I want to bring readers’ attention to a well-written book that has implications for all of us who are passionate about collaboration, Leadership for Smooth Patient Flow, by Jensen, Mayer, Welch, and Haraden; Health Administration Press, (http://www.ache.org/pubs/redesign/productcatalog.cfm?pc=WWW1-2073. Also available at  http://www.amazon.com/Leadership-Smooth-Patient-Flow-Jensen/dp/1567932657/ref=pd_bbs_sr_1?ie=UTF8&s=books&qid=1203717356&sr=8-1.)

The authors discuss six dimensions of flow:

• Efficiency:
  • it is not just the quantity of time, but also how providers spend their time
  • they point out the importance of doing fast things (non-value added tasks or routine, automated tasks) quickly and slow things slowly
• Decreased variation:
  • especially artificial variation that arises from personal preferences not supported by evidence
  • the other important source of variation to treat is variation in outcomes due to differing ability to diagnose and treat patients, which should be treated with education rather than punishment
• Systems thinking:
  • based on understanding the interconnectedness of processes, people, and transfers between stakeholders in the patient’s healthcare journey
  • this understanding requires seeing processes of change as moving pictures rather than as still photos
• Empowerment:
  • involves making sure that professionals at the front-line of care have the freedom (and responsibility) to adapt service to meet patient needs in real time
  • The operational question is, “Tell me about a time that you broke the rules on behalf of a patient.”
• Matching capacity to service demand:
  • service opportunity, once lost, is lost forever
  • decisions about staffing need to be made considering peak demand and not just “average” demand
• Creativity:
  • according to Mihaly Csikszentmihalyi’s book Flow: The Psychology of Optimal Experience, flow cannot be pursued- it must ensue, http://www.amazon.com/Flow-Psychology-Experience-Mihaly-Csikszentmihalyi/dp/0060920432/ref=pd_bbs_sr_1?ie=UTF8&s=books&qid=1203877905&sr=1-1
  • The role of hospital leaders is to create a safe environment in which the above conditions can occur
  • Each of the above conditions is a necessary but not a sufficient condition by itself

Smooth flow creates an environment of communication, predictability, and reliability that makes patients and families perceive the medical care setting as safe and caring.  Thus, flow is an opportunity for healthcare settings to improve their service and care outcomes.

Berwick states that every system is perfectly designed to achieve the results it achieves (Br. Med J 1996;312(7031):619-22.  What are your thoughts:

• Do we enable inefficient and ineffective systems for moving patients through their care experience?
• What changes are happening around the country (world) that improve patient flow

I welcome your input.

 Kenneth H. Cohn
www.healthcarecollaboration.com