Random Acts of Utilization (Part 1 of 4)

By Michael Donoghue

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Creativity is the ability to introduce order into the randomness of nature. - Eric Hoffer (American Philosopher, Ronald Reagan Presidential Medal of Freedom recipient)

In their book, Corporate Culture and Performance [1], Kotter and Hesketh wrote that corporations with deliberative processes significantly outperformed companies that left context to chance. The same can be said for the way hospitals manage inpatient capacity.  Hospitals need to have very deliberate processes for improving capacity utilization. A hospital's inpatient bed utilization should not be left to random chance. Those processes should be determined once the current environment is understood.

IHI has developed a Hospital Flow Diagnostic tool to categorize a hospital's patient flow characteristics using 2 simple metrics:
  1. Hospital throughput = acuity adjusted bed turns
  2. Utilization = bed turns/potential bed turns

The tool organizes hospitals into 4 quadrants and can be very helpful in determining patient flow improvement strategies or evaluating the effectiveness of previous work. To see where your hospital fits, visit the Flow Diagnostic Tool.

Over the next four posts, I will describe characteristics for each quadrant and suggest some improvement strategies. I start with Quadrant 2 (>90 adjusted bed turns and >90% utilization). About 5% of the nation's hospitals fall into Quadrant 2, with >90 adjusted bed turns and > 90% utilization. These hospitals undoubtedly suffer from over-crowding and congestion.

Quadrant 2 hospitals should have a strategy to optimize the use of existing IP beds or add capacity:
  • Smoothing elective admission will decrease census variability. This is especially critical at high utilization rates.
  • Getting the most out of your existing capacity means minimizing empty-bed time AND expediting activities on the patient's critical path.
  • Real time location technologies and sophisticated simulation models can improve the effectiveness of traditional process improvement (think about the FAA and Next Generation Air-Traffic Control).
  • Adding capacity should be a consideration only after census variability has been minimized and you have a better idea how much additional capacity you need.

Does your hospital fall into Quadrant 2? What improvement strategies have helped you bring some semblance of order to a once chaotic environment? Please share your thoughts and check back in the coming weeks as I post about strategies for the other quadrants.

[1] Kotter, J., Hesketh, J. (1992) Corporate Culture and Performance, Free Press


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