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Practical Guide to Patient Flow Initiatives

Updated: Mar 21, 2022

The Institute for healthcare improvement (IHI) released a comprehensive patient flow white paper titled “Achieving Hospital Wide Patient Flow” in 2017. The paper was a culmination of two decades of IHI’s research, innovation, and learnings about hospital-wide patient flow, and is meant to guide leaders and quality improvement teams on high impact interventions that improve hospital flow. Three key approaches or primary drivers of patient flow outcomes were highlighted:

(1) Shape or Reduce Demand

(2) Match Capacity and Demand

(3) Redesign the System

Source: IHI White Paper “Achieving Hospital Wide Flow”

Shaping (or reducing demand) and Redesigning the System are valuable strategies, especially in the age of value-based care and increasing pressure on operating margins. These are big building blocks of patient flow that cannot be avoided and can yield significant results if dealt with in a precise manner. However, they can be expensive & time consuming to implement, can be disruptive, and, at times, imprecise in their ability to impact overall patient flow and throughput.

Match Capacity & Demand: On the other hand, real time demand capacity management (RTDC) is a technology agnostic and non-disruptive process that is easy to implement and holds the building blocks (described above) together. See below for a quick overview:

  • Process Overview: Matching demand with capacity can be thought of as having two broad levels of maturity. Level 1 entails leveraging advanced analytics to predict demand down to the minute and using workflow technologies to enable transparent view of capacity. Level 2 goes one critical step further and is the focus of RTDC. It builds on the analytics and establishes a 4 step process where front line staff and operational leaders (or command centers) are actively aligned on the tasks required to improve throughput that specific day.

  • Easy to Implement: Using our proprietary tools that are easy to adopt, a hospital can implement RTDC in a week with the help of our experts, who developed this process during their time as senior fellows at the IHI. To learn more visit our website at or leave us a note.

  • Holds “Building Blocks” Together: The fourth step in the 4-step RTDC process acts as the data source that will systemically identify barriers impeding throughput on any given day and will drive initiatives impacting the bigger building blocks like shaping/reducing demand or redesigning the system. This is different from isolating a single process and using data to identify opportunities to improve that specific process. RTDC provides a structure that allows you to pinpoint barriers spanning across all flow related processes. As a result, the risk of being imprecise when dealing with these high impact initiatives is significantly lower. In addition, the overall impact of those larger initiatives when combined with RTDC is compounded.

  • Results: After implementing RTDC, our previous health system clients have realized improvements in LOS, deferral rates, request to occupy from the ED, PACU overnight holds, ED LWBS and median discharge time. More specifically, one academic hospital was able to accept 700 more admissions over a 6 month period despite a 20 percent increase in acuity index, without adding to capacity in the form of beds or staff.

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