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The aim of this paper is to investigate which integrative planning and control practices are used in hospitals and what their effects are on patient flow.

The study is based on a three‐hospital multi‐case study carried out in The Netherlands. The main findings are based on over 40 in‐depth interviews and the analysis of detailed patient flow data. The analysis of the flow data is used to explore the effects of integrative practices on lead times and patient flow.

Based on the various patient groups examined in the different hospitals, four integrative practices stand out: sharing waiting list information, sharing planning information, cross‐departmental planning, and combining appointments. In line with earlier studies, the overall level of integration in hospitals was found to be low. However, patient flow performance is significantly better in those hospitals that employ more of the above‐mentioned integrative practices.

The study was limited to three major patient groups within the orthopedic supply chain. The deliberate choice for these patients groups was based on the expectations that integration in hospitals is relatively low and that the highest levels of integration would be found in high volume – low variety patient groups. Further research should include patient groups with less favorable characteristics such as lower volumes and/or greater variety.

This study provides clear support for the value of integration initiatives in healthcare operations. The performance of hospitals, in terms of patient flows, benefits from cooperation between the various members of an internal supply chain. Hospital administrators and medical professionals could learn from these results and attempt to abandon their silo mentality and start integrating for and their patients' and their own benefit.

Despite the importance of integration in hospitals, little is known about the integrative practices hospitals actually employ. Most existing studies on patient flows are confined to a single stage in the care process. In this study, the effects of integration in the internal supply chain from the first visit to the end of treatment are examined.

This study aims to explore the involvement of middle management in forming strategies to manage variable acute patient flows at a hospital.

Empirical evidence from a university hospital was gathered via interviews, internal documents, observation and participation in meetings. The role of middle management in the development of strategies was analyzed using literature on middle management involvement.

In managing variable acute patient flows, middle management adopts a number of roles and behavioral characteristics that have been previously described in research. The role of facilitator is the most prominent, with middle managers prioritizing individual goals and strategies for the clinical departments that they manage before their collective responsibility for hospital performance. Unclear responsibilities and mandates within the organization, together with a lack of hospital-wide strategies concerning how the acute patient flow should be managed, are contributing factors to this behavior.

The research is based on an explorative, single case study methodology. Future research assessing the extent of different middle management roles in health care, in which more empirical data and quantitative analysis is conducted, is encouraged.

There is a need for top management to establish long-term goals to enhance middle management roles when developing strategies for managing variable patient flows.

Middle management involvement in developing strategies for managing variable patient flows is a novel topic for research. The interface and division of tasks between top and middle management is crucial for successful strategies in managing variable patient flows.

Improving hospital patient flow has become a policy priority, to effectively balance the increasing demands of an unknown and variable volume of patients with limited available hospital resources. A systematic literature review was conducted in order to identify actions, actors involved and enablers in improving hospital patient flow. The paper aims to discuss this issue.

Searches were conducted in Scopus, Web of Science, MEDLINE and The Cochrane Library for quantitative and qualitative empirical primary studies with patients (adults) receiving inpatient acute hospital care. The study protocol was based on PRISMA-P guidance. A critical appraisal of included studies was performed by using the Quality Improvement Minimum Quality Criteria Set.

In total, 38 key papers were identified. A wide range of actions are reported, but most studies focus on one or a few departments instead of a whole hospital. Process efficiency is most often used as a performance indicator, clinical outcomes are poorly analyzed, and patients’ expectations and experience are rarely considered. Top-management commitment and front-line staff involvement are considered key factors for the success of implementations. Patient involvement in the process improvement is rarely mentioned.

Achieving improvements in hospital patient flow requires the design and implementation of complex, multifaceted and coordinated interventions. This study may be of value to healthcare managers, helping them to act effectively in their context, and to researchers of future studies including the different variables and the patient’s perspective.

In hospitals, several patient flows compete for access to shared resources. Failure to manage these flows result in one or more disruptions within a hospital system. To ensure continuous care delivery, solving flow problems must not be limited to one unit, but should be extended to other departments – a prerequisite for solving flow problems in the entire hospital. Since most current studies focus solely on overcrowding in emergency units, additional insights are needed on system-wide patient flow management. The purpose of this paper is to look at the information available in system-wide patient flow management studies, which were also systematically evaluated to demonstrate which interventions improve inpatient flow.

The authors searched PubMed and Web of Science (Core Collection) literature databases and collected full-text articles using two selection and classification stages. Stage 1 was used to screen articles relating to patient flow management for inpatient settings with typical characteristics. Stage 2 was used to classify the articles selected in Stage 1 according to the interventions and their impact on patient flow within a hospital system.

In Stage 1, 107 studies were selected. Although a growing trend was observed, there were fewer studies on patient flow management in inpatient than studies in emergency settings. In Stage 2, 61 intervention studies were classified. The authors found that most interventions were about creating and adding supply resources. Since many hospital managers these days cannot easily add capacity owing to cost and resource constraints, using existing capacity efficiently is important – unfortunately not addressed in many studies. Furthermore, arrival variability was the factor most frequently mentioned as affecting flow. Of all interventions addressed in this review, the most prominent for advancing patient access to inpatient units was employing a specialized individual or team to maintain patient flow and bed placement across hospital units.

This study provides the first patient flow management systematic overview within an inpatient setting context.

This study aims to describe and understand the contributions of frontline, middle and top management healthcare professionals in detecting areas of potential improvement in hospital patient flow and proposing solutions.

This is a qualitative interview study. Semistructured interviews were conducted with 22 professionals in the orthopedic department of a 250-bed academic teaching hospital. Data were analyzed through a thematic framework analytical approach by using an a priori framework. The Consolidated Criteria for Reporting Qualitative (COREQ) checklist for qualitative studies was followed.

When dealing with a hospital-wide process, the involvement of all professionals, including nonhealth professionals, can reveal priority areas for improvement and for services integration. The improvements identified by the professionals largely focus on covering major gaps detected in the technical and administrative quality.

This study focused on the professional viewpoint and the connections between services and further studies should explore the role of patient involvement. The study design could limit the generalizability of findings.

Improving high-quality, efficient hospital patient flow cannot be accomplished without learning the perspective of the healthcare professionals on the process of service delivery.

Few qualitative studies explore professionals' perspectives on patient needs in hospital flow management. This study provides insights into what produces value for the patient within a complex process by analyzing the contribution of professionals from their particular role in the organization.

In preparation for health care reform, many hospitals are contemplating redesigning their physical facilities and altering patient care policies. Uses a large Texas hospital as the subject of this study which was considering implementing policy changes in obstetric patient care along with constructing labour, delivery, recovery room suites. Uses simulation models based on Markovian patient movement to analyse whether their proposed changes will improve overall operational efficiency. The existing as well as proposed obstetric patient movement systems were developed and comparisons made based on average length of stay and total per‐patient cost to the hospital. The quantitative models proved useful in improving decision making with regard to the alternatives. Argues that the methodology can be extended to other hospitals who seek to streamline patient movement to enhance efficiency and patient convenience.

The purpose of this study is to establish empirical relationships between patient flow problems, healthcare service quality and patient satisfaction with emergency department (ED) service factors from the patient perspective.

In the overall study, of which the current investigation is a part, a mixed-method research approach was to achieve the research objectives. The results reported in this paper are based on a comprehensive questionnaire survey where a well-designed and reliable questionnaire was used to survey ED patients. This study conducted partial least squares structural equation modelling (PLS-SEM) by using Smart PLS software.

Results show that the respondents mostly agreed with the proposed concept of quality in ED and patients were less satisfied with ED services in general and with the internal and external environments in ED in particular. It was found that relationships between nine identified scales of patient flow problems, healthcare service quality, and patient satisfaction are significant. The findings reveal that the relationship between patient flow problems and patient satisfaction is positively mediated through healthcare service quality, which shows the predictive capability of the model, indicating high predictive relevance.

This research involves a relatively small sample from a single case study. The positive relationship between patient flow problems and patient satisfaction indicate practical significance of the model for guiding to improve overall patient satisfaction.

This research, through the involvement of both hospital staff and the patient, brings out a holistic approach in terms of operational excellence in a critical unit such as the ED. The empirically established relationships form the benchmarking and guide for developing guidelines for designing policies for service improvements of ED practices.

This study aims to explore the empirical correlation between patient flow issues, quality of green health services and patient satisfaction in specialist medical department factors from patients’ perspectives as service consumers.

This research is a type of nonintervention empirical research that uses an open survey to explore the views and experiences of users of specialist medical department services. The targeted population is hospital patients included in the top five national PERSI (Indonesian Hospital Association) Award 2022 Green Hospital Category, with a total number of respondents of 572 people. This study uses the partial least square-structural equation modeling analysis method with the SmartPLS application.

Patient flow problems generally affect the quality of eco-friendly health services, except for the waiting time problem, which affects service quality. It should be understood as a top priority for patients to receive services from medical specialists without risking time as a core service aspect from the patient’s perspective. In addition, all variables in eco-friendly hospital services affect patient satisfaction, except in the case of visits to specialist medical departments, which do not affect medical support services and hospital practices that are responsive to the delivery of care services resulting from medical support services that are inseparable in integrated services as well as health care following medical ethics.

This study has a novelty in understanding the implications of green practice in determining patient satisfaction in medical specialist department as the epicenter of hospital services and the main object of assessment for the quality of hospital services.

The purpose of this paper is to systematically investigate the patient flow and waiting time problems in hospital emergency departments (EDs) from an integrated voice of customer (VOC) and voice of process (VOP) perspective and to propose a new lean framework for ED process.

A survey was conducted to better understand patients' perceptions of ED services, lean tools such as process mapping and A3 problem-solving sheets were used to identify hidden process wastes and root-cause analysis was performed to determine the reasons of long waiting time in ED.

The results indicate that long waiting times in ED are major concerns for patients and affect the quality of ED services. It was revealed that limited bed capacity, unavailability of necessary staff, layout of ED, lack of understanding among patients about the nature of emergency services are main causes of delay. Addressing these issues using lean tools, integrated with the VOC and VOP perspectives can lead to improved patient flow, higher patient satisfaction and improvement in ED capacity. A future value stream map is proposed to streamline the ED activities and minimize waiting times.

The research involves a relatively small sample from a single case study. The proposed approach will enable the ED administrators to avoid the ED overcrowding and streamline the entire ED process.

This research identified ED quality issues from the integration of VOC and VOP perspective and suggested appropriate lean tools to overcome these problems. This process improvement approach will enable the ED administrators to improve productivity and performance of hospitals.

The purpose of this paper is to address a gap in operations management empirical research through the use of diffusion of innovation (DOI) theory to develop further insight into patient flow and bed management, a problem that has been taxing healthcare organizations across the world.

The study used an action research (AR) approach and was conducted over an 18-month period within an acute hospital in the north east of England. Data were generated through enacting AR cycles, interviews, participant observation, document analysis, diaries, meetings, questionnaires and statistical analysis.

The research conducted within this study has not only led to practical outcomes for the hospital in terms of the successful adoption of a new patient flow system but has also led to new knowledge about the determinants of diffusion for technological and process innovations in healthcare organizations which are complex and highly political.

AR is not suited to all organizations and is most appropriate within those that are culturally attuned to participative and democratic ways of working. The results from this study are not generalizable but some similar organizations may see merits in this approach.

The AR approach has supported the hospital in adopting the new system, PFMS. This system is helping to improve the quality of patient care, providing facilities to support the work of clinicians, aiding timely discharge of well patients back into the community and saving the hospital money in terms of not needing to open emergency “winter” wards.

From an operations management perspective this work has demonstrated the potential to bring theory, in this case DOI theory, and practice closer together as well as show how academic research can impact organizations. Local-H intends to continue developing its AR approach and take it into other systems projects.