1st Edition

Hospital Capacity Management Insights and Strategies

By Robbin Dick, Robert Agness Copyright 2021
    244 Pages 47 B/W Illustrations
    by Productivity Press

    244 Pages 47 B/W Illustrations
    by Productivity Press

    244 Pages 47 B/W Illustrations
    by Productivity Press

    Continue Shopping

    Hospital Capacity Management: Insights and Strategies details many of the key processes, procedures, and administrative realities that make up the healthcare system we all encounter when we visit the ED or the hospital. It walks through, in detail, how these systems work, how they came to be this way, why they are set up as they are, and then, in many cases, why and how they should be improved right now. Many examples pulled from the lifelong experiences of the authors, published studies, and well-documented case studies are provided, both to illustrate and support arguments for change.

    First and foremost, it is necessary to remember that the mission of our healthcare system is to take care of patients. This has been forgotten at times, causing many of the issues the authors discuss in the book including hospital capacity management. This facet of healthcare management is absolutely central to the success or failure of a hospital, both in terms of its delivery of care and its ability to survive as an institution. Poor hospital capacity management is a root cause of long wait times, overcrowding, higher error rates, poor communication, low satisfaction, and a host of other commonly experienced problems. It is important enough that when it is done well, it can completely transform an entire hospital system.

    Hospital capacity management can be described as optimizing a hospital’s bed availability to provide enough capacity for efficient, error-free patient evaluation, treatment, and transfer to meet daily demand. A hospital that excels at capacity management is easy to spot: no lines of people waiting and no patients in hallways or sitting around in chairs. These hospitals don’t divert incoming ambulances to other hospitals; they have excellent patient safety records and efficiently move patients through their organization. They exist but are sadly in the minority of American hospitals. The vast majority are instead forced to constantly react to their own poor performance. This often results in the building of bigger and bigger institutions, which, instead of managing capacity, simply create more space in which to mismanage it. These institutions are failing to resolve the true stumbling blocks to excellent patient care, many of which you may have experienced firsthand in your own visit to your hospital. It is the hope of the authors that this book will provide a better understanding of the healthcare delivery system.

    Table of Contents


    Letter from the Authors

    About the Authors

    Chapter 1 Hospital Priorities

    Chapter 2 Bed Assignment

    Chapter 3 Inpatient and Outpatient

    Chapter 4 Emergency Department

    Chapter 5 Types of Hospital Beds

    Chapter 6 Capacity Management Strategies

    Chapter 7 Discharging Patients

    Chapter 8 Surgical Short Stay Unit

    Chapter 9 Hospital Capacity Management Metrics

    Chapter 10 Complex Care Patients

    Chapter 11 Integrated Patient Care

    • The PCAT (Patient Centered Admission Team)
    • Efficient Patient Transfer
    • Team-Based Care
    • Standardized Discharge Process
    • An Emergency Department PCAT Model: Hot Zone
    • 30-Day Readmission Discussion and Strategies

    Chapter 12 Additional Capacity Management Programs (Proceduralist Program)

    Chapter 13 Discharges before Noon

    • Achieving Discharges before Noon

    Chapter 14 Leveling

    Chapter 15 Ancillary Demand Level Staffing

    Chapter 16 Surge

    Chapter 17 Starting a Patient Flow Team

    Chapter 18 Optimal Hospital Operational Strategies

    Chapter 19 Process Improvement

    Chapter 20 Conclusion





    Robbin Dick, MD, FACP started his career in 1988 working in the Emergency Department and trained in Internal Medicine. This role served him well in developing concepts and principles around efficiency and process improvement. Robbin developed the first recognized observation unit in NY State to improve ED efficiency in 1996 which started him on the journey of observation medicine and hospital capacity management. In 2003, he joined the University of Rochester Emergency Department and implemented and managed a 36-bed observation unit. In 2009, he had the opportunity to focus on the use of Lean-Six-Sigma concepts in hospital capacity management. As Vice President of Clinical Efficiency, Dr. Dick developed new models of care delivery and integration. His professional work career includes being Director of Observation Services managing the Observation Service line for Medical Emergency Professionals across the state of Maryland. In 2016, his company joined USACS (US Acute Care Solutions) where Robbin served as Chief of Observation Services for the organization until October, 2018. During his time with USACS, he developed a National Observation Service Line which included well-defined protocols, a robust teaching module based off a MKSAP (Medical Knowledge Self-Assessment Program), testing guidelines, a peer-review process, electronic I-PAD patient satisfaction program and national oversite of the Observation Programs operational development. USACS currently has over 15 Observation units with over 70,000 encounters yearly and is the largest Observation program in the United States. Currently, Robbin’s focus is on consultative services in Observation Medicine and Hospital Capacity Management. Robert Agness, BA is an experienced professional in operational management. He received Lean Sigma training under Shingo Ztisu trainers at Eastman Kodak’s Lean Institute early in his career. His role at Kodak involved the application of Lean Sigma principles restructuring and redesigning internal processes and facilities. Robert spent his last years at Eastman Kodak implementing a lean factory as Operations Manager of its Digital Graphics manufacturing site. Robert brought his expertise in Lean Six Sigma methodologies and implementation to Rochester General Health Systems in 2007. There he educated the leadership, developed a Lean Sigma Black Belt program equivalent, and facilitated the redesign of patient flow in the Emergency Department, Radiology, Peri-op and Inpatient Care Units. He also has designed and implemented the system’s Central Bed Management Department, effecting greater efficiency across numerous departments. He managed patient flow and capacity management for two of the system’s hospitals, totaling 600 beds. Robert is currently semi-retired and works part-time as a consultant in Hospital Capacity Management providing recommendations and assistance utilizing Lean Sigma training.

    "Hospitals are enormously complex institutions.  This book seeks to de-mystify how they can operate more effectively.  Hospital Capacity Management- Insights and Strategies, is an important addition to the literature at a time when many institutions are confronted with a myriad of capacity challenges.  

    Dr. Dick and Robert Agness have written a timely book during a time of great stress within the hospital industry.  Hospital Capacity Management: Insights and Strategies, does a terrific job in describing how hospitals can operate more efficiently and with improved patient care services to meet the capacity challenges of these difficult times. 

    The current pandemic has elevated the challenges that hospitals face in meeting the health care demands of the communities that they serve.  Dr. Dick and Robert Agness have written a timely book that assists hospital management and consumers alike, in understanding and improving how capacity demands can be met and patient care services improved.  This book is an important read for those interested in understanding the complexities of the hospital environment and the steps necessary to meet the challenges of our times. "

    Steven I. Goldstein, M.H.A., President & CEO, Strong Memorial Hospital, URMC

    "A refreshingly candid and thoughtful look at the state of hospital capacity management in the U.S., and the vital role it plays in driving the healthcare industry’s Triple Aim – better care, better health, better value. Dr. Robbin Dick is an industry thought leader who has devoted his career to making healthcare better. This patient-centered "playbook" provides healthcare leaders with proven strategies and practical process improvement tools for redesigning patient flow and capacity management in ways that can deliver a consistently exceptional patient care experience with greater efficiency and reliability."

    Mark C. Clement, President and CEO, TriHealth System

    "The book provides a map for hospital leaders in navigating the challenge of reducing length of stay and increasing throughput. The approaches are practical and directed to increasing quality of care. The book belongs on the bookshelf of every hospital leader who is charged with capacity management."

    Kevin Casey, MD, President Rochester General Hospital at Rochester Regional Health  

    "Hospital Capacity Management manages to take a highly complex topic and simplify it to tangible and executable recommendations. As hospital leaders we continually looking for better ways to use our resources in a cost effective and efficient manner. This book certainly provides the backbone to achieve these goals."

    Michael Cetta, MD, FACEP, FACHE, Chief of Integrated Acute Care, US Acute Care Solutions