Community Care Access Block
A few years ago, my 84 year old father was hospitalized for pneumonia. At the time he was living independently, looking after his home, and doing yardwork. He w…
Read the storyLeadership
Practical strategies and essential knowledge to help healthcare staff and managers deliver more efficient, higher-quality care.
Leadership: Essential Knowledge
System change begins with leadership. Leaders require a working grasp of accountability, patient flow, and the levers by which a system can be moved.
Effective leaders know their accountability zone and ask how their teams would operate if closing the door were not an option. They hold programs to explicit goals and targets for flow and access. The challenges are systemic rather than a matter of individual provider performance, and the principal levers are operational improvement and accountability frameworks.
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Reducing Care Delays in Your Hospital
Recommendations organised by the point in the patient journey at which the delay occurs.
ED Inflow Recommendations
Guidance on improving how patients enter the department, covering intake, diversion, and the link to the community.
Coming soonED Throughput Recommendations
Guidance on shortening the time each patient spends in the department, covering testing, consultation, and decision-making.
Coming soonED Outflow Recommendations
Guidance on moving patients out of the ED more quickly, covering admission, discharge, and coordination with inpatient teams.
Coming soonALC Recommendations
Guidance on reducing alternate level of care delays, which consume capacity needed by patients still requiring acute care.
Coming soonTeaching Materials
Resources for training doctors, nurses, and managers to deliver more efficient patient care.
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Healthcare Stories
First-hand accounts of improving patient access and flow.
Going Home Early
While reviewing a busy urban emergency department, the ED leadership group highlighted their inflow challenges. First, we walked through a packed waiting room w…
Read the storyHot Dogs and the Healthcare System
Jayden Zeta’s birthday party fell on a blue-sky Saturday afternoon*. Parents chatted on the deck while their kids played in the back yard. A father consoled his…
Read the storyReverse Triage: Code Purple
Monday at 10 am in a large Canadian hospital, the ED was a disaster zone. The department was full, mostly with admitted patients waiting for inpatient beds. All…
Read the storyWaiting Room Headache
His wife Jill was tidying the breakfast dishes. She looked at him, puzzled. “What’s wrong?” “Headache,” he muttered. A wave of nausea hit him and he vomited int…
Read the storyReferences
The studies and sources that inform our recommendations.
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Key Accountability Strategies
Strategies that programs can adopt to improve patient access and flow.
PDF versions coming soon
Intake Areas & Low-Acuity Diversion
Divert patients who do not require an ED stretcher to more appropriate settings, freeing capacity for those who do.
Coming soonRationing & Ethical Allocation
Prioritise patients of greatest need and apply ethical triage and reverse triage so the most seriously ill are not left waiting.
Coming soonThe One vs. the Many
Weigh the needs of an individual patient against system-wide flow, a tension central to every capacity decision.
Coming soonMatching Demand & Capacity
Align staffing and resources with projected demand to reduce variability and maintain system balance.
Coming soonReducing Variability
Smooth care demand and address bottlenecks so that flow becomes more predictable and efficient.
Coming soonTask Shifting
Explore new staffing models and expanded scopes of practice to increase care capacity.
Coming soonOperational Self-Assessment Survey
Assess your program's operational performance and identify improvement opportunities.