There are many ways of managing workflows in organizations. One that’s increasingly seen as offering genuine insight is value stream mapping (VSM). It’s a technique that is all about the high level flow within an organization.

VSM can take different forms: it could be about how departments come together and interact with one another. Or, within larger organizations, it could be how different geographic sites or channel partners work together.

While you might initially think of industrial settings when you think of deploying VSM, it’s a process that fits extremely well into a healthcare environment. Of course, there’s an added dimension to the challenge: healthcare providers have many of the same issues that manufacturers have to deal with, in terms of interconnecting processes, but with the very real distinction that they’re dealing with patient outcomes and quality of care.

In fact, we can go further and say that VSM benefits healthcare more than it does any other industry. Everything in health is connected: Healthcare is a total system and no single part of it works independently. What happens in primary care impacts on secondary, tertiary and social care. When patients can leave secondary care depends very much on the number of beds that are needed in a community, for example. 

VSM can help authorities and healthcare organizations in the decision making needed to smooth the patient journey through these systems and improve outcomes.

Bed allocation

One of the ways in which the technology is used is in predicting bed usage and capacity. There are many factors involved in doing this accurately, but by using simulation hospital managers can see the impact of decisions on the whole system to predict more accurately how many beds are needed and for how long.

What makes this a tricky process is that beds can often be blocked at a hospital. This can be interpreted in a couple of ways: it could be that a patient would have to stay within the hospital because he or she couldn’t be discharged into social care due to the unavailability of care workers. It could be the other way around – a patient could not be admitted because of the shortage of available beds, which would then have a knock-on effect if theater time has to be rescheduled.

In either case, the process is complex. It’s a prime example of where VSM can be used to solve tricky management decisions.

Improving patient throughput

There are many factors involved in managing patient throughput. These can start from predicting how many patients will arrive at a given time, to the impact of the wider system, such as social care requirements outside the hospital setting.

Clearly, the covid pandemic changed a lot of thinking and disrupted calculations. Again, VSM can help here.

The technology can be used to help more effective interdepartmental interactions for better patient pathway management. For example, if the radiology department is overwhelmed, this will slow down treatment time for patients in the emergency department. Equally if that department is overloaded with emergency orthopedic patients, then planned elective work will be delayed, which will impact revenue. Or, to take another example, healthcare providers may be restricted by the speed of testing within hospital labs before a patient can move onto their next consultation.

VSM will join all of these dots to provide a guide as to how long it will take to initially assess the patient, and from there simulation will enable management to calculate workflows through the hospital. In doing this, it will allow for the availability of medical staff and corresponding bed availability, so that healthcare managers will be able to get to grips with all parts of the process and calculate timescales and resource allocation more accurately.

Case study

As an illustration of how this works in practice, consider how Simul8 worked with the Ayrshire and Arran NHS Board in Scotland to improve emergency and unscheduled care. It demonstrated how to allocate beds and handle patient flow in the most optimal manner.

The body was looking at how to reorganize its casualty facilities, moving away from two emergency centers to just one. An exercise involving a number of simulations was put together by Simul8: these looked at the demands placed on the organizations by elective and acute patients and looked at factors such as bed availability. After the exercise was completed, Ayrshire and Arran was satisfied that its proposed solution of one casualty center was the right one.

Conclusion

We’re just emerging from a worldwide pandemic, one that has had a massive effect on the way that hospitals and other healthcare providers operate. Figures available from the NHS in the UK are a stark reminder of the effect that covid has had on infrastructure. 

At the start of the pandemic, there were 4.43 million people on the NHS waiting list for care, this has now risen to 6.1 million. There are nearly 300,000 patients waiting for more than a year for treatment, and there are 186x that number on the wider waiting list: that’s a huge backlog to manage.

Meanwhile, in the US, a survey by McKinsey on hospital patient volumes in February 2022 revealed a similar picture. While outpatient and surgical volumes are expected to increase in 2022 following a slowdown over the pandemic, more than one-third of respondents expected demand to exceed provider capacity in several specialities such as orthopedic surgery over the next six months. All respondents highlighted staffing challenges as affecting capacity for elective care. It said:

“With workforce challenges expected to persist, healthcare systems may continue to improve operational efficiency and patient throughput to ensure patients have continued access to care they need.”

This highlights the urgency to manage resources more efficiently, as providers make attempts to clear the backlog. VSM can play a vital role here. It provides management teams with the ability to look at the collective system and create a shared understanding of how the different aspects link together, where any potential bottlenecks are, and how to manage them.