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Solve capacity problems... without the last-minute panic!

By Michael Donoghue

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This is Part 2 of a 4-part series titled "Random Acts of Utilization - A Look at the IHI Flow Diagnostic".

Calvin: You can't just turn on creativity like a faucet. You have to be in the right mood.
Hobbes: What mood is that?
Calvin: Last minute panic!

-Calvin and Hobbes

I previously blogged about the need for hospitals in Quadrant 2 of the IHI Flow Diagnostic to have very deliberate processes for improving capacity utilization. Those hospitals have high adjusted bed turns (>90) and high utilization of staffed beds (>90%).

In this post, I will describe characteristics of those hospitals in Quadrant 3 (<90 adjusted bed turns and <90% utilization). About 60% of the nation's hospitals fall into Quadrant 3. Many of these hospitals are underutilized and yet still experience the effects of overcrowding on occasion. While some of these hospitals seek growth opportunities to treat more patients with the existing capacity, others strive to treat the same amount of patients with fewer staffed beds. Both strategies can effectively increase bed turns and capacity utilization.

Many of the hospitals that I visit today are finding creative ways to flex capacity in response to sometimes-dramatic swings in inpatient census. In a previous post, I looked to Calvin and Hobbes for inspiration when writing about changing surgeon behavior. When speaking of creativity, I think Calvin has good intentions but I feel there is a more effective way to manage capacity without the last minute panic. Rather than being reactive, hospitals can take a more proactive approach that is safer for patients and staff and decreases the episodes of last minute panic. This more scientific approach is to:
  1. Decrease controllable census variability by smoothing elective admissions.
  2. Utilize historical patient data and simulation modeling to determine the right number of each type of bed that is required to treat the expected patient population.
  3. Expedite critical activities on each patient's care plan with bed management workflow tools.

Check out the IHI tool to see where your hospital falls.

Does your hospital fall into Quadrant 3? What improvement strategies have you deployed? Are you seeking to treat more patients in the existing infrastructure or treat the same number of patients more efficiently? Please share your thoughts and check back in the coming weeks as I post about strategies for the other quadrants.

Comments (2)






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  • steve December 6, 2010 6:52 AM

    models are great for everyone except for the realties.
    medicare,nursing homes, discharging patients on time,
    except when a doctor requires the pateint to stay longer, communication w/the staff and patient,nothing
    really goes as you want never mind that what about the paperwork that used to be 5 minutes is now one hour. I suggest you work in a major hospital for one month to really find out what a hospital staff has to do on a daily and its not getting better. most staffs in major
    hospitals are working an average of fifty to sixty hour
    a week and longer. harvard and g.e business models are
    great in theory but not in reality!!

  • Michael Donoghue December 8, 2010 3:15 PM

    Hi Stephen. Thank you for your post. Your point is well taken and the variables you mention make affecting positive change very difficult. They are also the reason no model can perfectly reflect reality. That said, it is also true that healthcare cannot ignore the principles of management science that have helped nearly every industry for decades. Models can be a safe way to test potential changes and can demonstrate how even modest changes to one variable can have dramatic effects on the system as a whole. Many hospitals share common challenges with capacity management and patient flow. Few hospitals that we have worked with have the exact same solution to the problems. Spending time in the hospital with the staff as you suggest is truly the best way to understand how to apply unique solutions to solve complex problems. “Here is a case study describing how we have worked with hospitals to improve patient flow." http://nextlevel.gehealthcare.com/capacity/breaking-the-bottleneck-in-transfers-from-ed-1.php