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1.2. A Metaphor for Hospital Operations

Recently, an estimated 20,000 people from the community turned out for the grand opening of an architecturally and aesthetically stunning new children’s hospital. As they streamed through the sparkling entrance, the enchanted visitors were struck by the success of the design in captivating the young. Wide-eyed children stared at dynamic sculptures and mixtures of professional and elementary school art. Upbeat colors and vaulting spaces gave reassurance that this was a place to get well. Operating rooms (ORs) were large and flexible, inpatient rooms state of the art. Panoramic views of the surrounding trees and rivers inspired parents and children alike. The site even contained an onsite hotel to enable parents to stay close to their sick child, and the Neonatal Intensive Care Unit (NICU) had convertible furniture to provide sleeping accommodations for parents who could not emotionally tolerate even a few floors of separation.

Unfortunately, however, many visitors never saw the full wonder of the new hospital. Stairwells had been closed off during the open house for safety reasons, and only the central elevators were operational. Insufficient elevator capacity led to long lines on every floor. Worse, although eager guides were positioned throughout the hospital to answer questions, neither they nor the signage steered people along the planned route from top to bottom. The resulting random traffic patterns served to further aggravate the congestion. Frustrated with their inability to move from floor to floor, many people gave up and went home.

This (true) story is an apt metaphor for modern hospital operations. Infrastructure and equipment are exquisite, but flows are ill-designed and confused. Visible capital assets are awe inspiring, but invisible processes are frustratingly inefficient. Technology is state-of-the-art, but management is not. People are dedicated and knowledgeable in their fields, but they are largely unaware of operations. The net result is a system that performs far below the sum of its parts.

But it need not be like this. Just as there is a science of medicine that guides the treatment of patients, there is a science of operations that can and should guide the design and management of hospitals. For example, the physics of flows implies that it is impossible to respond quickly to highly variable demand without surplus capacity. In an acute care hospital, patient arrivals are highly variable, both over time and in levels of severity. Capacity, in the form of nurses, physicians, and high-tech equipment, is costly and therefore not installed in abundance. So the delays that are prevalent in hospitals are completely predictable.

Fortunately, the physics of flows also tells us that when resources are busy, with long queues of patients and other tasks waiting for attention, even small capacity enhancements or demand reductions will yield disproportionately large returns. That is, a little bit goes a long way. Modest increases in staffing, improvements in resources, and efforts to eliminate waste, if applied in the right places, can achieve major improvements in responsiveness. These insights can be used to speed the flow of visitors through a new hospital or the flow of patients through an existing one.

In this book, we define, explain, and apply management principles related to physical flows, decision making, quality, and human behavior. These principles encapsulate essential insights about management that can be used throughout the hospitals of today to significantly improve responsiveness, throughput, quality, patient satisfaction, and financial viability. But, because principles are by their nature timeless, they also provide the conceptual building blocks for ultra-high performance hospitals of the future.

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