Exploring patient flow management through a lens of cognitive systems engineering

Hospitals work to provide quality, safety, and availability to patients with a wide variety of care needs, which makes efficient prioritisation and resource utilisation essential. Anticipation of each patients’ trajectory, while monitoring available resources across the hospital, are major challenges for patient flow management. This study focuses on how hospital patient flow management is realised in situ with the help of concepts from cognitive systems engineering. Five semi-structured interviews with high level managers and shadowing observations of seven full work-shifts with management teams were conducted, to explore how patient flow is coordinated and communicated across the hospital. The data has been analysed using qualitative content analysis. The results describe patient flow management using an adapted Extended Control Model (ECOM) and reveal how authority and information might be better placed closer to clinical work for increased efficiency of patient flow. Practitioner summary: This study describes how a large tertiary paediatric hospital’s patient flow management functions. The results offer a new understanding of how patient flow management is communicated and coordinated across organisational levels of the hospital and how authority and information might be better placed closer to clinical work for increased efficiency.医院致力于为各类照护需求的患者提供优质、安全且可及的医疗服务，这使得高效的优先级排程与资源利用成为不可或缺的环节。预判每位患者的病程轨迹，同时监控全院可用资源，是患者流量管理面临的核心挑战。本研究聚焦于如何借助认知系统工程（cognitive systems engineering）的相关理念，在医院场景中落地患者流量管理实践。为探究医院内部患者流量的协调与沟通机制，研究团队对5名高层管理者开展半结构化访谈，并对7个完整工作日的管理团队进行跟随观察。本研究采用质性内容分析法对所获数据进行分析。研究结果基于改进型扩展控制模型（Extended Control Model, ECOM）阐释了患者流量管理的实践模式，并揭示了如何通过将权限与信息更贴近临床一线配置，以提升患者流量管理效率。实务摘要：本研究阐述了某大型三级儿科医院的患者流量管理运作逻辑。研究结果为理解医院内部跨组织层级的患者流量管理沟通与协调机制，以及如何通过将权限与信息更贴近临床一线配置以提升管理效率提供了全新视角。