How Do Health Systems Address Patient Flow When Services Are Misaligned With Population Needs? A Qualitative Study.

Area of Science:

• Health Services Research
• Healthcare Management
• Systems Engineering

Background:

• Patient flow is a critical system issue in healthcare, often addressed with localized interventions.
• Intractable flow problems may stem from a misalignment between healthcare service offerings and population needs, necessitating system redesign.
• Limited understanding exists regarding health systems' strategies for addressing population-capacity misalignment and guiding system redesign.

Purpose of the Study:

• To explore health system strategies for addressing or preventing population-capacity misalignment.
• To derive principles for system design to improve patient flow.

Main Methods:

• Qualitative study involving in-depth interviews with 300 managers across 10 jurisdictions in urban Western Canada.
• Purposive sampling across all healthcare sectors and management levels.
• Constant comparative method used for data analysis to understand strategies and develop design principles.

Main Results:

• Population-capacity misalignment is pervasive across all studied regions.
• The most common response was mutual accommodation (case-by-case problem solving), followed by capacity reallocation, and rarely population redefinition.
• Key principles emerged: define populations by clusters of need, balancing narrow/rigid models for homogeneous needs and broad/flexible models for heterogeneous needs.

Conclusions:

• Health system planners must identify separable vs. fused population needs clusters.
• Select appropriate service models, allocate sufficient capacity, and use mutual accommodation for exceptions.
• Over-reliance on case-by-case solutions perpetuates population-capacity misalignment.