Blog — Better Patient Flow

The blog

Everything we've written

Everything we've written on flow, constraints, and the realities of the floor. All of it free to read, organized by subject.

ECAT

ECAT is hard to game — and that's a good thing

CMS's new ECAT measure folds rooming delays, walkouts, boarding, and long stays into one score. The easiest way to improve performance will be to actually improve flow.

5 min read

Field notes

Are you incentivizing your doctors to break flow?

How incentives that reward starting the next patient can undermine emergency department flow, and why coordinating around finishes matters.

4 min read

The five focusing steps, translated for the hospital floor

Theory of Constraints gives you five steps. Here's what each one looks like when the system is an emergency department and the throughput is people.

8 min read

Theory of constraints

Why adding beds rarely fixes a crowded ED

The intuition is everywhere: we're full, so we need more capacity. But the constraint is almost never where the crowd is. Here's how to find where it actually lives — and why the cheapest fix is usually the right one.

12 min read

Big idea

Big idea: discharge hard, then hold half the beds empty

Push patients off the floor the moment they're ready — then refuse to backfill every open bed. The empty beds aren't waste. They're the buffer that keeps the whole hospital moving.

7 min read

Opinion

Boarding is a flow problem wearing a staffing costume

When admitted patients pile up in the ED, everyone reaches for the same explanation: we're short-staffed. The data usually says something else.

6 min read