Friday, September 2, 2016

Designing Patient Flow

Patient flow in healthcare continues to be a daunting challenge. It is not the same as building a car. All patients are different and their clinical needs and rate of improvement vary. The hospital doesn’t get to choose how many patients it will serve in a day. It serves all who need care. Because of the variability in these inputs, it is very important that we approach patient flow the way an engineer would. We study the patient demand and try to have just the right number of clinicians and support staff to serve them. And we design the system of patient movement to minimize the waste of time and energy.

Previously in the blog, I have discussed the concept of synchronization.  It’s a change concept that brings the players or processes in a design into “harmony.”  When we synchronize processes in patient flow, we allow the operators to organize their work so they can be ready to act at a specified time. In order for success, all parties involved must align their work to be ready for the chosen time.

People do not like to feel overwhelmed in their job. When we don’t synchronize, we run the risk that the “downstream” function isn’t ready to accept the patient when we want to move them. An example of this is the emergency department calling an inpatient unit to move a patient to them but there is no nurse ready to accept the patient. The emergency department gets upset because they want to get the patient out so that they can see the next patient. The inpatient unit gets upset because they feel they are being ‘jammed’. Both groups feel that the other doesn’t respect them.

Synchronizing flow from one unit to the next begins with a conversation before the patient moves. Information is shared about the patient and a time is chosen with the input of the sender and the receiver with enough advance notice for both to be ready.

Monica Goetz, our clinical nurse manager for the Medical Intensive Care Unit (MICU -- Unit 57) and her team felt that the previous process for moving patients out of the MICU was leading to many challenges as well as dissatisfied and frustrated staff on both ends of the transfer.  This is why they redesigned the process and are now studying it during LDM rounds, helping them to focus on how best to complete the transfer they redesigned the process.

The MICU team redefined the term “ready to move” as when both the sending and receiving nurse could safely perform a patient inclusive bedside handoff. Now, when the patient’s room is ready, the ICU nurse calls the new unit to identify a time, within the hour, that they both will be prepared to meet.  This allows both nurses to plan their work to be ready. At the agreed upon time, they meet in the new room, perform bedside handoff, review the patient’s belongings & share the “getting to know you” form. The “getting to know you” form is a tool used by the MICU team to learn about who a patient is as a person; their hobbies, things they enjoy when they are not in the hospital, fun facts, and things they want us to know about them.  

Monica shared a recent story to illustrate how the new design is working;
We had a patient (87-year-old male), with many co-morbidities and more hospitalizations than he could count.  He has always hated hospitals, the feel of being in them, and how he is treated…until this hospitalization.  He went on to describe that the care he received was like a well-orchestrated symphony.  Everyone in tune and working in harmony.  From the conductor (manager) to the lead violinist (the charge nurse) ...all setting up to tune for the concert (the shift).  Everyone worked together to make the beautiful music that we call patient care.  

This story is a good example of the work that the MICU is doing with patient transfers…. moving our patients in “synchrony”.  Working together to find a time that is agreed upon (within the hour) and then performing the handoff at the bedside – making the transition not only safer but patient inclusive.  This design demonstrates improvement from the back and forth phone tag, impersonal phone report and leaving a patient in a room alone until someone on the new unit is able to greet them.   I am very proud of Monica and her team and all of the nurses and others who have designed this new system. Let’s hear it for synchrony!


  1. Bravo Monica and Team and all GBMC Staff that assisted in this fine tuned harmony of Service Excellence in patient care and safety. You are an example for all to follow!


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