How Hospitals can improve bed utilization, lessons from the Hotel industry

A sincere thanks to Joe Nassoura and Steven Stefaniuk of Fairmont Dubai for their insights and exchange of best practices.

Looking to other industries to see how healthcare could benefit is an interest of mine. 'Comparative administration' as I term it, is where we look to industries that excel at certain operational activities and learn from their manner of doing things to thereby develop relevant best practices. One of the recent, most heralded safety initiatives in healthcare, the WHO surgical checklist, was inspired by preflight checklists done by pilots in the aviation industry. Another example being the Williams Formula 1 Racing team applying their efficiency in pits stops to help Code Pink teams.

Given the importance and implications of operational efficiency and effectiveness in healthcare, to not learn from other industries would be a lost opportunity with the cost measured in lives or increased morbidity. Imagine paramedic services utilizing air traffic control procedures to deliver the sickest patients to the right hospital and avoiding hospitals already over capacity. Or looking at manufacturing and line production to streamline how operations are scheduled and conducted, so that more patients could be operated on, thus reducing wait times. Some of this is not new but healthcare has to develop a culture of efficiency without sacrificing empathy and care to deal with future challenges such as increasing costs and an aging population.

Admittedly managing hospital beds and hotel beds is very different, there is a large amount of unpredictability in healthcare bed utilization, length of stay can differ from patient to patient, needs differ but the underlying principle of patient flow to optimize beds is something we can definitely learn from the hotel industry.

Hotels such as Fairmont, look back on their prior bed utilization to calculate future demand, take into account macro environmental factors (events, vacations in neighbouring countries, in coming flights, changes in demand and supply) to then calculate how to manage housekeeping, bellboys and valet parking for example. We in the healthcare sector paradoxically seem to reduce staff at peak demand, any doctor or nurse who has worked during Christmas or New Year in Canada would know where I'm coming from, the same applies to most western hospitals.

Thus when family physicians and walk-in clinics have shut their doors during the vacation period, hospitals should be ramping up service not reducing them. We can predict peaks during the weekend and thus should have increased coverage of auxiliary services and allied health on Sundays and Mondays to smooth over bed utilization. We can predict a few days or weeks in advance when flu season will hit and be better prepared to deploy treatment/isolation areas in Emergency Rooms and try to free up beds on the medical wards and ICUs to accommodate those sicker patients.

One idea which was eye opening was the use of surge teams to cope with unexpected demand. So when the hotel is at 100% utilization or is nearing that point, team members who are cross trained help housekeeping, front end staff and porters. In some cases this can mean admin staff helping to strip rooms so that housekeeping can clean rooms quicker or even the manager welcoming guests to free up staff for other duties. Admittedly this culture of cooperation requires developing and nurturing but much as the guest is the key focus of hotels, hospitals should develop practices so that patients are not left waiting for rooms or at worst being accommodated in hallways. A practical application of this would be the use of volunteers to assist environmental and transport services.

Hotels do have an advantage of having set check out and check in times, a luxury we do not have in hospitals but with the utilization of waiting lounges for those patients known to be discharged later that day, we could free up beds in the early hours of the morning to cater for sicker patients and those in more need of close monitoring, treatment and access to allied staff, thereby accommodating overnight admissions. Staffing in terms of nurses, allied health, auxiliary services, even diagnostics could be rammed up in the mornings to early afternoons, utilizing more part time staff which in itself could lead to cost savings.

To conclude there are a number of initiatives that can be summarized below and I hope that healthcare leaders will look inward and outward to improve the utilization of their beds.

• Better utilization of past data, supplemented with marco-environmental information to predict bed occupancy and staffing requirements. More flexibility in ramping up staff when needed.
• Deploying volunteers to assist other staff such as porters and room cleaners to make them more efficient and prevent them from becoming bottlenecks.
• Using waiting lounges for patients being discharged later that day to free up beds for those who need them more who have been admitted overnight.
• Reversing the trend of hallway patients, with it being the exception not the norm. Imagine yourself being a paying guest in a hotel, you wouldn't accept being put into a closet or hallway so neither should we demand the same of our patients.