Bottom-up perspectives on hospital-wide patient flow – a multi-site qualitative study of solutions to organisational paradoxes

Journal article, 2026

Background: As the demand for healthcare outpaces capacity, improving hospital productivity has become critical. Research suggests that hospital-wide improvements in patient flow can enhance efficiency but has largely neglected the insights of frontline healthcare professionals without managerial responsibilities. This article explores those professionals’ perspectives on enabling efficient patient flow across hospitals. Methods: Semi-structured interviews were conducted with 15 nurses and 15 physicians at six tertiary and secondary care hospitals in Sweden, followed by thematic analysis based on inductive reasoning to identify meaningful subjects and themes. Results: Analysis revealed seven paradoxes experienced by frontline healthcare professionals that are associated with hospitals’ efforts to enable efficient hospital-wide patient flow and linked to leadership, organisational design, routines, professional culture, and technology. Associated tensions intensify under operational stress and often lead to overtime or compromised care. Professionals emphasised the need for more aligned structures, clearer patient flow strategies, performance metrics that support the efficient transitions of patients, more centralised coordination, better adherence to standardised routines, and investment in IT tools to improve decision-making. Meanwhile, a gap in nurses’ understanding of patient flows and patient progression and their limited authority and mandates to advance patients highlights the need for stronger nurse–physician collaboration. Conclusions: Enhancing hospital-wide patient flow requires increased system-level coordination, better-aligned hospital structures, and improved operational planning. The solutions proposed by frontline professionals also largely align with previously identified managerial strategies for improved hospital-wide patient flow, which suggests a shared understanding that could be leveraged to drive meaningful change.