Achieving swift and even hospital-wide patient flows

Doctoral thesis, 2025

Healthcare systems worldwide face mounting challenges as surging demand outpaces care delivery capacity. This imbalance leads to longer waiting times for consultations and surgeries, as well as overcrowded emergency departments and wards. Meanwhile, healthcare costs continue to rise as a share of GDP, underscoring the urgent need for innovative solutions. Over the past two decades, practitioners and researchers have focused on patient flow optimization to improve hospital throughput. Yet, most improvement efforts have been local, targeting specific units rather than adopting a hospital-wide perspective. This dissertation addresses this gap by investigating patient flow comprehensively, identifying key barriers, and with contributing new knowledge on enhancing hospital-wide efficiency.

To explore this, five studies were conducted, each offering distinct perspectives. Study I, a systematic literature review, maps barriers and root causes. Study II, an international interview study with senior executives, examines solution strategies. Study III, a single-case study of a full-service clinic, investigates the impact of patient volume, variability, and complexity. Study IV, an international multiple-case study of leading hospitals, explores decision-making authority and governance structures. Study V, a multi-site interview study with frontline professionals, provides insights from nurses and physicians.

Synthesizing findings across these studies, this dissertation advances both theory and practice by applying a systems perspective to the complexity of patient flow. The theoretical contribution lies in employing operations management theories to healthcare, highlighting context-specific challenges hospitals face in maintaining smooth flows. The research identifies a multi-level system of barriers, often producing unintended consequences when well-intended initiatives lead to suboptimal outcomes. In this intricate context, continuous trade-offs arise between individual patient needs and population-level efficiency, with decentralized decisions frequently resulting in poor resource utilization. Optimizing patient flow requires hospitals to adopt a dual approach: combining flexibility and autonomy with centralization and structure to safeguard overall efficiency.

The practical contributions offer policymakers and hospital leaders actionable frameworks for diagnosing flow-related barriers, designing effective strategies, and tailoring processes to patient volume and complexity. These insights provide a foundation for improving hospital-wide throughput and addressing the pressing challenges facing modern healthcare systems.