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Efforts to address variability in the care delivery system reap a range of benefits that improve access to care, allow patients to move efficiently through the care delivery system and improve financial performance by reducing waste and enhancing revenue. Hospital Emergency Departments (ED) most often feel the effects of patient flow bottlenecks in the hospital delivery system. Lack of access to inpatient services is the principal cause of ED overcrowding, resulting in ambulance diversion and boarding of patients. MVP faculty led the groundbreaking study in two Massachusetts hospitals that established that relationship and that identified variability as the root cause of the problem. Similar research carried out by MVP faculty established in another Massachusetts hospital the relationship between variability and rejection of patients seeking ICU care. MVP faculty also participated played a key role in helping studies at St. John’s Hospital in Missouri to implement variability methodology that also established the relationship between artificial variability and the inability of the hospital to meet demand for inpatient services. When patient flow bottlenecks occur in the delivery system, patient throughput is diminished. Efficient patient throughput assures timely access to and provision of care and optimizes revenue by allowing hospitals to serve more patients. Research carried out by MVP faculty has established the positive benefits, for both quality of care and financial performance, by addressing variability and consequent bottlenecks and improving throughput. Research carried out by MVP faculty at Boston Medical Center resulted in smoothing vascular and cardiac surgery schedules by changing block time distribution, eliminating block scheduling from one OR suite, designating an other OR suite for emergent cases and another two for orthopedic cases , and going to an “open” scheduling system for other OR suites. Results were significant. Hospital throughput increased by more than 4% and ED diversion hours were significantly reduced. Revenue has increased substantially due in large measure to these changes . At St. John’s Hospital in Missouri, very significant results have been achieved similar results were seen by smoothing artificial variability. |
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