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The Origins of Flow in Healthcare

Posted by BestPractices on June 14 2011

As the precepts and principles of industrial models of improving quality (including continuous quality improvement, total quality management, and other models) began to be applied to healthcare in the 1970s and 1980s, one area of particular emphasis was the concept of variation and its effect on the ability to consistently deliver quality care. An emerging sense developed that reducing this variation, particularly through the redesign of processes, could have a substantial impact on the fundamental way in which healthcare was delivered. The 2003 white paper published by the Institute for Healthcare Improvement (IHI) “Optimizing Patient Flow: Moving Patients Smoothly Through Acute Care Settings” stated the problem succinctly:

Patients and providers alike regard waits, delays, and cancellations as a normal part of getting and giving care. Particularly in hospitals, waiting seems intrinsic and, to many, intractable.

In many ways, the fundamental problem is helping leaders understand that poor flow may be intrinsic to many of our systems, but our challenge is to prove not only that it is not intractable but that specific tools exist to dramatically improve flow. The white paper began to discuss the intersection of three vectors as possible components in understanding flow:

  1. Variation
  2. Waits and Delays
  3. A fundamental mismatch between demand and capacity

To our knowledge, this was the first publication specifically addressing flow in the patient care setting, and its primary emphasis was on reducing process variation.


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