Enhancing Hospital-Wide Patient Flow: Strategies and Innovations from ICHI (Full Transcript)

Speaker 1: This white paper is the culmination of approximately two decades of the Institute for Healthcare Improvement's research, innovation, and learning about hospital-wide patient flow. It guides leaders and quality improvement teams through an in-depth examination of a system's view of patient flow, theories for improvement, and high-leverage strategies and interventions to improve patient flow throughout the hospital setting. ICHI's recommended approach is based on the following principles. First, integrate a comprehensive framework to create hospital-wide patient flow, such as quality improvement, lean management, operational engineering, complex systems analysis, and operations research. Next, utilize advanced analytics data analytics to reduce artificial variation in elective surgical scheduling. And also to forecast patient demand patterns and to match capacity, primarily beds and staff and patient demand. Also focus on reducing demand with change ideas to actually reduce hospital utilization by relocating care to less costly and, in many cases, higher quality care, such as advanced illness planning and palliative care. And also focus on shaping demand by the expansion of operating room scheduling system capabilities to predict and plan for patients who need intensive care and care in other inpatient units after surgery. A system-wide approach to patient flow with a few simple rules to govern the complex hospital system and a learning system to understand and mitigate flow failures is critically important. Let me take a couple minutes and explain the three concepts for the recommended change ideas and improvement initiatives. Reduce or shape demand, match capacity and demand, and redesign the system. First, shape or reduce demand. Instead of adding capacity to the hospital departments or units to meet patient demand, waits and delays in patient flow throughout the hospital stay can be reduced by shaping or reducing demand. Next, match capacity and demand. Both demand for care and capacity to deliver care can vary by month, day, shift, and actually hour. Often, changes can be made to better align systems capacity with demand. Lastly, redesign the system. Creating efficiencies throughout the system can increase capacity without adding resources. Redesign efforts involve changing processes, removing waste, and redesigning work for constrained resources, specific units, or specific staff roles. Doing tasks in parallel, eliminating steps, and synchronizing tasks. These three concepts and change ideas are just the tip of the flow iceberg. We are excited to launch this publication and hope that you'll find several strategies and change ideas that will help you and your colleagues advance your work to improve hospital-wide patient flow. I invite you and your colleagues to explore the white paper. Share your feedback on our website and join us in this critically important work.