Most organizations use acute care length of stay (LOS) as their measure of patient flow success. This measure translates into a decentralized flow strategy. Executives set LOS targets for local leaders, who develop a department-level flow strategy to meet their target.

This approach worked well for over a decade. But now that most organizations have achieved their department-level quick wins, the decentralized approach is failing to yield further gains, for two reasons.

First, siloed efforts by individual departments often don’t translate into a reduction of organizational length of stay. These individual efforts may inadvertently be in conflict with one another. Or it may be hard to identify (and prioritize) the department-level pain points that have the biggest impact on the broader organization.

Second, the traditional approach overlooks a major opportunity: reducing avoidable hospitalizations. Across the U.S., there’s an average of 49.4 discharges for ambulatory care-sensitive conditions per 1,000 Medicare enrollees. These inpatient days should be avoided altogether. But because of the focus on reducing length of stay, reducing avoidable hospitalizations hasn’t been a main goal of throughput efforts.