The document discusses patient flows and the productivity paradox in healthcare. It explains that increasing productivity and throughput is challenging due to bottlenecks that can form from small variations in patient arrival times and processing times. This causes wait times and the number of patients to grow disproportionately. True improvements require focusing on the entire system, continuous improvement, empowering frontline staff, and understanding workflows and interdependencies rather than just focusing on cost cutting or productivity in isolation.

1. Patient Flows & The Productivity Paradox
© primeASCENT, 2015
Paul Schilstra, primeASCENT
November 20, 2015

2. The Physics of Patient Flows
Scheduling
Admission/
Registration
Assessment Treatment
Education &
Discharge
Laboratory &
Imaging
Unscheduled
Emergency
Patients
Harmed
Patients
Pharmacy
© primeASCENT, 2015
Frustrated
Patients
Frustrated
Patients
Causes of Delays and Waiting
• Poor scheduling practices
• Limited business hours
• Variation in volumes and case mix
• Variation in capacity availability
• Variation in skill sets and experience
• Variation in care
• Equipment breakdowns
• Communication disconnects
• Errors
Impact of Flows
• Revenues
• Quality and safety of care
• Patient Experience
• Investments
• Expenses
• Unevenness in flows and workload
• Overburdening of front-line staff
• Staff morale
The Productivity Paradox
What Management Wants:
1 - Be productive all the time!
2 - Do more with less!
Little’s Law Imposes A Physical Limit:
“A queue becomes infinitely long when
utilization approaches 100%”
This happens when patients or orders
arrive faster than can be processed ➔
Bottlenecks ➔ Harried and frustrated
staff ➔ Poor safety + unhappy patients
➔ Increase in cost per patient

3. Increasing Productivity Is Not Straightforward …
© primeASCENT, 2015
What happens if we cut CT capacity to reduce costs and increase productivity,
without understanding the processes and interdependencies involved?

4. The Productivity Paradox At Work
© primeASCENT, 2015
Productivity does go up but even small variations in arrival and scanning times will
cause wait times and the number of patients to grow dramatically and
disproportionally.

5. A Simple Illustration
Click Here For Video
© primeASCENT, 2015

6. Improving Clinical Productivity
Why Many Efforts Fail
• Top down-mandated process
• Main motivation is cost reduction
• One time effort (“Problems are like
weeds. They come back if you don’t
keep improving”)
• Not empowering frontline staff
• Focus on one area only
(“suboptimization”)
• Emphasis on Lean tools instead of
creating a learning and continuously
improving organization
The Right Way -
Understanding & Knowledge
• Focus continuously on:
o The patient experience and
perceptions
o The entire system
o Continuous improvement: reduction
in unevenness in patient flows,
overburdening of staff, and waste
(including safety problems)
o Empowerment of and respect for
frontline staff
o Work & communication flows
Scheduling
Admission/
Registration
Assessment Treatment
Education &
Discharge
Laboratory &
Imaging
Unscheduled
Emergency
Patients
Harmed
Patients
Pharmacy
© primeASCENT, 2015
Frustrated
Patients
Frustrated
Patients
The Weakest Link Determines
Overall Performance
The Constraint or Bottleneck
Market - Quality - Capabilities - Capacity - Policies

7. Thank You!
Paul Schilstra, President
Email: paul.schilstra@primeascent.com
Phone: 410-444-6024
www.primeascent.com
© primeASCENT, 2015