Summary: A study identified six failings, comprised from varying combinations of capacity, process, and errors of population, that impede smooth patient flow. The study identified an absence of a coherent system-level strategy, and provided recommendations to improve access.
Excerpt: “Although well-established principles exist for improving the timeliness and efficiency of care, many organizations struggle to achieve more than small-scale, localized gains. Where care processes are complex and include segments under different groups’ control, the elegant solutions promised by improvement methodologies remain elusive. This study sought to identify common design flaws that limit the impact of flow initiatives.
Typically, flawed initiatives focused on too small a segment of the patient journey to properly address the impediments to flow. The proliferation of narrowly focused initiatives, in turn, reflected a decentralized system in which responsibility for flow improvement was fragmented. Thus, initiatives’ specific design flaws may have their roots in a deeper problem: the lack of a coherent system-level strategy.
Findings suggested that smooth flow depends on linking a defined population to appropriate capacity by means of an efficient process; flawed initiatives reflected failure to consider one or more of these essential elements. Many initiatives focused narrowly on process, failing to consider that the intended population was poorly defined or the needed capacity inaccessible; some introduced capacity for an intended population, but offered no process to link the two. Moreover, interveners were unable to respond effectively when a bottleneck moved to another part of the system. Errors of population, capacity, and process, in different combinations, generated six ‘formulae for failure’.”
WBB Assessment: Effective flow management is foundational to solving problems regarding access, meeting patient demand, and reducing cost. Without effective flow management, emergency departments (EDs) become crowded, inpatient beds fill and block further admissions, and costs climb sharply. Many hospitals and healthcare systems have adopted piecemeal flow management methods, and as a result have not seen improved patient flow.
Moreover, healthcare systems have not sufficiently learned lessons from the mistakes of others, and have failed to reap the benefits of effective knowledge management. As a result, many mistakes have been repeated across the industry, and flow improvement projects experienced delays, additional costs, and sub-optimal outcomes. WBB has previously identified lessons associated with several of the scenarios reported in the BMJ paper, such as incorrect focus for projects, adding capacity in the wrong place, and inadequately layering new processes on old processes.