Does your organization often go into panic mode when it gets really busy (even before COVID)? It’s easy to assume it’s a surge, but a true hospital surge indicates an emergency – and you should have a plan that reflects that.
But how often do you assume you have a surge because you have no beds, but it turns out this is your fifth “surge” this month. Unfortunately, frequent “surge” probably means you have a flow problem, not a surge problem.
Flow Problem #1: You are operating above capacity
Calculating capacity is easy. You take your Length of Stay (LOS) X Average Admits per Day and divide it by the total number of beds available. If this number is over 80-85%, you have a capacity problem.
Wait – shouldn’t the target be 100%?
The simple answer: No.
You should be operating at 80-90% to allow for the variation that occurs in healthcare customers (ie, sick people). We want to allow for variation for each patient, and by operating at less capacity it allows us to do so.
This gets a little tricky when you talk about hospitals, since there isn’t an option to close to patients. The best way to improve capacity in hospitals is to focus on removing waste in order to help reduce LOS.
Flow Problem #2: You have too much waste in your system
Ok, so a lot of these seem like bathroom metaphors, and I’m sorry. Waste in this situation stands for anything that does not bring value to the customer.
What do you do in your organization that does not bring value to the customer? Do you document too much? Do you have supplies located too far from where the work happens? Do you complete tests and scans and procedures just prior to discharge that could be scheduled and completed in an outpatient setting? Do your customers experience waiting? If you answered “Yes” to any of these, you have waste.
The only way to understand what waste exists and what you can do to remove it is to observe and analyze (if you want help with that, we would love to talk to you about how we can help.
Flow Problem #3: You have bottlenecks in your process
An analogy: Do you ever get on the freeway and find there are a lot of cars trying to take the same exit, resulting in a massive backup? This is a bottleneck. There are more cars trying to take the exit than there is capacity for the cars.
Where do bottlenecks happen? Bottlenecks of patients who present to an Emergency Room and there aren’t enough beds. Bottlenecks of patients who need an inpatient bed but are stuck in the Emergency Room either for lack of bed capacity or lack of staff.
Bottlenecks are the result of producing too much, too fast. We produce more than what the next person can handle. The best way to combat this is to match your demand with your capacity. See my last post to see how restaurants do this really well. It’s a little more complicated in hospitals, but it can be done.