Before we go further, we will answer our own question: Of course the patients in your hospitals are human beings, with real and often complex ailments your caregivers compassionately heal. They are not widgets or production units; they’re the people who form the communities you serve.
But analogies to other industries do help clarify the power of logistics in improving throughput, care quality and patient satisfaction. My colleagues debate about the best ones. Our CTO, Jim Rosenblum, favors the air traffic analogy. It maps well to the logistics of patient care. Airlines and airports have systems for reservations, ticketing, scheduling, staffing and maintenance, along with gate agents, pilots, mechanics, caterers and crews. But those systems and people alone won’t get planes off and on the ground safely. Central air traffic controllers at the airport must be able to see all planes, know weather conditions and fuel levels, and manage runway and gate availability to orchestrate safe takeoffs and landings for all planes in flight, all the time.
There’s a challenge with the airport and airline analogy, however: People hate flying. They find the entire experience unpleasant, unreliable and frustrating. In fact, some people get downright angry when you suggest that hospitals should run like airports. The people, processes and technologies that power air traffic control deliver astounding predictability in meeting their primary mission: Safety. That doesn’t make the average traveler feel any better about airport security bottlenecks, flight delays, poor customer service and crying babies.
Our president, Karl Straub, likes the simplicity of the hotel analogy. And if you subtract coordination of care (yes, that’s a big consideration), then hospitals share many logistical similarities with hotels. Who could run a hotel efficiently without knowing when customers were checking in and out, which beds are available when, and balancing the load of appropriate staff members with guest volumes and needs? Many hospitals still operate every day with a tenuous grasp of these fundamentals. Variability and uncertainty rule where precision should.
I like to bring it back to the catchy-tuned evangelists of logistics: UPS. Consider the logistics that UPS uses to ensure that all packages arrive on time. Every package has a common set of linear delivery milestones. The better and faster they can complete each milestone, the more reliably the package will arrive where it belongs on time.
UPS also has proven processes and technologies to orchestrate the complex logistics of reliably delivering all packages on time, no matter where they came from and where they’re headed:
- Hub-and-spoke distribution model
- Methods and technologies to staff the right number of the right people to accept, route, sort, track, transport and deliver all of those packages
- Systems that ensure that enough trucks and planes are fueled and ready, pickups are timely and that deliveries occur in the most efficient order
It’s all about fulfilling simultaneous high demand with limited resources. In hospitals, inpatients demand beds, clean rooms, transport, diagnostic services, and appropriate treatment for their clinical conditions. Hospitals historically have not used logistics to orchestrate the simultaneous care and throughput of patients in hospitals. That’s exactly what a comprehensive logistical control system provides—the thinking, processes, methods, measures and software to reliably and predictably manage the highest quality care and most efficient throughput for all patients in your hospital.
Just as every UPS package shares logistical delivery milestones, every patient has a common set of linear throughput milestones from admission through discharge. (Read more about the eight milestones and the need for system focus here.)
These milestones make perfect sense for a single patient. The challenge for hospitals is efficiently advancing these milestones for all patients under care. People and departments working in isolation and at cross purposes can’t effectively orchestrate the care of all patients. Every caregiver, department and service area must work together, with the right tools and information, to ensure:
- Patients are where they’re expected to be for timely treatments and services.
- People and resources are available exactly when needed to advance the patient’s care plan.
- Beds and rooms are ready when they’re supposed to be.
- Transport is on time.
- Units are staffed with precision to meet clinical demand.
- Everyone can see the statuses of patients and orders at all times.
- Coordinators deliver diagnostic services with priority that best serves both patient care and overall throughput targets.
- Both caregivers and patients have a clear and reliable itinerary for care.
- Departments work in harmony, not in isolation and conflict.
- Hospital executives have accurate, updated information they can act on quickly to make sure everyone has what they need to provide prompt, quality care.
In our experience, hospitals succeed in reliable, predictable, sustainable throughput by adopting a centralized, hub-and-spoke logistical model similar to the one UPS uses. It works for the same reasons–applying centralized control and visibility to advance all of the required activities of care coordination for all patients.
The math reflects the chaos at hand. Let’s say your hospital has 15 people across units and service areas communicating to coordinate care. That 105 single paths of communication. Those 15 people and 105 pathways create 1.3 trillion possible combinations of communications.
A centralized, hub-and-spoke approach to care coordination simplifies communication paths and makes handoffs smooth and consistent. Suddenly, 105 paths become 15, with fewer and more controlled combinations of communications. You can see how centralized care coordination quickly applies control to manage the chaos.
Adopting this model for care coordination requires significant organizational commitment. For the central hub handle all of the activities, communications and handoffs, it needs better processes, leadership participation and software built specifically to power logistics for throughput. The supporting technology is critical to let caregivers see and orchestrate everything they need to deliver timely, quality care, all the time for all patients. But just as it does for packages, planes and products, system-focused logistics ensures the best quality patient care and most efficient throughput for hospitals. It’s a journey and a way of life for the hospital, not a project.