Client Success Stories
IHO’s unique services and solutions have brought great success stories and outstanding results to clients. We strongly believe that, similar to patients, every health care provider have unique “vital signs” (goals, challenges, policies, data and cultures). This determines our services as collaborative efforts with our clients whom we work closely with to identify issues, and explore the right solutions to fit their organizations goals. We view the below success stories as the achievements of our clients and our role as a guide and a trainer that helps bring them to their desired place. Finally, we measure success in terms defined by our clients. Our work is completed only when our clients reach desired return on investment.
The experience, expertise, methodologies, and tools that the IHO offers have been successfully adopted in a wide range of hospitals in the US (e.g., teaching, community, pediatric) and internationally (e.g., Canada and the UK), outpatient and primary care clinics. By applying these techniques, hospitals can substantially reduce variability in patient flow and thereby significantly reduce cost and increase quality. Financial returns on investment at hospitals that have implemented this methodology range between $17,000 and $300,000/bed/year coupled with improvement in quality of care.
The benefits following implementation of the IHO Variability Methodology® include:
- Reduced waiting times, delays, ED overcrowding, and overall hospital length of stay
- Reduced mortality, medical errors, hospital acquired infections, and readmissions
- Reduced bumping/cancellation of elective surgeries
- Reduced OR overtime and higher OR prime time utilization
- Greater surgical throughput (increase in overall surgical volume) or reduced cost/surgical case
- Proper allocation of resources (i.e. bed capacity, nurse staffing) to maximize patient throughput
- Improvements in patient safety
- Improved patient and provider satisfaction
Individual Hospital
IHO approaches are scientifically grounded and have been successfully applied with dramatic financial and quality of care improvement results at numerous leading hospitals. For more information about IHO programs and services, please contact us.
University Health Network (Optimized OR Flow & Surgical Inpatient Flow)
- Created additional operating capacity to 105-110% and cleared surgical backlog from 4300 down to 3200 cases; performed over 1,000 additional surgical cases during the COVID pandemic
- Created the opportunity for UHN to perform over 3000 additional elective surgeries
- High compliance with wait time for urgent/emergent surgeries by an additional 13% to 20% for UHN hospitals (significantly reduce patient mortality and length of stay)
- Improved patient placement in the preferred unit/bed
- Provided strategies to optimally ramp surgical activities back up to reduce the provincial backlog
- Well-positioned the Surgery Leadership team to manage the COVID pandemic
- Related Articles:
Mayo Clinic, Jacksonville, Florida (Optimized OR Flow )
- Surgical case volume increased by 4%
- Surgical minutes and OR utilization increased 5% each
- Average OR overtime staffing decreased 27%
- 84% compliance with waiting time limits for emergent and urgent care
- No reported incidences of not being able to access OR in a timely manner
- Annual staff turnover cost reduced by $1.07 million
- OR annual net revenue increased by $5 million
- Article: Re-engineering the Operating Room Using Variability Methodology to Improve Health Care Value
Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio (Optimized OR Flow, Surgical Inpatient Flow & Medical Inpatient Flow)
Results from Optimizing OR Flow:
- Weekday OR waiting time for emergent/urgent surgical cases reduced by 28% (despite an increase in case volume of 24%)
- Weekend OR waiting time decreased by 34% despite an increase in volume of 37%
- OR overtime reduced by 57%
- Surgical throughput increased by 5% (an equivalent of an additional OR)
Results from Optimizing Scheduled Inpatient Flow & Inpatient Capacity:
- Multi-year 7% increase in annual surgical throughput without adding new ORs
- $115 million increase in annual revenue/cost savings
- Over $100 million in avoided capital cost
The Ottawa Hospital, Ottawa, Ontario (Optimized OR Flow)
- Improved access for patients needing emergency surgery within 24 hours from 60% to 90%
- Reduced mortality rate for patients requiring urgent surgery from 3.9% to 3%, resulting in 40 lives saved
- Achieved efficiency gain equivalent to $9million by decreasing length of stay and better use of beds
- Reduced surgery cancellations due to bed shortages from more than 600 per year to zero
- Reduced Neurosurgery inpatient census from 46 to 33, resulting in a savings of 13 beds
- Related Articles
The Johns Hopkins Hospital, Baltimore, Maryland (Optimized OR Flow)
- Waiting time for emergent/urgent surgical cases decreased by 39%
- Throughput increased by 5 cases per day in the main ORs and by 4 cases per day in their outpatient facility
- Overtime decreased by 6.6%
- Relative increase in surgical volume resulting in annual $4 million increase in incremental margin
Boston Medical Center, Boston, MA (Optimized OR Flow & Surgical Inpatient Flow in one unit)
- Surgical throughput increased by 10%
- Emergency Department ambulance diversions reduced by 20%
- 2.8 hour wait in one of the state’s busiest EDs compared to 4-5+ hours for most academic hospitals in Boston
- Annual number of postponed or canceled elective surgeries reduced by 99.5%
- Reduction in nursing stress levels: 30 minute reduction (6%) in nurse hours per patient day in the step-down unit, resulting in $130,000 annualized reduction in nursing costs
Palmetto Richland Memorial Hospital, Columbia, SC (Optimized OR Flow)
- 3% increase in surgical volume
- 38% decrease in weekday waiting time for non-elective cases
- Opportunity to further increase surgery volume with $8m projected annual margin increase with $2 million achieved in the first year
Greater Baltimore Medical Center, Towson, Maryland (Optimized Medical Inpatient Flow)
- Savings of approximately $2million in avoided capital expenditures by opening needed medical beds rather than building telemetry beds
- Savings of more than $1million per year in staffing costs
Great Ormond Street Hospital for Children, London, England (Optimized Surgical Inpatient Flow)
- An average increase of 2.2 cardiothoracic theatre procedures per week (representing a minimum increase in annual revenue of £1.72 million), meaning that they can treat more children urgently requiring specialist surgery
- A decrease of 2.5 stress-related nursing shifts lost per week, representing an annual saving of more than £30,000 in agency costs
- A weekly decrease of 2.3% in theatre procedure cancellations
- An increase in theatre utilization from 55-60% to 80%
Elliot Hospital, Manchester, New Hampshire (The largest Maternity Ward in New Hampshire)(Optimized OR Flow)
- Eliminated morning chaos
- Reduced the demand for additional staffed beds by 6 positions (50%)
- Improved quality of care
Multi-Hospital Collaborative Programs
In the Multi-Hospital System format, we bring together hospitals within the same health system that are interested in employing IHO’s Variability Methodology® services in a particular setting, such as the Operating Room or inpatient units. These programs provide extensive education and coaching for various levels of hospital management and empower health care systems to redesign their patient flow.
Participating hospitals benefit not only from our Faculty’s expertise, but also from learning from each other as they work through challenges of implementation together.
NHS Scotland – Nationwide Whole System Patient Flow Program
A global leader in patient safety, National Health Service Scotland (NHSS) worked with the Institute for Healthcare Optimization (IHO) to reduce delays, improve efficiency and further enhance the quality and safety of care.
Four pilot boards initially engaged in improvement work to implement IHO Variability Methodology®. These hospitals reported numerous subjective and measurable improvements from their work, including:
- Created access for additional 1,072 patient admissions without adding expensive new beds or medical and nursing staff
- Increased compliance with clinically acceptable waiting limits for unscheduled surgery from about 85% to over 95%
- More patients admitted to appropriate wards
- More patients moving from receiving units to inpatient wards during day time hours when they can receive earlier consultant review in a more timely manner
- Fewer patients being asked to come to hospital the day before planned surgery
- Identified opportunity to increase admissions further by about 2,100 per year without adding resources. Read full article here »
This Whole System Patient Flow Programme then expanded to include hospitals throughout Scotland, led in conjunction with NHSS leadership and support from the Health Performance and Delivery Directorate. Expansion of work included implementation of IHO Variability Methodology(R) in additional health boards and development of an online certification programme in IHO Variability Methodology(R).
Publications
CMS Partnership for Patients – New Jersey
Fourteen hospitals participated in a 15-month patient-flow collaborative with IHO organized by the New Jersey Hospital Association (NJHA) as part of the Center for Medicare and Medicaid Innovation hospital engagement program. Participating hospitals demonstrated significant quality improvements, reduced ED overcrowding, shortened wait times, and provided more access to patients while reducing costs. Overall program outcomes include:
- Access increased for 11,800 – 17,300 additional patients without adding inpatient beds or operating rooms
- Access for ~ 20,000 additional emergency department patients 21% to 85% decrease in wait times for emergency department patients to be admitted to a hospital bed
- 3 -percent to 47 % reductions in the length of hospital stays for certain groups of patients
Sample hospital results:
CentraState Healthcare System, Freehold, NJ (Optimized Medical Inpatient Flow)
- Telemetry beds required decreased from 54 to 42 while providing adequate clinically appropriate access
- Inappropriate telemetry admissions decreased from 18% to 1%
- Average ED boarding time for incoming patients decreased from 18.2 hours to about 9 hours
- Telemetry length of stay decreased 31% from 4.4 days to just under 3 days
- Delays in discharging patients out of telemetry decreased from 8.3 hours to 3.5 hours on average
- Patient satisfaction increased from 56% to 73%
Monmouth Medical Center, Long Branch, NJ (Optimized Surgical Inpatient Flow)
- Increased patient satisfaction score from the 88th to the 99th percentile of comparable hospitals
- Decreased variability in nurse workload (number of admissions, transfers, and discharges) by over 40%
- Significantly decreased PACU boarding
- Increased throughput resulting in an annual margin improvement of $411K
Overlook Medical Center, Summit, NJ (Optimized Medical Inpatient Flow)
- ED boarding time for ICU admissions decreased by 21%
- ICU ALOS decreased by over 14% from 3.5 to 3 days
- 40% reduction in mortality
- Waiting time of discharge- and transfer-ready patients in the ICU decreased by 34% and 84% respectively
Ocean Medical Center, Brick, NJ (Optimized Medical Inpatient Flow)
- Telemetry ALOS decreased by 6%
- Average ED boarding time decreased 56%
- $1.07 million cost reduction
Newark Beth Israel Medical Center, Newark, NJ (Optimized Medical Inpatient Flow)
- Eliminated 26 telemetry beds, resulting in a savings of over $10 million per annum while reducing cost of care and improving quality of care
- Decreased ALOS of telemetry patients by one full day leading to fewer hospital-acquired infections
HackensackUMC Mountainside, Montclair, NJ (Optimized OR Flow)
- Improved elective OR block utilization resulting in increased capacity for 1,000 cases annually without additional resources
- More than 95% of emergent/urgent patients can access the OR in a timely manner, thereby projected decreasing their ALOS by almost 40%
Surgery
Below are select outcomes from hospitals that engaged with IHO to Optimize OR Flow and/or Surgical Inpatient Flow for improved quality, safety and throughput while achieving cost savings. For more information about IHO programs and services, please contact us.
University Health Network (Optimized OR Flow & Surgical Inpatient Flow)
- Created additional operating capacity to 105-110% and cleared surgical backlog from 4300 down to 3200 cases; performed over 1,000 additional surgical cases during the COVID pandemic
- High compliance with wait time for urgent/emergent surgeries by an additional 13% to 20% for UHN hospitals (significantly reduce patient mortality and length of stay)
- Improved patient placement in the preferred unit/bed
- Provided strategies to optimally ramp surgical activities back up to reduce the provincial backlog
- Well-positioned the Surgery Leadership team to manage the COVID-19 pandemic
- Related Articles:
Mayo Clinic, Jacksonville, Florida (Optimized OR Flow)
- Surgical case volume increased by 4%
- Surgical minutes and OR utilization increased 5% each
- Average OR overtime staffing decreased 27%
- 84% compliance with waiting time limits for emergent and urgent care
- No reported incidences of not being able to access OR in a timely manner
- Annual staff turnover cost reduced by $1.07 million
- OR annual net revenue increased by $5 million
- Article: Re-engineering the Operating Room Using Variability Methodology to Improve Health Care Value
Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio (Optimized OR Flow, Surgical Inpatient Flow & Medical Inpatient Flow)
- Weekday OR waiting time for emergent/urgent surgical cases reduced by 28% (despite an increase in case volume of 24%)
- Weekend OR waiting time decreased by 34% despite an increase in volume of 37%)
- OR overtime reduced by 57%
- Surgical throughput increased by 5% (an equivalent of an additional OR)
Results from Optimizing Scheduled Inpatient Flow & Inpatient Capacity:
- Multi-year 7% increase in annual surgical throughput without adding new ORs
- $115 million increase in annual revenue/cost savings
- Over $100 million in avoided capital cost
The Ottawa Hospital, Ottawa, Ontario (Optimized OR Flow)
- Improved access for patients needing emergency surgery within 24 hours from 60% to 90%
- Reduced mortality rate for patients requiring urgent surgery from 3.9% to 3%, resulting in 40 lives saved
- Achieved efficiency gain equivalent to $9million by decreasing length of stay and better use of beds
- Reduced surgery cancellations due to bed shortages from more than 600 per year to zero
- Reduced Neurosurgery inpatient census from 46 to 33, resulting in a savings of 13 beds
- Related Articles
The Johns Hopkins Hospital, Baltimore, Maryland (Optimized OR Flow)
- Waiting time for emergent/urgent surgical cases decreased by 39%
- Throughput increased by 5 cases per day in the main ORs and by 4 cases per day in their outpatient facility
- Overtime decreased by 6.6%
- Relative increase in surgical volume resulting in annual $4 million increase in incremental margin
Boston Medical Center, Boston, MA (Optimized OR Flow & Surgical Inpatient Flow in one unit)
- Surgical throughput increased by 10%
- Emergency Department ambulance diversions reduced by 20%
- 2.8 hour wait in one of the state’s busiest EDs compared to 4-5+ hours for most academic hospitals in Boston
- Annual number of postponed or canceled elective surgeries reduced by 99.5%
- Reduction in nursing stress levels: 30 minute reduction (6%) in nurse hours per patient day in the step-down unit, resulting in $130,000 annualized reduction in nursing costs
Palmetto Richland Memorial Hospital, Columbia, SC (Optimized OR Flow)
- 3% increase in surgical volume
- 38% decrease in weekday waiting time for non-elective cases
- Opportunity to further increase surgery volume with $8m projected annual margin increase with $2 million achieved in the first year
HackensackUMC Mountainside, Montclair, NJ (Optimized OR Flow)
- Improved elective OR block utilization resulting in increased capacity for 1,000 cases annually without additional resources
- More than 95% of emergent/urgent patients can access the OR in a timely manner, thereby decreasing their ALOS by almost 40%
Monmouth Medical Center, Long Branch, NJ (Optimized Surgical Inpatient Flow)
- Increased patient satisfaction score from the 88th to the 99th percentile of comparable hospitals
- Decreased variability in nurse workload (number of admissions, transfers, and discharges) by over 40%
- Significantly decreased PACU boarding
- Increased throughput resulting in an annual margin improvement of $411K
Great Ormond Street Hospital for Children, London, England (Optimized Surgical Inpatient Flow)
- An average increase of 2.2 cardiothoracic theatre procedures per week (representing a minimum increase in annual revenue of £1.72 million), meaning that they can treat more children urgently requiring specialist surgery
- A decrease of 2.5 stress-related nursing shifts lost per week, representing an annual saving of more than £30,000 in agency costs
- A weekly decrease of 2.3% in theatre procedure cancellations
- An increase in theatre utilization from 55-60% to 80%
- PowerPoint Presentation of the project can be downloaded here
Elliot Hospital, Manchester, New Hampshire (The largest Maternity Ward in New Hampshire)(Optimized OR Flow)
- Eliminated morning chaos
- Reduced the demand for additional staffed beds by 6 positions (50%)
- Improved quality of care
Medicine
All hospitals highlighted below implemented one of three main interventions in IHO’s Variability Methodology(R): Optimize Medical Inpatient Flow
Greater Baltimore Medical Center, Towson, Maryland
- Savings of approximately $2million in avoided capital expenditures by opening needed medical beds rather than building telemetry beds
- Savings of more than $1million per year in staffing costs
CentraState Healthcare System, Freehold, NJ
- Telemetry beds required decreased from 54 to 42 while providing adequate clinically appropriate access
- Inappropriate telemetry admissions decreased from 18% to 1%
- Average waiting times for incoming patients (i.e. ED boarding) decreased from 18.2 hours to about 9 hours
- Telemetry length of stay decreased 31% from 4.4 days to just under 3 days
- Delays in discharging patients out of telemetry decreased from 8.3 hours to 3.5 hours on average
- Patient satisfaction increased from 56% to 73%
Ocean Medical Center, Brick, NJ
- Telemetry ALOS decreased by 6%
- Patient waiting time (i.e., average ED boarding time) decreased 56%
- $1.07 million cost reduction
Newark Beth Israel Medical Center, Newark, NJ
- Eliminated 26 telemetry beds, resulting in a savings of over $10 million per annum while reducing cost of care and improving quality of care
- Decreased LOS of telemetry patients by one full day leading to fewer hospital-acquired infections
- Publications: “Optimizing Patient Flow: Advanced Strategies for Managing Variability to Enhance Access, Quality, and Safety”, Chapter 10: Rightsizing Inpatient Medical Units
Overlook Medical Center, Summit, NJ
- ED boarding time for ICU admissions decreased by 21%
- ICU LOS decreased by over 14% from 3.5 to 3 days
- 40% reduction in mortality
- Waiting time of discharge- and transfer-ready patients in the ICU decreased by 34% and 84% respectively
Outpatient & Primary Care Clinics
IHO approaches are scientifically grounded and have been successfully applied to outpatient and primary care clinics with dramatic financial and quality of care improvement. For more information about IHO programs and services, please contact us.
St. Thomas Community Health Center, New Orleans, LA
- Improved capacity by 35% thereby improving access to care for patients
- Increased number of patients treated by 25% by proper allocation of resources and scheduling practice
- Reduced patient waiting time
- Timely access to same day and next day service
- Improved team performance, provider and patient satisfaction
- Increased operational efficiency and quality of care
Media Coverage
- Watch Dr. Erwin speak about his work with IHO here »
- Article: St. Thomas fills health care need in community »
Cost reduction through optimal patient Flow Variability Management Healthcare Cost Corner
Hospital costs can be decreased by millions of dollars annually by adopting the Institute for Healthcare Optimization’s approach to managing variability in healthcare delivery.
Case Study
See how Cincinnati Children’s Hospital increased annual revenue by $137M, and avoided $100M in cost, while improving quality of care.
Resources
Joint Commission Resources Book
The IHO’s approach to managing variability in healthcare delivery is the central theme of Joint Commission Resources’ new book.
See Commission Results
IOM Report: Transforming Health Care Scheduling and Access
The Institute of Medicine (IOM) recommended IHO Variability Methodology as one of the six principles to address the compelling issue of access to healthcare.
Get the Report