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How to Manage Patient Flow

Jeremy Miller, MD, Clinical Advisor, Sg2, for HealthLeaders Media, May 16, 2011

Less conspicuously, deliberate policies about marketplace positioning and staff alignment can be used to change the demographic contours of the organizational referral base. For example, an organization could survey the community landscape from a needs or profitability standpoint and make a deliberate decision to position itself in the market as a leader in managing diabetes or treating chronic obstructive pulmonary disease. Likewise, a Systems of CARE (Clinical Alignment and Resource Effectiveness) approach to prevention means that epidemiologic trends need not dictate organizational destiny. This type of smart growth, in considering appropriate care along the care continuum, not only delivers value to patients and creates institutional financial stability, but can also be used as a strategy to address care fluctuations.

Improving Management of Fluctuating Care Patterns
There are 2 basic strategies for rationally approaching care fluctuations: Go with the flow in maximizing flexibility for unpredictable situations or conversely, buck trends by understanding what can be altered, leveraging this knowledge to the benefit of the organization and the patient. These 2 actions must coexist in situations that have both controllable and unpredictable variations. To best succeed in leveraging inherent variability in the near- and long-term:

  • Anticipate and monitor trends in your organization. Recognize which metrics are important and track their variations by year, month, day and time to assess process and patient flow. Selecting the right metrics to track on a daily and even hourly basis can inform staffing, which can drastically alter the profitability of a service line and the organization as a whole. In terms of operational fluctuation, metrics documenting procedure volume and type may be important, as well as the number of visits, type of imaging or tests and census. To understand the severity of fluctuations, analyze the seasonal, daily and even particular hours when fluctuations impact the work flow.
  • Discuss care fluctuations with clinical staff. Recognize the clinical aspects of variation and determine why they exist, understanding both physician behaviors and patient characteristics. The clinical staff can help explain staffing implications, as well as provide insight into what can be controlled and what volume fluctuations are natural.
  • Temper variation with flexibility. For example, staffing flexibility can be achieved by cross-training nurses in various areas, or designating an on-call team.
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