Use of Systems Engineering to Design a Hospital Command Center

1 January, 2019

The Joint Commission Journal on Quality and Patient Safety 2019; 000:1–10

In hospitals and health systems across the country, patient flow bottlenecks delay care delivery—emergency department boarding and operating room exit holds are familiar examples.

In other industries, such as oil, gas, and air traffic control, command centers proactively manage flow through complex systems.


A systems engineering approach was used to analyze and maximize existing capacity in one health system, which led to the creation of the Judy Reitz Capacity Command Center.

This article describes the key elements of this novel health system command center, which include strategic colocation of teams, automated visual displays of real-time data providing a global view, predictive analytics, standard work and rules-based protocols, and a clear chain of command and guiding tenets. Preliminary data are also shared.


With proactive capacity management, subcycle times decreased and allowed the health system's flagship hospital to increase occupancy from 85% to 92% while decreasing patient delays.


The command center was built with three primary goals—reducing emergency department boarding, eliminating operating room holds, and facilitating transfers in from outside facilities—but the command center infrastructure has the potential to improve hospital operations in many other areas.

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