Fixing patient flow—who owns it, and where to look for help

By Michele Mayes, PE, MS

Managing a patient’s journey through the hospital is messy. Despite many hospitals’ best efforts, the number of hand-offs that occur from admission to discharge often lead to miscommunications, where a message can change entirely moving from one recipient to another.

In one study conducted by one of our research teams, we found that patients go through an average of 24 hand-offs during an inpatient stay. So there are, at the very least, 24 opportunities for human error in relaying a patient’s status, updates on any testing, and information on what’s next for the patient.

Miscommunications around patient flow have real-world consequences, everything from delayed discharge to unnecessary utilisation. As a result, the average hospital spends millions of dollars a year unnecessarily, and patients have a worse experience than they should.

These patient flow issues are actually quite fixable. But it requires breaking down silos.

Siloed operations are the primary culprit

I’m always amazed when I walk into a hospital and see departments that don’t actually talk to each other about patient activity. And the siloed activity can be broken down in many ways: from nurses to transport to maintenance staff, or from radiology to doctor to case management.

I’ve found the status quo at many hospitals is to submit a service order and wait. No follow-up unless prompted, no group conversations, and often no one-on-one conversations.

These inpatient care providers have gotten by behind “closed doors” for so long that they almost don’t know any other way to operate. But this way of operating is causing costly build-ups in the hospital, not to mention the negative impact on care quality when caregivers are working with limited information.

Who should 'own' patient flow?

Because hospitals are so siloed from department to department, it’s a challenge to identify the party ultimately responsible for patient flow. Many hospitals have let the responsibility fall solely on case management or nursing. While these are necessary components of successful patient flow, neither should be responsible for overseeing it, because it creates a lens that is too zoomed in on one area, and not enough on another.

Learn strategies for ensuring your care team is prepared to treat the modern patient →

Someone needs to “own” the process of monitoring patient flow, and mending any issues that should arise. From my experience, this should really be a single person in a leadership position, ideally someone with an operations background that knows the path of the patient—such as the COO, CNO, or clinical integration officer.

Taking a lesson from the ED

One area that excels at breaking down silos and getting the patient through their stay is the emergency department. Because of its fast-paced and intensive nature, the ED has long needed to collaborate across the spectrum to move patients in and out as quickly as possible—and it has worked for them. And their process-oriented model can be applied to the entire hospital to break down departmental and staff silos.

Explore tactics to improve efficiency in your emergency department →

While it may be daunting to think about how to implement a whole new model for patient flow, there are two lessons hospital leaders can immediately take away from the ED:

  1. Establish a culture of communication. In the ED, all parties communicate with each other, as there is no time for sending orders and waiting. Nurses, doctors, and administrative and support staff stay in constant contact with each other throughout a patient’s visit in the ED. There are no processes in place that restrict the type of communication they can have with each other. Even the paramedics bringing patients into the ED provide as much information as possible during the patient hand-off.

    To establish a culture of communication that can break down silos, hospital leaders must step outside of their day-to-day activities, convene the right mix of individuals who are empowered to effect change, and set new cross-divisional protocols that represent the patient stay in its entirety without limiting communication channels between teams.

  2. Track patient flow measures. The ED is fraught with regulations that have resulted in a swath of metrics EDs must track, much of it measuring patient flow and timeliness of care. Not only do hospitals measure their performance for continuous improvement, but they regularly compare their performance across national best practice. What’s more is that many EDs make the data visible to everyone through an interdisciplinary forum with patient access managers and nurses who discuss it regularly.

    To understand how the hospital stacks up on patient flow performance, hospital leaders need to track more than length of stay. Other key metrics include the number of boarders in the ED, and the percentage of discharges after 11 a.m. But don’t stop there. Leverage the same group responsible for improving communication to also discuss where breakdowns in patient flow occur, and how they can identify when those breakdowns happen. Then create a plan for tracking, communicating, and improving upon them.

Patient flow is an executive-level issue that needs serious attention for hospitals to succeed in today’s cost-cutting environment. In the hospitals that I’ve worked with, an average of 25% of the patients lying in a bed don’t need to be there. Hospitals today simply can’t afford to continue to avoid solving these issues.

Related research: The Discharge Strategy Handbook

This study offers executives a strategic guide to the greatest opportunity to reduce length of stay and make the most of available capacity: eliminating discharge delays.


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