Improving Patient Flow and Capacity at Cedars-Sinai with Heidi High

Summary

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Podcast Summary

Podcast: Becker’s Healthcare Podcast
Episode: Improving Patient Flow and Capacity at Cedars-Sinai with Heidi High
Guest: Heidi High, Executive Director of Capacity Management, Cedars-Sinai
Date: September 19, 2025
Host: Scott Becker

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Episode Overview

This episode delves into the transformation of patient flow and capacity management at Cedars-Sinai, featuring insights from Heidi High, an experienced ICU nurse-turned-executive leader. The conversation highlights persistent challenges in hospital bed capacity, the evolution of patient flow management from paper-based processes to tech-driven systems, and the cultural and operational shifts that enable successful system redesign.

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Key Discussion Points and Insights

1. Persistent Challenges in Patient Flow

• Capacity Limitations:
  • Cedars-Sinai faces continual challenges due to not having enough beds to meet patient demand.
  • “We do not have enough beds for all of the patients seeking our care... you want to be able to care for every single patient that comes to your site for care.” — Heidi High [01:50]
• Complex Collaboration Needs:
  • The larger the organization, the harder alignment becomes, even with a generally unified team.
  • “The bigger your organization gets, the bigger your team gets and the harder it can be to align.” — Heidi High [02:12]

2. Evolution from Paper to Technology

• Historical Context:
  • Early systems relied on paper, with information quickly becoming outdated during daily rounds.
  • “I remember rounding with a clipboard… by the time I had rounded on all 40-some units, of course the information was old.” — Heidi High [03:13]
• Cultural Change through Daily Huddles:
  • Instituted in 2019, daily cross-department huddles now bring together staff from nursing, environmental services, pharmacy, lab, physicians, and more.
  • These huddles foster transparency, fast information sharing, and coordination.
  • “That has been the most transformative from a cultural perspective.” — Heidi High [03:58]
• Optimizing Data Use:
  • Cedars-Sinai is “very data rich,” so the key is surfacing actionable information that directly drives behavior.
  • “How do we actually drive behavior? Using that technology has been an important journey.” — Heidi High [04:33]

3. Redesigning Discharge Workflows

• Empowering Those Closest to the Patient:
  • Moved critical information and actionable items directly into the hands of bedside nurses, not just charge nurses or leadership.
  • Example: Bedside nurses notified if their patient qualifies for the discharge lounge.
• Improvements Measured:
  • Tangible gains in both discharge lounge utilization and discharge order processing time.
• Support Services Prioritization:
  • Tools now allow services like CT, pharmacy, and transport to prioritize patients most urgently needing attention.
  • “Our support services departments have the information they need on who to prioritize.” — Heidi High [06:12]

4. Managing Culture Change and Staff Engagement

• Early and Open Involvement:
  • Brought nursing leadership into the process from the outset and actively listened to concerns.
  • “We have done a lot of celebrating. We have something that's called MOVE awards and they are tied to the metrics that we are trying to improve…” — Heidi High [07:11]
• Recognition and Ownership:
  • Celebratory acknowledgements (MOVE awards), and creating a sense of community (referring to the leadership group as “our BFFs, our best friends in Flo”).
• Psychological Safety:
  • Fostered a culture where staff could safely express skepticism or concerns about new systems.

5. Overcoming Resistance & Driving Adoption

• Initial Concerns:
  • Expected pushback when introducing systems outside the electronic health record.
• Surprising Buy-In:
  • Early buy-in emerged when nursing staff recognized the time and workload reductions from improved information sharing.
  • “As soon as they were able to see the value and the information that they were to gain… They started to spread the news themselves.” — Heidi High [08:14]
• Role of Nursing Staff:
  • Nurses constituted the large workforce necessary for the initiative’s success.

6. Lessons Learned & Advice for Others

• Collaborate Beyond the Institution:
  • Peer learning and commiserating with other capacity management leaders were invaluable.
  • “When you get outside of your organization and learn from what other organizations are doing, it really helps… sometimes just in commiserating in the struggle and the challenges…” — Heidi High [09:49]
• Ongoing Learning:
  • Validating and refining initiatives by benchmarking with others helped ensure best practices.

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Notable Quotes & Memorable Moments

• On the Core Challenge:
  • “We do not have enough beds for all of the patients seeking our care.” — Heidi High [01:51]
• On Technology’s Impact:
  • “Whatever system that we're using, the most important part of that has been what information we actually bring to the surface…” — Heidi High [04:21]
• On Engaging Staff:
  • “If you bring them to the table, give them the safety in being able to express their concerns... and have them help with the joint ownership of the problem, we've really made great strides.” — Heidi High [07:38]
• On Unexpected Buy-In:
  • “I did not expect such early buy-in, but as soon as they were able to see the value... they started to spread the news themselves.” — Heidi High [08:14]
• On Learning from Others:
  • “When you get outside of your organization and learn from what other organizations are doing, it really helps... in validating that the initiatives that we're implementing are the right ones...” — Heidi High [09:49]

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Timestamps for Key Segments

• Heidi High introduces herself & career: [00:54]
• Biggest challenges with patient flow/beds: [01:50]
• Evolution from paper to tech/daily huddles: [03:06]
• Redesigning discharge workflows, role of bedside nurses: [05:04]
• Driving culture change and staff engagement: [06:52]
• Buy-in and resistance to new tools: [08:33]
• Lessons learned and collaboration advice: [09:43]

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Tone and Language

Throughout, Heidi shares candid reflections and practical advice, maintaining a warm, collegial, and solutions-oriented tone. The conversation is peppered with engaging anecdotes, appreciation for her team, and a focus on practical impact for both patients and staff.

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Conclusion

This episode offers a concise, actionable roadmap for healthcare leaders seeking to improve capacity management and patient flow, emphasizing the importance of cultural change, transparent data, frontline empowerment, and peer collaboration. Heidi High’s practical experiences and lessons learned provide valuable insights adaptable to diverse hospital settings.

Transcript

[A]

This is Scott Becker with the Becker's Healthcare Podcast. I'm thrilled today to be joined by a brilliant leader from Cedars Sinai and Cedars Sinai. For people that are not familiar, you got to be familiar. One of the top five systems in the country, ranked by quality. A fantastic health system. We're joined today by Heidi. Hi. Heidi's the executive director of capacity management, and we're going to talk today a lot about thorough throughput patient flow and a lot more. Heidi's got this fascinating background. Before coming to Cedars Sinai, she spent. She's been at cedars Sinai for 15, 17 years. So he's had a great, great career there and watch that system just blossom and blossom. Before that, she spent time in Hawaii. So, you know, it had to be a great opportunity to leave Hawaii to come to Cedar Sinai and just a fantastic career. Heidi, can you take one moment to introduce yourself and then we'll talk about capacity management, some of the initiatives that Cedar Sinai is working on, and a lot more.

[B]

You bet. Thank you, Scott, and appreciate the opportunity. I am an ICU nurse by background and got into logistics of flow while I was in Hawaii, and yes, that was a wonderful place to live. And there I was a nursing supervisor and really got intrigued by the workings behind the hospital. How. How do we care for all of these patients in such a seamless way? And it really opened my eyes. And I've been in hospital flow ever since.

[A]

Thank you very, very much. And hospital flow must have changed tremendously over the last 15 years and even the 10 years that you were in Hawaii. But talk about trying to improve patient. What were some of those pressing challenges that your teams were facing at Cedars Sinai as you tried to sort of work through patient flow and try to improve and try different approaches? Tell us a little bit about what you were looking at when you began to try and improve patient flow.

[B]

In my 15 years here, it really has always been the same problem in that we do not have enough beds for all of the patients seeking our care. And so probably the greatest challenge in that is you are dealing with human lives and you want to be able to. To care for every single patient that comes to your site for care. And I would say probably the second biggest challenge is in the collaboration that is required at such a large organization. The bigger your organization gets, the bigger your team gets and the harder it can be to align. At times we have an aligned organization, but again, with it being so large makes it difficult to bring everybody on.

[A]

The same page 100% and talk a Little bit about how has patient flow evolved and what tactics are you focusing right now to sort of improve patient flow? And Cedars is a large institution, but it's not thousands of beds. It's one of the great hospitals in the country. But patient flow and throughput, so important. How have these things evolved and what techs are using or focusing on right now to improve this?

[B]

Yeah. So 15 years ago, when I started, we were using paper. I remember rounding with a clipboard and writing down information about upcoming discharges and admissions. And by the time I had rounded on all 40 some units, of course the information was old, but that's how we were doing it. And if there was whatever, well, whoever wanted to declare that we were having an emergency and that we had too many patients waiting in the emergency department, we'd all come into a conference room and everybody'd have their piece of paper, and we would report out again on information that was old through time. One of the greatest things that we've done from a cultural change perspective is start daily huddles. And that was started back in 2019 and utilizing technology, being more transparent with our data and how many patients were waiting, where the discharges were, where the bottlenecks might be. Everybody from the frontline nursing staff to our environmental services, to pharmacy to lab, to physicians and beyond come to our daily huddle. And that has been the most transformative from a cultural perspective, from a data and technology perspective. Whatever system that we're using, the most important part of that has been what information we actually bring to the surface, because we are very data rich, and so how do we actually drive behavior? Using that technology has been an important journey.

[A]

Heidi, a lot of the initiative is about how rethinking how patient flow works, how discharge works, and so forth. Can you talk a little bit about. Walk us through how Cedars Sinai approached redesigning discharge workflows and what were some of the most meaningful changes that you did to try and drive collaboration and to help people adopt in the process?

[B]

Yeah. So probably where we gained our greatest gains is in bringing the information as close to the hands of the people doing the work that we could. So I mentioned our daily huddles, and while we have charge nurses in those daily huddles, they aren't always the ones that we're asking to discharge a patient or asking to send a patient to our departure lounge. So once able to get that information to the bedside nurses and with actionable items of what we were actually asking them to do, such as your patient qualifies for the discharge lounge, please consider patient sending the patient to the discharge lounge, you know, signifying whether they had a discharge order or not. This is where we really started to see incremental improvements in especially our discharge lounge metrics. In addition, our discharge order processing time. So the time from when we get a discharge order to the time the patient is discharged, that is improved. We have put tools in the hands of our support services department for prioritization. So whether it's a ct, whether it's pharmacy delivering meds to beds, our support services departments have the information they need on who to prioritize. Prioritize patients first.

[A]

Thank you. And talk a little bit about sort of when you work through changes in how you do systems, how you work through systems, how you work through discharge, how do you deal with sort of culture change in getting people involved in this? And what steps do you take to keep people sort of aligned with how you're changing things? So as you make changes, it always bothers the cause of stress for some people. How do you, how do you deal with that?

[B]

Yeah, one of the greatest things that we've done is bring our nursing leadership to the table very early on and really listening to them and what motivates them, what motivates their people. Of course, food is always a great motivator, but I don't have a budget for that for these folks. So we have done a lot of celebrating. We have something that's called MOVE awards and they are tied to the metrics that we are trying to improve, such as our departure lounge utilization, our discharge order processing time, our pulling patients up from emergency department. And I tell you, if you bring them to the table, give them the safety in being able to express their concerns and why it might not work, and then bring them along and have them help with the joint ownership of the problem. We've, we've really made great strides. And I call them rsuite16 because initially it was nursing leadership, then it started to expand and now we call them our BFFs, our best friends in Flo. And they are absolutely key to our improvements that we have seen.

[A]

Thank you very, very much. And talk for a moment about follow up. Looking back, as you change the system for patient flow, as you adopted new systems, new artificial intelligence, new technology, were there any unexpected moments of buy in or resistance that helped shape how you led the transportation to changing your, your system for discharge, your system for patient flow in any unexpected changes or resistance or challenges?

[B]

Well, I expected resistance when we were asking teams to utilize a system outside of the electronic health record. Where the surprise came in is I did not expect such early buy in, but as soon as they were able to see the value and the information that they were to gain, that really came to the surface. Cut out hours of chart digging, they started to spread the news themselves. When I say they, it's really the nursing group because they are such a large workforce and without them it's hard to move any initiative forward. So a resistance I knew was coming, but actually was surprised by the buy in.

[A]

It's fantastic. And any other lessons or closing thoughts that you have and how you work through sort of changing systems on patient flow and discharge and so forth to make sure it both it works great, improves efficiency and improves the quality that Cedarsani is so known for. Any sort of closing thoughts on trying to make these things work?

[B]

Yeah. Considering not just the collaboration within your organization, but also collaborating with those outside of your organization. Because in inside of organizations, capacity management leaders can often feel like they're on an island. They're kind of an in of one, we say. But when you get outside of your organization and learn from what other organizations are doing, it really helps not only in validating that the initiatives that we're implementing are the right ones, but also sometimes just in commiserating in the struggle and the challenges that it takes to be improving capacity management.

[A]

No, a hundred percent. You know, I want to thank you, Heidi, for taking the time to join us. I know you're busy in doing fantastic work. We are so appreciative of you taking the time to join us on the Beckers Healthcare Podcast to share some of your lessons in sort of moving to a new system on patient flow, moving a new system on discharge and the work that you're doing. Thank you so much for joining us today on the Becker's Healthcare Podcast. Thank you very, very much.

[B]

Absolutely. Thank you, Scott.