Working with Us

We work closely with our hospital clients to identify patient flow issues and to implement changes to effectively resolve those issues. Our typical engagement with a hospital involves three phases:

Phase I – Patient flow assessment and reengineering of scheduled vs. unscheduled operating room flow

Phase II – Smoothing of daily operating room flow and resulting flow to preferred units

Phase III – Determination of specific bed and staffing needs for major hospital units

The overall engagement takes between 15 and 24 months, with each phase ranging from 5 to 8 months in duration. The structure and benefits of each of these phases is described in the following sections.

PHASE I – PATIENT FLOW ASSESSMENT/ SCHEDULED VS. UNSCHEDULED OR FLOW

Phase I starts with an overall patient flow assessment. In order to perform that assessment, we request a variety of historical data from the hospital’s existing information systems such as ADT and OR information systems. We also conduct an extensive on-site visit. During that visit, we meet with the appropriate clinical and non-clinical staff involved with the major units being assessed to discuss patient flow issues. Upon the completion of the patient flow assessment, we conduct a half-day on-site presentation and discussion where we review our findings, present our recommendations and discuss next steps. As part of that meeting, we share our written assessment report that will contain the detail and analysis behind our presentation and recommendations.

Phase I concludes with the implementation of scheduled vs. unscheduled OR flow changes identified through the patient flow assessment. These changes will encompass identifying and implementing the appropriate number of unscheduled operating rooms by day and by hour. We will work with the hospital on implementing these changes for a one to three month period while closely monitoring the results. We make the commitment that these changes will not reduce the surgery volume of any surgeon by even a single case and will not have any adverse effect on patient care, or we will cease the implementation immediately. Quite to the contrary, the benefits that we expect the hospital will realize through Phase I are:

  • Shorter waiting times for surgery for unscheduled patients
  • Reduced bumped elective surgeries
  • Lower nursing overtime
  • Higher OR prime time utilization
  • Greater surgical throughput (increase in overall surgical volume)
  • Improvements in patient safety

These benefits will be achieved without adding additional staff or expanding current facilities and will begin to accrue before the completion of Phase I.  The benefits go well beyond the pure financial to encompass improved physician, nursing and patient satisfaction.

PHASE II – SMOOTHING DAILY OR FLOW AND FLOW TO PREFERRED UNITS

During Phase II, we identify whether additional separation of disparate surgical patient flows is advisable (e.g., inpatient vs. outpatient surgery, complex vs. short cases) and how artificial variability in scheduled surgeries by day of week and hour of day can be substantially reduced. This phase also includes smoothing the outflow from surgery to the preferred units designated for surgical patients leaving recovery.

The benefits that we expect the hospital will realize through Phase II are:

  • Reduced waiting times for placement in an inpatient bed for both surgical and medical patients
  • Increase in percentage of patients placed in the preferred unit based on their condition
  • Additional increases in surgical throughput beyond what is achieved in Phase I
  • Further improvement in OR prime time utilization beyond what is achieved in Phase I
  • Additional decreases in nursing overtime beyond what is achieved in Phase I
  • Improvements in patient safety and reduced mortality

These benefits will also be realized without adding additional staff or expanding current facilities. The benefits of Phase II occur on top of the benefits of Phase I and are maximized when Phase I changes are optimally implemented. As with Phase I, this phase further enhances physician, nursing and patient satisfaction.

PHASE III – DETERMINATION OF SPECIFIC BED/STAFFING NEEDS BY UNIT

Phase III includes analyzing the specific number of beds needed in routine and ICU units and the resulting staffing necessary to achieve a desired level of service. This phase involves developing complex simulation models regarding actual and projected patient flows and is only productive after the successful reduction of artificial variability through Phase I and Phase II of the project.

The benefits that we expect the hospital will realize through Phase III are:

  • Proper allocation of bed capacity to maximize the availability of the right bed for medical and surgical patients, thereby reducing waiting times, ED boarding, patient misplacement and the likelihood of medical errors
  • Proper allocation of bed capacity and nursing resources, thereby decreasing nursing stress and improving the quality of patient care
  • Proper allocation of bed capacity to reduce inpatient length of stay, thereby reducing the number of disallowed hospital days and increasing patient throughput
  • Improvements in patient safety and reduced mortality

Our experience indicates that the capital cost of an extra (unneeded) bed to meet artificial swings in patient demand is approximately $1 million and its annual cost exceeds $250,000.