Variability Methodology

The faculty of the Institute for Healthcare Optimization have developed Variability Methodology (VM) to address artificial variability in patient flow, which is a key driver of cost, quality and access issues in healthcare. In a nutshell Variability Methodology involves identifying, classifying and quantifying different types of variability in patient flow, followed by smoothing of artificial variability, thereby creating the foundation for scientifically determining the magnitude of resources for various patient streams. The main goal of VM is to increase patient throughput, decrease patient waiting times, and maintain or improve safety and quality, without commensurately increasing resources.

Approach

The following three phase implementation approach is recommended for hospitals and other healthcare delivery organizations:

Phase 1	Separate homogenous groups, i.e. elective vs. non-elective and inpatient vs. outpatient flows in order to, Reduce waiting times for urgent / emergent cases, increase throughput in the operating room and cath lab, decrease overtime, and decrease delays for elective scheduled cases

Phase 2	Smooth the flow of electively scheduled cases in order to, Decrease the competition between unscheduled (e.g. ED) and elective admissions, increase hospital-wide throughput, achieve consistent nurse-to-patient staffing, increase patient placement in appropriate units

Phase 3	Estimate resource (e.g. beds. ORs, MRIs, staff) needs for each type of flow to ensure right care at the right time and place for every patient

Benefits

Phase 1

• Increased throughput, i.e. volume or access, particularly in services such as the operating room and cardiac catheterization labs
• Reduced waiting times for urgent / emergent cases
• Decreased overtime
• Decreased cancellations and delays for scheduled patients

Phase II

• Further decreased competition between unscheduled (e.g. ED) and elective flows
• Increased system-wide throughput
• Achievement of consistent nurse-to-patient staffing
• Increased patient placement in appropriate units
• Decreased delays in the ED, and in Recovery areas in the OR and Cath Lab
• Further decreased overtime

Phase III

• Ensure right care at the right time and place for every patient