Smoothing the Way to High Quality, Safety, and Economy

Artificial peaks and valleys in hospital demand, driven by planned surgeries, foster health care delivery that endangers patients, reduces access to care, puts pressure on clinicians at some times, and results in underutilization of health care resources at others. In recent years, health care institutions have awakened to the need to provide safe, high-quality care at lower cost. The Centers for Medicare and Medicaid Services is implementing multiple incentives and penalties intended to help realize this goal. For example, innovations designed to reduce the rate of infections associated with ventilators or central venous catheters have had demonstrated success. We believe that greater attention to a frequently overlooked parameter in health service design — patient load and flow — would accelerate progress toward reliable, safe, efficient care. A reliable health system is one that functions properly in difficult and unanticipated . . .