Most hospital operations are organized around admitting, which means that everything is geared toward getting patients moved into a bed. Practically everything in the hospital revolves around admissions: the priorities, the infrastructure, the processes, the measures, the staffing levels, the training, and even the attitude and culture.
To be sure, this approach is time-tested, but the reality is that, when the hospital is full, this method can strangle patient flow.
The system starts to break down when a lot of patients pile up waiting for an inpatient bed. Waiting patients is a chronic problem for hospitals. And, when the queue forms, hospital management inevitably mobilizes to "fix the problem." Phones start ringing and managers, directors, or administrators start walking the hospital in search of beds.
Hospital management usually handles fixing this problem because no one else has access to the information that defines the true state of the hospital. It takes time to manually collect reliable information on patient/bed status, so managers frequently find themselves investigating, expediting, and firefighting. This often pays off in the short term, because the bed crisis is always – and eventually - solved when patient discharge is expedited, a hidden bed is uncovered, or a physician is called to action.
However, the core problem underlying the bed crunch has not been resolved. So the expediting culture becomes institutionalized, breeding the kind of inefficiency and bureaucracy that has well-intended professionals actually slowing patient flow. This results in a vicious cycle that leads to lower bed capacity and new unintended problems with trust, accountability, and confusion.
These problems are more preventable when the focus shifts to discharging patients
The only way to prevent an overload of waiting patients is to have clean beds available. By focusing on discharging patients who meet the criteria for being sent home – regardless of the status of the hospital or non-clinical issues – the hospital will actively prevent the overload condition by systematically moving patients through the hospital.
Changing the focus to discharge puts the census in a new light. Too often in hospitals a patient stay is colored by such non-clinical conditions as socioeconomic issues, familial matters, or physician whims. A hospital passive about discharge tends to leave these decisions unchallenged, until the hospital is full. Then, with expediting, patients who lack the conditions that necessitate hospital care are discharged —sometimes abruptly. This is losing proposition for nearly everyone involved and a situation that is preventable.
With a simple change in focus, the entire hospital becomes organized and geared toward anticipating the action necessary to consistently and safely discharge every patient that meets appropriate criteria. This approach frees up bed capacity before it is needed, smoothing out workflow and optimizing patient placement.
Equally important, the hospital permanently resolves the expediting problem. If the hospital sticks to its creed of discharging every patient that meets the criteria for being sent home, then, by definition, when the hospital is full, it really is full.
In addition, because patients have been moved proactively through the hospital, the common "bed crunch" expediting becomes needless. Eliminating the constant expediting will result in a dramatic improvement in staff satisfaction by relieving the stress of constantly being in crises. Patient/bed information will be truly trustworthy and the entire staff can become more effective, improving organization confidence and accountability.
It might seem like magic, but a simple change in philosophy can have a huge impact on hospital operations.
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