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Designing the Patient Flow to Fight Covid-19

by Lean Leaper
April 29, 2020

Designing the Patient Flow to Fight Covid-19

by Lean Leaper
April 29, 2020 | Comments (0)

By Cristina Adalid Fontcuberta, Flávio Battaglia, Denise Bennett, Oriol Cuatrecasas, Alice Lee, Dr Carlos Frederico Pinto and Dr Javier Sala Mercado.

The Global Lean Healthcare Initiative is supporting healthcare organizations around the world as they apply lean thinking and practice in coping with the Covid-19 pandemic. Sharing our lean thinking around across four continents, we have come up with seven key lean practices -- each with a set of actionable tips -- that can help a healthcare team handle this emergency more effectively.

The Lean Post is sharing this critical, quick-read information in a seven-part series, beginning with tips for designing patient flow. 

  • Understand demand and pace for each patient flow.
  • Visually map your newly-designed flows and processes to better understand and share.
  • Physically segregate flows and ensure that critical patients have access to dedicated resources, so that they don’t cross paths with other patients. Separate those with respiratory symptoms from those without. Minimizing the number of flow groups reduces complexity as we move patients through the system.
  • Develop a plan for every flow: for example, Covid patients with mild symptoms and Covid patients with severe symptoms.
  • Encourage “pull”, by having downstream care providers actively look for their next patients in order to move them to the right place as fast as possible. Pulling patients from ICU into an available bed will allow the next patient to flow in. If possible, maintain some downstream capacity for outflow.
  • Assign highly skilled professionals to the intersections of the flow and to areas making key decisions (like Triage).

EXAMPLE 1 – ARGENTINA In a hospital in Cordoba, to separate the flow of Coronavirus patients from that of regular patients, we have converted the cardiac rehabilitation center into a dedicated Covid-19 space. In this area (located in a separate building), we have mapped the flow of patients, physicians, nurses, technicians, materials and information and made several improvements, in order to reduce exposure and reduce the number of PPE per patient seen. We know that when the number of infections ramps up and severe or critical cases arrive, we will have to bring Covid-19 patients into the hospital. That’s when we will separate and isolate entire areas in three different stages to avoid any risk of further spreading the infection.

Segregating flow for Covid-19 in a lean hospital in Argentina


EXAMPLE 2 – SPAIN This simple graphic maps the process that is followed for Covid-19 patients in a hospital in Catalunya.

Mapping the patient flow at a lean hospital in Catalunya

EXAMPLE 3 – USA A community health center in Massachusetts has reorganized its work streams across different locations to reduce infection risk for staff and patients.

Reorganizing work streams at a Massachusetts community health center

Click here to gain immediate access to the full report featuring all seven critical lean healthcare practices. 

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