Navigating the Hospital Superhighway

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On a recent drive from Chicago to Milwaukee, I noticed quite a few similarities between drivers dealing with traffic and hospitals managing capacity. Without the proper tools and information, both situations cause people to act hastily which leads to a variety of results. Have you seen these driver / hospital situations before? Let's take a look at how some of these drivers navigate:

Driver A: "Captain Oblivious." This driver leaves the house with very little information - simply a destination. He follows the signs and hopes for the best. Often this is the car plodding along in the left-hand lane completely unaware that it is holding up multiple cars behind it because the driver is occupied with something other than the road - talking on a cellphone, applying makeup, singing along to the radio, etc. Not only is he annoying to other drivers, but also poses a safety issue due to a lack of attentiveness. Hospitals do the same thing when they aren't reviewing the right metrics, overlooking market trends, or actively soliciting their staff for input. They simply function the same way they always have and let the operation run itself - whether that is running at a utilization of 60% with many inefficiencies; or over 85% with every day full of chaos and bending over backwards to make things work. Essentially, they take a "hope for the best" mentality that they will sustain any environmental challenges, putting themselves at risk in a variety of ways - physician and staff retention, high LOS, loss of market share/volume, patient satisfaction, patient safety, and even regulatory compliance.

Driver B: "Maniac Marvin." Marvin is the aggressive driver that habitually changes lanes in an effort to get to his destination as soon as possible. While the intention is not necessarily wrong, he often makes abrupt decisions based on very little information and without any forethought about the long-term impact. He sees a small opening in a lane and takes it, but soon finds that he's stuck behind another slow car while all of the cars he already passed slowly move ahead once again. You'll also often see him on the side of the road fuming as the state trooper writes him a speeding ticket. Like Marvin, healthcare organizations do the same thing when they try to alleviate bottlenecks by making 'on the fly' decisions, which ultimately can result in more problems downstream or in related areas. Examples of this are transferring patients unnecessarily, increasing/decreasing staffing levels in a reactive manner, tweaking processes in one department without analyzing downstream patient flow effects on another, or making changes to hours of operation without evaluating information. These decisions have an impact on the efficiency of the hospital and affect important outcomes such as length of stay, patient safety, volumes, and financials.

And then there is Driver C: "Jimmy GPS." We've finally moved onto a situation where a driver is using information to improve their outcomes. Jimmy has a GPS with integrated traffic notifications - allowing for him to make better decisions and re-route when necessary. Hospitals with the right bed board functionality - as well as an empowered bed management center -use information to better place patients in the right bed and enable the alleviation of bottlenecks as they develop. However, this isn't a silver bullet on the road or in the hospital - the GPS won't allow Jimmy to lift off and fly over traffic or congestion, just as an advanced bed board can't create another bed.

Indeed, the reality is that the environment of the majority of healthcare systems today plays out in a combination of the four examples listed above. Even with the best intentions, the best outcome is not always within reach. The future lies in the further enhancement of prediction technologies, coupled with three well-functioning aspects of hospital operations:
  1. Effective and autonomous governance structures, with multi-disciplinary participation
  2. Schedules that are designed to ensure steady flow and a reduction in peaks and valleys of arrivals/admissions of patients
  3. Efficient workflows that support the entire system
Using real-time information to make informed decisions allows drivers to determine where traffic is going to occur before they get behind the wheel...the most efficient route will be mapped given analysis of current data. Similarly, as hospitals become more sophisticated, they will be able to use aggregate data from multiple sources to correctly forecast bed/unit demand and avoid congestion before it starts. These systems will not only help with daily operations, but also allow administrators to more effectively map out resources to accommodate the future demand, thus improving the hospital's "navigation highway."

Comments (4)

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  • physician scheduling August 11, 2011 7:15 AM

    Adjuvant develops and markets solutions for critical scheduling challenges in healthcare environments. We provide online tools and technology to help ensure availability of the right provider, in the right place, at the right time.

  • George Cybulski, MD, MBA August 13, 2011 6:18 PM

    Great observations....the absolute lack of sharing knowledge amongst the constituent groups causes roadblocks and traffic jams as you have noted.

  • physician scheduling August 17, 2011 10:15 AM

    Adjuvant develops and markets solutions for critical scheduling challenges in healthcare environments. We provide online tools and technology to help ensure availability of the right provider, in the right place, at the right time.

  • Garrett Lyman November 5, 2011 1:01 PM

    Just curious if you're familiar with Central Logic and our impact on the patient flow process. Perhaps there is a way to work together.