#106 2005 · Cincinnati Children's Hospital · Healthcare
Cincinnati Children's flattened its own surgery schedule and the ER stopped drowning
the problem
Scheduled surgeries were jamming the emergency room
background
Hospitals facing overcrowded ERs and boarded patients almost always reach for the same fix: more beds, more staff, more capital construction to absorb the chaos of unpredictable emergency arrivals. That assumes the chaos is unavoidable — an act of nature nobody could plan around — and it points every fix toward buying more capacity rather than questioning where the crowding actually comes from.
Eugene Litvak's variability methodology drew a distinction hospitals had blurred: emergency demand is genuinely random, but elective-surgery demand is scheduled by the hospital itself, and hospitals generally cluster it on particular weekdays — commonly Monday and Tuesday — partly so surgeons aren't called in to check on patients over the weekend. That self-inflicted, entirely controllable surge, not the ER's unpredictable one, is what a smoothed schedule frees up.
the move
Eugene Litvak's variability methodology: smooth elective surgery scheduling — the controllable flow — so random emergency arrivals fit in the remaining capacity.
the payoff
Absorbed years of admission growth without building beds; the hospital cited nine figures of avoided construction.
what came after
Cincinnati Children's is reported to have generated additional annual revenue exceeding $100 million by using its existing beds, operating rooms and staff more effectively, rather than building new capacity. Litvak's Institute for Healthcare Optimization has since worked with other hospitals reporting similar gains, but Litvak himself says adoption is "definitely the minority" among the roughly 6,000 US hospitals two decades on — the fix is cheap and proven, but it asks administrators to reschedule surgeons' convenience, not just buy more beds.
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references
- [1]Spreading out elective admissions could save lives, strengthen hospitals, and reduce health spendingSTAT News, 2026statnews.com
- [2]Managing Variability in Healthcare DeliveryNational Academy of Medicine, 2017nam.edu