Hardwiring Flow Chapter Tools

Chapter 1 – Defining Flow: The Foundations of Flow
The benefit-to-burden ratio defining flow in health care (Figure 1.1)
Mechanisms to increase, decrease, or keep static variables of benefits and burdens and increase or decrease value (Figure 1.2)
The seven types of waste that must be eliminated (Figure 1.3)
The two kinds of hunts (Figure 1.4)

Chapter 2 – Hardwiring for Flow: Key Strategies for Improving Flow
Demand-capacity management strategies (Figure 2.1)
Patient flow in an emergency department (Figure 2.2)
MICU utilization and patient rejection (Figure 2.3)
A real-time dashboard to manage queuing (Figure 2.4)
Analyzing and managing bottlenecks in a hospital (Table 2.1)
Effect of variation of call length on number of callers on hold (Figure 2.5)
Navy flight mishap rates (Figure 2.6)

Chapter 3 – Flow’s Teammates: Customer Service, Patient Safety, Lean Management, Six Sigma, and High-Reliability Organizations
A-team members (Figure 3.1)
B-team members (Figure 3.2)
The patient custo-meter (Figure 3.3)
The patient/customer relationship (Figure 3.4)
The three A-team behaviors (Table 3.1)
The A-team toolkit: Ten highly effective tactics for improving patient satisfaction and perception of flow (Figure 3.5)
The two pathways of Six Sigma (Table 3.2)
Representative patient-safety programs (Figure 3.6)

Chapter 4 – Leading for Flow
Extrinsic vs. natural change (Figure 4.1)
Extrinsic vs. intrinsic change (Figure 4.2)
Differences between the skills of leadership and management (Figure 4.3)
The difference between level 5 and level 4 leaders (Figure 4.4)
Pillar management: Populating the pillars with defined goals (Figure 4.5)

Chapter 5 – Show Me the Money: Making the Business Case for Improving Flow
Reducing wage cost per admission from a flow perspective (Figure 5.1)
Increasing bed turns (Figure 5.2)
The benefits of using scribes (Table 5.1)

Chapter 6 – Engaging Physicians in Flow: The Rate-Limiting Step
Differences in the education and training of physicians and nurses (Table 6.1)
Three models for obtaining physician engagement (Table 6.2)
Rogers’ theory of change (Figure 6.1)
Pillar management with discrete goals in each of the five pillars (Figure 6.2)
Physician behavior standards – best practices – Inova Fairfax Hospital, department of emergency management (Figure 6.3)

Chapter 7 – Emergency Department Flow: The Hospital’s Front Door
Patient satisfaction by time spent in ED (Figure 7.1)
Critical ED patient flow concepts (Figure 7.2)
Emergency department arrivals and staffing by hour (Figure 7.3)
The front end flow cascade: A portfolio of programs to increase value and eliminate waste (Figure 7.4)
The ESI five-level triage system (Figure 7.5)
Segmenting ED patient flow (Figure 7.6)
Keep your vertical patients vertical and moving (Figure 7.7)
Identifying and communicating potential admissions from the emergency department (Figure 7.8)
Accelerating admissions from the ED and optimizing patient flow (Table 7.1)

Chapter 8 – Inpatient Flow: Rethinking the Hospital Experience
An administrative system for flow (Figure 8.1)
The inpatient flow dashboard (Figure 8.2)
The IHI approach to real-time demand-capacity management (RTDC) (Figure 8.3)
WellSpan Hospital’s patient-flow zone system (Figure 8.4)
WellSpan York Hospital’s bed capacity guidelines (Figure 8.5)
A systems approach to improving flow based on demand-capacity management (Figure 8.6)

Chapter 9 – Surgical Flow
Tactics for optimizing surgical flow (Figure 9.1)
A surgical process timeline (Figure 9.2)
Staggered start time (Figure 9.3)
Surgical admission case demand mapping (Figure 9.4)

Chapter 10 – Case Studies in Flow
Challenges to implementing a proposed new and off-site fast track (Figure 10.1)
Reducing waiting times in the ECC (Figure 10.2)
Key words used to deflect resistance (Table 10.1)
Results of Wenatchee Valley Medical Center’s triage-improvement trial (Figure 10.3)