Mastering capacity management: Strategies for an effective command center

A regional, northwest health system engaged Guidehouse on a multiphase capacity management transformation, achieving the following in 12 months:

• Reduced ALOS by 0.47, allowing the system to serve an additional 11,065 patients
• Improved the bottom line by approximately $64 million without adding any capital investments in physical acute beds
• Expanded overall access opportunity by 120 beds

The ON TIME approach to capacity management

Guidehouse’s ON TIME approach to capacity management focuses on eliminating silos between departments, strengthening operational processes that impact capacity, and using technology as a tool to maximize both of those efforts. By successfully following this model, healthcare organizations can enhance throughput and improve patient outcomes.

The Fundamentals of ON TIME Care

Prior to implementing technology, it's crucial to first address any operational inefficiencies. Simply adding technology to flawed processes can lead to short-term fixes, rather than sustainable improvements that truly enhance care. Our approach focuses on going "back to the basics" to identify and resolve root causes, then operationalizing those solutions while using technology to support seamless, efficient care delivery.

Addressing capacity and throughput with this foundational approach results in a healthy data ecosystem that reaps exponential benefits. This includes: 

• Organizational alignment: It’s important for stakeholders to be aligned across clinical operations, technology, finance, and other key departments. An ON TIME approach requires standardized processes and key performance indicators (KPIs), supported by a culture of accountability that is aligned to your operating model and key imperatives. 
• Negate barriers in real-time through real-time root cause analysis and resolution: Patient flow and discharge can be optimized by minimizing barriers and leveraging technology to allow for real-time visibility, response, and swift resolution of delay. A formal root cause analysis is a critical step so that stakeholders don’t rely on anecdotal evidence and miss hidden opportunities.
• Technology integration promoting instantaneous visibility: The electronic health record (EHR) should be the source of truth and reduce paper processes for the front line, promoting real-time visibility. An organization with consistent, accurate data will be better able to take advantage of predictive analytics and AI tools.
• Increase access and optimize bed utilization: A comprehensive throughput strategy enhances patient flow and reduces wait and boarding times. Improvements to access position your facility as the hospital of choice for your community.
• Movement of patients to drive throughput: Level-loading techniques, including staffing and visualizing validated licensed beds, can help ensure consistent movement throughout your facility. Streamlined patient movement for routine ancillary processes and discharge ensures the appropriate level of care, optimized length of stay and a reduction of unnecessary patient movement.
• Elimination of silos by improving communication: When information is centralized and operations are coordinated across departments and facilities, leaders are able to break down what is often a siloed, independent approach. This fosters better communication and seamless data integration, improving overall coordination and efficiency.

Next steps

Dive deep into your current state to understand what processes directly drive value around capacity and patient flow. As you begin to take action, start with these best practices and guiding principles:

Standardize and optimize: Get more patients “in” by first defining how teams will get patients “out” effectively. Start by defining a standard, streamlined approach to patient intake and movement procedures, including intra-hospital movement and all movement after post-acute placement. Create a sense of urgency around early discharges by increasing communication through IT tools, capacity huddle effectiveness, and valuable care team handoffs. Finally, ensure your team is ready to handle challenges, with clearly defined paths of escalation for care delays with alignment of service level agreements.

Build out technology infrastructure: Optimize your EHR facility structure and other technology to reduce technology debt and staff burden. Dashboards that aggregate data from across sources offer staff real-time visibility of KPIs and help leaders identify the root cause of problems. When used with predictive analytics tools, dashboards can help you create net-new models based on historical population health data. Equipped with these insights, leaders can implement a decision support algorithm that assists with triage, prioritization, and clinical placement of patients.

Defer to local experience: A ground-up approach is essential to ensuring cohesiveness between local hospitals and a central command center. Strategies should prioritize local knowledge, leveraging the system command center as a second layer of aid to improve patient flow.

Cultivate experts in capacity management: Leaders should invest in recruiting capacity management experts and training existing staff within multiple levels and disciplines. This should include workflow training and standard operating procedures that focus on reducing the burden on the front lines and staffing wards based on real-time needs. 

Develop a governance structure: Your organization should have a capacity management governance structure that supports your strategy, enables scalability and adhere to a repeatable, standardized approach. Regardless of department or service line, capacity-related projects should have common processes, tools, and behaviors. This starts with clearly outlining the roles that leaders within corporate, service lines, hospital, and project management/process improvement have when it comes to capacity management. Performance scorecards can also help ensure a culture of accountability at both the hospital and system levels. 

There is no one-size-fits-all approach to building out your capacity management and command center strategy. Guidehouse’s ON TIME care philosophy, coupled with a detailed root analysis, can help healthcare organizations improve access, address the unique concerns of providers, and empower all employees to play a part in achieving operational and financial goals.