Patient flow is one of the most common challenges that healthcare is facing. We are seeing this even more in exceptional circumstances, such as that during the COVID-19 pandemic. Hospitals, medical offices, and small clinics depend on maximizing operational efficiency, especially during crisis, but even in normal occasions when one healthcare organization is dedicated to retaining patients and keeping them satisfied.  Lean management is widely used by the healthcare care industry as it provides with the best directions on eliminating waste and maximizing value delivery from the customer’s (i.e. patient’s) perspective. Healthcare focuses a lot lately on continuous improvement, which is why lean methodology is a “must have” for any provider, like a hospital, a clinic or a medical office. Shared responsibility and shared leadership are two critical principles that help to continuously improve processes, purposes and people working to serve the patients in the best possible way. However, going deeper in linking lean management with efficiency, in healthcare, many organizations overlook an important aspect of lean methodology. A good idea to eliminate waste and deliver more value can be “born” at any level of the hierarchy, the key is to trust people, at any level, to generate and apply good ideas because they are the experts on finding out how they can best do the job. Therefore, critical challenges, such as patient flow efficiency, are tackled by letting people at each step of the process to figure out how to eliminate waste, it is all about sharing responsibilities and leadership, up to some extent.

According to the Institute of Healthcare Improvement, “achieving hospital-wide patient flow, and ultimately improving outcomes and the experience of care for patients, requires an appreciation of the hospital as an interconnected, interdependent system of care.”

The challenge is to find the right way to improve that experience of care for patients. Patient flow is critical for that improvement. First of all, reporting is very crucial, as patient moves from one point of contact to another. Documentation is absolutely necessary to ensure firm control and good insights regarding actions taken between departments. Documentation also allows for generating useful reports with information, in order to spot where performance, resources utilization and patient flow staggers.  Embracing the right culture of accountability could also affect patient flow, especially in smaller clinics and medical offices. Studies have shown that culture and therefore the way people interact with patients is directly influencing higher performance. Senior leaders should always set clear directions: treating people as their best resource, building trust among employees and leaders but at the same time challenging them to boost problem solving in timing, documentation, and reporting activities regarding patient flow.

Match capacity and demand. Staffing is not static anymore, so exploring different staffing models is wise. Jennifer Mensik, a former administrator for nursing and patient care at St. Luke’s Health System in Idaho, states “nurse leaders can, to some degree, control the flow of patients and staff accordingly, if they harness unit-level data to find trends and identify how they change staffing and routines to accommodate those trends.” As long as a hospital or smaller clinic has data in its hands, managers will be able to plan better and match capacity to predicted demand. The organization should take advantage of data which will be revealing capacity constraints and various demand patterns. If we match capacity and demand, we will reduce delays in patient flow. Take for instance emergency department planning, examining average and peak admissions per day in this department will assist in predicting demand and will allow for being proactive, in other words planning the amount the resources needed in order to meet both average and peak demand.

Take it as simple as possible. A simple patient flow map will help reveal time management constraints and drawbacks as also staff management challenges. The goal is to minimize waiting time and therefore maximize high-quality customer experience. A map, like that in the example below, could provide a complete assessment of the procedure a patient follows in a medical office. Call centers are essential to be efficient, answering calls as soon as possible and having the software to quickly book appointments based on the doctors’ availability. Many medical offices choose to outsource calling, this first point of customer contact because of working after hours and promptly directing other calls to the actual office. If scheduling is well managed then check in and waiting times in the reception area will create no friction and will be minimized eventually. Doctors flow in examination rooms is another challenge as it affects the wait time of patients in exam rooms. The time a doctor is with a patient in the exam room cannot be easily predicted and managed, however, if making and signing prescriptions is fast through proper technology tools, it can save up a lot of time. Then, checking out, collecting co-payments, and rescheduling appointments is considered to be a point of contact with much less friction, where it can maximize customer satisfaction while increasing the flow.

What is the actual structure of your medical office? Apart from staff and time management, we should not ignore the actual design of the medical office. Is it easy for patients to find the check-in area and follow a path towards check out? The map above should be somewhat closely linked to the office’s design. Experts suggest that medical offices that are inefficiently designed, could cause bottlenecks and subsequent delays in the patient flow, undermining the customer experience to a great extent. Patients moving in a circular motion might be the key. With that circular pattern, there are no backtracks or cross paths with other patients. Moreover, a good design allows doctors and patients to easily locate each other and effectively communicate, along with easy access to supply areas in order to set up exam rooms more quickly. The example of a large medical office design below indicates that it is important to circulate patients one way around the “support core” – the office or reception, which avoids any bottlenecks with the personal intake (check-in) and check-out. Also, the check-in and check-out points are recommended to be separate from the waiting area, as privacy is what matters the most in all points of contact inside a medical office. Comfort and efficiency are the main motives for constructing the

Why should you have a good patient flow? Reducing waste and maximizing value is critical to the customer/patient experience and the organizations’ bottom line. Reducing waste is rather a major objective as delays increase costs, and decrease staff efficiency, therefore worsening the patient experience in the medical office, which may be translated as losing business. The value that is maximized from the other side is all about utilizing resources in the best possible way, have satisfied patients with high satisfaction levels, that will come again to the medical office and will recommend it to other patients too, therefore boosting the business and the number of patients coming to the office. The answer to the “why” question above can be evaluated by four elements: stress, no-show rate, operational waste, and data capture.