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Restructuring patient flow logistics around patient care needs: implications and practicalities from three critical cases

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Abstract

To make hospitals more patient-centered it is necessary to intervene on patient flow logistics. The study analyzes three innovative redesign projects implemented at three Italian hospitals. The three hospitals have reorganized patient flow logistics around patient care needs using, as proxies, the expected length of stay and the level of nursing assistance. In order to do this, they have extensively revised their logistical configuration changing: (1) the organization of wards, (2) the hospital’s physical lay-out, (3) the capacity planning system, and (4) the organizational roles supporting the patient flow management. The study describes the changes implemented as well as the results achieved and draws some general lessons that provide useful hints for those other hospitals involved in such type of redesign projects. The paper ends by discussing some policy implications. In fact, the results achieved in the three cases investigated provide interesting material for further discussion on clinical, operational, and economic issues.

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Notes

  1. Diagnosis-related group (DRG) is a system to classify hospital cases into homogeneous groups, also referred to as DRGs, expected to have similar hospital resource use. The system, firstly developed by Medicare as part of the prospective payment system, is now extensively used as hospital payment system in different countries, including Italy.

  2. Queues form most commonly when arrival patterns or service times have a random element. Generally, the greater the variation in arrival of service time, the more likely it is that there will be a queue and the expected queue will be long.

  3. It is important to stress that nursing acuity and severity of illness may or may not be correlated in a given patient or patient population. For example, severely ill patients who are receiving only palliative care may require less nursing-care time than patients who are less acutely ill but require intensive education and discharge planning.

  4. For example, in the case of Foligno hospital it is a nurse that is in charge of managing and coordinating patient inflows and outflows from the High Care Unit. At Forlì hospital two nurses occupy the position of hospital rounds coordinator and supply coordinator.

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Acknowledgements

The research presented in this paper was carried out within CERGAS-Bocconi’s Observatory on Italian Health-Care Management (OASI) and was made possible thanks to the active collaboration of Emilio Duca (former Chief Medical Officer Foligno Local Health Authority), Joseph Polimeni (former Clinical Director Pontedera Hospital) and Maria Grazia Stagni (Clinical Director Forlì Hospital).

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Authors and Affiliations

  1. Center for Research in Health and Social Care Management, CERGAS, Bocconi University, Viale Isonzo 23, 20135, Milan, Italy

    Stefano Villa & Marta Barbieri

  2. IPAS Institute of Public Administration and Health Care Management, Bocconi University, Milan, Italy

    Federico Lega

Authors
  1. Stefano Villa
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  2. Marta Barbieri
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  3. Federico Lega
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Correspondence to Stefano Villa.

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This particular manuscript is for the Special Issue: ORHAS ’2007 Conference.

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Villa, S., Barbieri, M. & Lega, F. Restructuring patient flow logistics around patient care needs: implications and practicalities from three critical cases. Health Care Manag Sci 12, 155–165 (2009). https://doi.org/10.1007/s10729-008-9091-6

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