Unlocking Hospital Capacity: Revolutionizing Hospital Operations through Push to Pull Lean Redesign of Inpatient Flow

This project focuses on revolutionizing hospital operations by transitioning from traditional push systems to innovative pull systems that ensure seamless, continuous patient flow from the Emergency Department to admission and discharge. The initiative targeted bottlenecks caused by batching decisions and tasks in clinical settings, which often create "idle time" for patients and constrain hospital capacity.

By addressing the impact of extended hospital stays beyond medical readiness, the project tackled systemic delays that perpetuate outdated workflows, increase length of stay (LOS), and reduce bed availability. Using A3 Lean and Six Sigma methodologies, the team conducted a comprehensive operational redesign, engaging stakeholders and leveraging data-driven strategies to optimize hospital flow.

The Challenge

Many hospitals struggle with limited bed capacity, straining their ability to provide timely acute care. This gap between bed availability and demand disrupts patient flow, leading to longer ED wait times, extended hospital stays, patient denials, ambulance diversions, and reduced satisfaction for patients and staff. Despite hospitals' proactive measures to open additional beds across various departments, a substantial bottleneck persists as medically ready patients remain hospitalized without receiving discharge orders. This ongoing bottleneck continues to hamper the efficiency of patient flow, perpetuating the discord between supply and demand within the healthcare system. 

Hospitals use Lean Six Sigma (LSS) principles to address workflow bottlenecks, identifying high-constraint areas and promoting a flow where discharge readiness aligns with medical readiness, reducing discharge delays. Some studies suggest setting discharge targets (e.g., by 10 am), though results are mixed. However, this approach still promotes a “push system” of batching orders around a time rather than focusing on discharging patients promptly upon achieving medical readiness (e.g. a pull system triggered by medical readiness). 

In push systems, work accumulates in a queue and is processed in batches at specific times, resulting in visible peaks on an XY graph. In contrast, a lean system operates with a pull approach, characterized by continuous flow, where tasks are completed as soon as they are ready for review. 

The Goal

Adhering to these principles, our primary metric aimed to reduce the percentage difference in discharge orders between morning, afternoon, and evening, therefore naturally increasing the percentage of discharge orders in the morning. This would eliminate the peak nature of discharge orders post rounds and lead to continuous flow of discharges throughout the day (red). 

Applying A3 Lean and LSS principles highlighted the value of inclusive stakeholder engagement, a focus on true internal operational redesign for sustainable transformation and a data-driven approach to optimizing hospital flow. Lean improvement methods reduced the “push” nature of post-round discharges, improving length of stay while delivering financial and patient experience benefits.

Interventions

• Workload Leveling & Care Coordination Lead
• Discharge Huddle: Medical Readiness from Admission
• Clear Direction from Physicians, Patient Family Communication: Medical Readiness Pulled Flow
• EPIC Customization of Discharge Rounding, Milestones, Delays and Patient Communication

Results

Outcomes demonstrated significant improvements, including:

• Decreases in discharge order batching (the peak) from 32.18% to 23.93% (p = 0.007), discharge orders by 11 am naturally increasing from 15.11% to 21.11% (p = 0.001).
• Length of stay improved from 5 to 4.3 days (p = 0.0399), saving $1.6 million in direct costs and contributing to an additional 86 patient encounters.
• Patient satisfaction scores (NRC composite) rose from 73.25% to 81.56% (p = 0.0140) through collaboration and team integration with patients and the Patient Experience team.
• Time from prescription to discharge improved significantly, showing a decrease in variance (5.09 to 1.44; p = 0.011)

Eager to learn more about this project? Dr. Danna Qunibi will lead a COE Summit 2025 breakout session on Wednesday, April 9. This session will showcase how lean methods streamline hospital discharges, reduce length of stay, and deliver measurable financial gains—all while enhancing the patient experience and setting a new standard for patient-centered care.

The Ohio State University Center for Operational Excellence Summit, now in its 12th year, is a 3-day event dedicated focused on the latest best practices in leadership and problem-solving. With 4 engaging keynotes, 20 breakout sessions, and exclusive opportunities for networking and hands-on learning, the COE Summit is a high-value opportunity to equip your team with the tools and tactics to connect, collaborate, and reach your full potential.

Learn more and register for the COE Summit 2025