing the wrong behavior instead of the right behavior for patient flow."
3. Monitor behavior. Hospitals also need to maintain the organization's focus on patient flow so it doesn't revert back to inefficient processes. Communicating patient flow efforts to employees raises everyone's awareness of how the hospital is working towards optimal patient flow and why it's important. Dr. Richmond says the hospital needs to market these efforts within the hospital through policies and clear communication to keep employees and physicians engaged in the initiative. He suggests "frequent reminders and policy announcement and visual displays so [appropriate] behavior becomes ingrained in the way work happens."
For instance, Dr. Richmond says a policy to improve patient flow could be requiring the attending physician to estimate a discharge date for patients and to discharge the patient before noon. Providing a patient with an expected date of discharge "alleviates some anxiety and gives everyone goals they can work towards." In addition, discharging patients early in the day frees up space for patients coming through the emergency department, which is typically most busy in the early morning and late at night, according to Dr. Richmond.
Learn more about Objective Health.
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