Hospital Capacity Management: Insights and Strategies details many of the key processes, procedures, and administrative realities that make up the healthcare system we all encounter when we visit the ED or the hospital. It walks through, in detail, how these systems work, how they came to be this way, why they are set up as they are, and then, in many cases, why and how they should be improved right now. Many examples pulled from the lifelong experiences of the authors, published studies, and well-documented case studies are provided, both to illustrate and support arguments for change. First and foremost, it is necessary to remember that the mission of our healthcare system is to take care of patients. This has been forgotten at times, causing many of the issues the authors discuss in the book including hospital capacity management. This facet of healthcare management is absolutely central to the success or failure of a hospital, both in terms of its delivery of care and its ability to survive as an institution. Poor hospital capacity management is a root cause of long wait times, overcrowding, higher error rates, poor communication, low satisfaction, and a host of other commonly experienced problems. It is important enough that when it is done well, it can completely transform an entire hospital system. Hospital capacity management can be described as optimizing a hospital’s bed availability to provide enough capacity for efficient, error-free patient evaluation, treatment, and transfer to meet daily demand. A hospital that excels at capacity management is easy to spot: no lines of people waiting and no patients in hallways or sitting around in chairs. These hospitals don’t divert incoming ambulances to other hospitals; they have excellent patient safety records and efficiently move patients through their organization. They exist but are sadly in the minority of American hospitals. The vast majority are instead forced to constantly react to their own poor performance. This often results in the building of bigger and bigger institutions, which, instead of managing capacity, simply create more space in which to mismanage it. These institutions are failing to resolve the true stumbling blocks to excellent patient care, many of which you may have experienced firsthand in your own visit to your hospital. It is the hope of the authors that this book will provide a better understanding of the healthcare delivery system.

While hospitals can learn from other industries, they cannot be improved or run like factories. With work that is more individualized than standardized, and limited control over volume and arrivals, even the leanest-minded hospital must recognize that healthcare systems are more dynamic than nearly any work environment.Written with the creativity n

In both rich and poor nations, public resources for health care are inadequate to meet demand. Policy makers and health care providers must determine how to provide the most effective health care to citizens using the limited resources that are available. This chapter describes current and future challenges in the delivery of health care, and outlines the role that operations research (OR) models can play in helping to solve those problems. The chapter concludes with an overview of this book – its intended audience, the areas covered, and a description of the subsequent chapters. KEY WORDS Health care delivery, Health care planning HEALTH CARE DELIVERY: PROBLEMS AND CHALLENGES 3 1.1 WORLDWIDE HEALTH: THE PAST 50 YEARS Human health has improved significantly in the last 50 years. In 1950, global life expectancy was 46 years [1]. That figure rose to 61 years by 1980 and to 67 years by 1998 [2]. Much of these gains occurred in low- and middle-income countries, and were due in large part to improved nutrition and sanitation, medical innovations, and improvements in public health infrastructure.

This book is dedicated to improving healthcare through reducing delays experienced by patients. With an interdisciplinary approach, this new edition, divided into five sections, begins by examining healthcare as an integrated system. Chapter 1 provides a hierarchical model of healthcare, rising from departments, to centers, regions and the “macro system.” A new chapter demonstrates how to use simulation to assess the interaction of system components to achieve performance goals, and Chapter 3 provides hands-on methods for developing process models to identify and remove bottlenecks, and for developing facility plans. Section 2 addresses crowding and the consequences of delay. Two new chapters (4 and 5) focus on delays in emergency departments, and Chapter 6 then examines medical outcomes that result from waits for surgeries. Section 3 concentrates on management of demand. Chapter 7 presents breakthrough strategies that use real-time monitoring systems for continuous improvement. Chapter 8 looks at the patient appointment system, particularly through the approach of advanced access. Chapter 9 concentrates on managing waiting lists for surgeries, and Chapter 10 examines triage outside of emergency departments, with a focus on allied health programs Section 4 offers analytical tools and models to support analysis of patient flows. Chapter 11 offers techniques for scheduling staff to match patterns in patient demand. Chapter 12 surveys the literature on simulation modeling, which is widely used for both healthcare design and process improvement. Chapter 13 is new and demonstrates the use of process mapping to represent a complex regional trauma system. Chapter 14 provides methods for forecasting demand for healthcare on a region-wide basis. Chapter 15 presents queueing theory as a method for modeling waits in healthcare, and Chapter 16 focuses on rapid delivery of medication in the event of a catastrophic event. Section 5 focuses on achieving change. Chapter 17 provides a diagnostic for assessing the state of a hospital and using the state assessment to select improvement strategies. Chapter 18 demonstrates the importance of optimizing care as patients transition from one care setting to the next. Chapter 19 is new and shows how to implement programs that improve patient satisfaction while also improving flow. Chapter 20 illustrates how to evaluate the overall portfolio of patient diagnostic groups to guide system changes, and Chapter 21 provides project management tools to guide the execution of patient flow projects.

Distilling the ideas central to managing operating theatres, this book provides a practical and easy to use toolkit to improve theatre efficiency and patient outcomes. It advocates using time as the key measurement and proposes a new norm of operating theatre management based on rational, data-driven principles. Notions of 'efficiency' and 'scheduling' are clearly defined, and a scheduling toolkit available to download accompanies the work. The book's easy to use format supports managers in list planning, performance monitoring and demand-capacity matching while considering limited budgets and resources. It includes contributions from around the world, demonstrating the global application of its core approach. Aimed primarily at operating theatre managers, this book will also interest consultants, senior trainees, nurses and administrators who are involved in the daily running of the operating theatre and/or want to develop their leadership/managerial skills.

This book presents healthcare logistics solutions that have been successfully implemented at a variety of healthcare facilities. In each case, a major challenge is presented, along with the solution approach and implementation steps, followed by the impact on hospital operations. Problems encountered when implementing the results in practice are also discussed. Much of the work presented is drawn from the experiences of members of the Center for Healthcare Operations Improvement and Research (CHOIR) at Twente, along with the CHOIR spin-off company, Rhythm.

Hospital Capacity Management: Insights and Strategies details many of the key processes, procedures, and administrative realities that make up the healthcare system we all encounter when we visit the ED or the hospital. It walks through, in detail, how these systems work, how they came to be this way, why they are set up as they are, and then, in many cases, why and how they should be improved right now. Many examples pulled from the lifelong experiences of the authors, published studies, and well-documented case studies are provided, both to illustrate and support arguments for change. First and foremost, it is necessary to remember that the mission of our healthcare system is to take care of patients. This has been forgotten at times, causing many of the issues the authors discuss in the book including hospital capacity management. This facet of healthcare management is absolutely central to the success or failure of a hospital, both in terms of its delivery of care and its ability to survive as an institution. Poor hospital capacity management is a root cause of long wait times, overcrowding, higher error rates, poor communication, low satisfaction, and a host of other commonly experienced problems. It is important enough that when it is done well, it can completely transform an entire hospital system. Hospital capacity management can be described as optimizing a hospital’s bed availability to provide enough capacity for efficient, error-free patient evaluation, treatment, and transfer to meet daily demand. A hospital that excels at capacity management is easy to spot: no lines of people waiting and no patients in hallways or sitting around in chairs. These hospitals don’t divert incoming ambulances to other hospitals; they have excellent patient safety records and efficiently move patients through their organization. They exist but are sadly in the minority of American hospitals. The vast majority are instead forced to constantly react to their own poor performance. This often results in the building of bigger and bigger institutions, which, instead of managing capacity, simply create more space in which to mismanage it. These institutions are failing to resolve the true stumbling blocks to excellent patient care, many of which you may have experienced firsthand in your own visit to your hospital. It is the hope of the authors that this book will provide a better understanding of the healthcare delivery system.