The 8 Milestones of Patient Throughput: A Logistical Lens for Improving Patient Flow

We named this website Care Milestones for a couple of reasons. One, the shift from volume-based to value-based care represents a watershed for hospitals. This healthcare milestone changes everything about the way hospitals operate, provide care and succeed financially. We firmly believe that hospitals will thrive in the face of this change by embracing logistics for patient throughput. It’s the lever that when pulled makes the most dramatic, sustainable improvements in length of stay, costs and quality.

We also monitor and measure efficiency based on eight milestones for patient throughput (click to enlarge):

8 Milestones of Patient Throughput Logistics

These milestones form the spine of a logistical control system for patient care from admission through discharge. Hospitals must focus on completing these milestones for all patients as efficiently as possible. To do so, hospitals must address efficient flow for all patients in the system, and not just think about how to advance these care activities for single patient at a time. Competition for limited resources will guarantee that a single-patient focus will fall short and still create continuous variability–which means you can’t predict or sustain throughput performance.

The milestones also demonstrate the need for departments to work in harmony, not isolation and conflict. Consider the four middle milestones related to intra-stay diagnostic and services coordination. Let’s say the radiology department undertakes a performance improvement effort, establishing practices for the greatest efficiency within that department. You can see the limited returns of such isolated efforts–a departmental focus cannot consider the throughput needs and priorities of all admitted patients. For the greatest system efficiency, hospitals must have a central order organizer with the tools and visibility to orchestrate all services for all patient on time and in the order that best serves patient care and hospital throughput goals.

Here’s a terrific article that explains this concept in manufacturing, citing an example of a company that tried to improve a 10-machine process by making each machine more efficient:

In the 10-machine manufacturing process illustrated in Figure 1, each machine had a team of manufacturing engineers managing its design and development. All 10 teams hit their performance target: 50 units per hour and 98 percent availability. A separate team of plant engineers developed the plant layout. Their objective was to develop a lean layout minimizing work-in-process inventory. By carefully arranging the 10 machines, they achieved perfect one-piece flow.


Before the new manufacturing process went into production, the teams briefed senior management on the status of the project. All involved had met or exceeded their objectives. Waste had been minimized. All the lean metrics looked great. Optimism for a successful launch was very high, and why not?

When the new manufacturing process was launched, production was only 42 units per hour and not the 49 units per hour that was expected. If all of those involved met or exceeded their objectives, what went wrong?

The interactions between the machines were not considered. When Machine 6 is down, Machines 1 through 5 are immediately blocked and Machines 7 through 10 are immediately starved. In isolation, each machine could produce 49 units per hour. In combination, they could not.

Emphasis added at the end, illustrating the importance of coordinating throughput as a system, not as a collection of functions or groups.

Look for additional posts that focus on each of the eight milestones for patient throughput, defining and clarifying how hospitals should measure milestone efficiency.

POSTED BY Doug Walker

6 thoughts on “The 8 Milestones of Patient Throughput: A Logistical Lens for Improving Patient Flow

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