Taking Healthcare by Storm: Industry Insights with John D’Alesandro

In this episode of Taking Healthcare by Storm, Quality Insights Medical Director Dr. Jean Storm speaks with John D’Alesandro, founder of Amplefi and a healthcare operations expert who has spent more than two decades helping hospital leaders improve how care actually moves through their systems. 

John explains that long ER waits and overcrowding are driven by hospital-wide flow blockages, cultural workarounds, and poor visibility into capacity—not simply staffing or space shortages. He describes adapting Lean thinking, using AI to anticipate admissions earlier, and creating shared accountability through an action center that tracks who can move, what they’re waiting on, and what barriers must be removed.

If you have any topics or guests you'd like to see on future episodes, reach out to us on our website.

The views and opinions expressed by the host and guests are their own and do not necessarily reflect the views, positions, or policies of Quality Insights. Publication number QI-060526-GK

Transcript

Welcome to "Taking Healthcare by Storm: Industry Insights," the podcast that delves into the captivating intersection of innovation, science, compassion, and care. 

In each episode, Quality Insights’ Medical Director Dr. Jean Storm will have the privilege of engaging with leading experts across diverse fields, including dieticians, pharmacists, and brave patients navigating their own healthcare journeys. 

Our mission is to bring you the best healthcare insights, drawing from the expertise of professionals across West Virginia, Pennsylvania and the nation.

Subscribe now, and together, we can take healthcare by storm.

Hi, everyone. Welcome to another episode of Taking Healthcare by Storm. I am Dr. Jean Storm, the medical director here at Quality and Insights. And today, we're taking a closer look at one of the most frustrating challenges in healthcare today: patient flow. Why emergency departments are overcrowded, why hospital beds seem unavailable, and why patients often wait far longer than anyone would like. My guest today is John D’Alesandro, a healthcare operations expert who has spent more than two decades helping hospital leaders improve how care actually moves through their systems. Before entering healthcare, John worked in the automotive industry with companies like General Motors and Ford Motor Company, where he learned lean manufacturing and just-in-time supply chain principles that now shape his work in hospital operations. He has worked with major health systems, including Cleveland Clinic, HCA Healthcare, and Houston Methodist, to help reduce patient boarding, shorten lengths of stay, and improve hospital capacity, often seeing measurable improvements in days instead of months. John believes that by fixing flow, not by adding more staff or building more space, hospitals can dramatically improve both patient care and operational efficiency. Two very important things. John, thank you so very much for joining me today. And thank you for a great introduction. Appreciate it. Yeah. So as I said, you began your career in the automotive industry working with lean manufacturing and just-in-time supply chains, and I, I mentioned at General Motors and, and others. How did your experience ultimately lead you into healthcare operations and hospital flow improvement? Well, The, fact of the matter is, is that, hospitals have been struggling with this problem since I graduated from college. In fact, my, uh, best man is an ER doc, and we were sitting around talking about what's really going on in the hospital. I visited him one day, and it is a just-in-time logistics system, but it's not a factory itself. The attempts to sort of use Lean and Six Sigma, these are very mature technologies, but they needed an adaption. They needed something that, could control the human machinery and all the context all the stuff that is more situational rather than systemic in, how patients move through the system. So they're not broken because the people don't care, and the processes aren't that much different than they were forty years ago. the issue is that we've taken something with a manufacturing metaphor and tried to force it into something it's not, and that's what the problem is. Where we've taken-- We're trying to secondize the flow, and it's not gonna work 'cause humans are involved. Situations are involved. Full moon's out, so the ER is packed, right? I mean, all the wives' tales you wanna use, but the bottom line is these things are human logistic systems Yeah. And I, and I love that, and I love that you were able to see that. And I will say where I've worked in healthcare, yeah, people think it is the full moon, right? Right. So you've spoken about facing a serious personal diagnosis that changed your perspective on healthcare. So how did this experience change your mission to help hospitals operate more efficiently and treat patients better? Well, you know, I was, diagnosed with a form of muscular dystrophy and I bounced around the healthcare the system for, no joke, three years. Biopsies, I had all this stuff. Why did it take three years? 'Cause the biopsy took about an hour Took three years because it takes six months to get the first appointment and then so many more months to get the follow-up. And then when you hear that you're... You need some assistance breathing twenty-four hours a day, you get a medical or a durable medical equipment company that didn't get the fax from the doctor's office, so they can't bring the equipment until the doctor's office sends a fax. Blah, blah, blah, blah, blah. These delays in care actually is rationing the care. And you know, we don't even have a true demand signal 'cause people can't even get in to get it. So this stopped being an interesting problem for me. It turned into a mission. If it could happen to me, I got great insurance. If it could happen to me, it could happen to anybody. Yeah. Definitely and we've-- I've heard many stories like that. And I mentioned in the, in the intro that emergency department wait times are one of the biggest frustration. You know, I've, I see people on Facebook often posting, you know, been in the ER eight hours, ten hours, twelve hours. Um, and it's an uncomfortable place to be, I know. So it's a, it's a big challenge for health systems. From your pers- Sure. Yeah. So your perspective, from your perspective working with hospital systems like Cleveland Clinic, HCA Healthcare, Houston Methodist, huge hospital systems, what are the real operational reasons that ER wait times become so long? Well, I think that it's because we look at it wrong. It's not that it's broken. we need to run it differently. See, the ER is just the first step in the flow they're urgent people. They don't need to be, uh, told to get off their butt or anything like that. They care about this. But, fact of the matter is, you got to flow through to the hospital, and one out of five people are admitted. And if you had a modest size ER, twenty beds you're looking at four admitted patients. You block-- You know, it could really start blocking people. You can't get people through the goose. And then there's the reaction. People start to react. Nurses in the ICU start not reporting the bed available until the shift ends. You get these little things that no one's going to go to the boss over, but it's just how the culture is. Those ladies up there are hiding all the beds. You know, you get into this, the lab does something, radiology does something, transport does something, and all of that friction lands in the ED, and they start complaining, and you get kaboom. A preventable problem that anybody could have saw if they just backed away from the, uh From the urgency, it got into how do we keep things moving? And you go to Disney and watch how that works. They give you a little pre-entertainment. They keep you moving through it, even though the line is long. If you kept people moving through it, you'd be better off. So you really gotta find out why aren't people moving rather than what's wrong with the process. Does that make sense? Yes. Yes. A-and I think, I think people, you know what did they say? Like, an unsolvable problem is just a question asked in the wrong way. Yes. This is that. This is that. Yes. That's right. And really, you know, one of the things... Let me stop 'cause you're about to ask about COVID. I'm about to tell a COVID story, so. Yeah, you, you're a little psychic. So yeah, I w-- I always kind of talk about the COVID. So, you know, it, the pandemic did expose a lot of vulnerabilities in the hospital operations. Uh, I mean so I'm sure you're gonna share with us a story, but I'm also interested in what effect, how the pandemic is still impacting hospital systems today. I think the pandemic didn't give us the opportunity we hoped it would give to start solving some capacity problems. 'Cause the first big thing was the finding that we didn't know what our capacity is. We were going... We shut down General Motors to build, uh, ventilators. Nobody said, "Where are we gonna get the nurses to staff it on a one-to-one ratio with somebody in a ventilator on an ICU?" that is not a problem that you're gonna solve, uh, with the government. What about the big white boats that showed up? Nobody went to them. We don't understand the demand on the system. The smartest people in the world shut the world off 'cause we were worried about overwhelming a capacity that d-- wasn't overwhelmed. We just put so much into it that it became the issue. Pretty soon, you start, questioning even some of the, you know, longly held beliefs about things like length of stay and velocity and the way we were running this thing. It just exposed it. It, and it didn't give us, unfortunately, the opportunity to, uh- To solve it. It just exposed it. The staffing instability, the burnout, the systems that work when everything's right started to fail us. And even small disruptions started to have big consequences. The uncomfortable truth about it all is that it was a great opportunity to fix, but we didn't. What we learned to do is survive it, and by surviving it, we sort of baked in a lot of the cultural impact that it had. And now people are really overwhelmed, and the patients are really confrontational now and yada, yada, yada. It's, it's actually gotten a lot worse, in my opinion. I would agree. I, I definitely think it has gotten a lot worse. Um, and I think people don't even have a feel-- They feel so overwhelmed, they don't even know how-- they don't even feel like they have the time to stop and,, solve, which is unfortunate. You, talked a little bit about lean, uh, manufacturing, and you have a background in lean manufacturing, and that has heavily influenced your work in hospitals. How can principles originally developed in manufacturing be applied to healthcare, which is totally different, to improve patient flow? Because we wanna keep people moving from admission to discharge. I know that hospitals masquerade as factories of care if you want, but they really don't have the same sort of tools. For example, lean is about thinking about, waste. Parts sitting in inventory is waste. It's a waste of money. It's sitting there waiting, buffering the system against shock. But where do we get-- Where do we build inventory of, uh, ER doc care when it needs buffered? You can't. You have to get in line. You have to wait. If something goes wrong in manufacturing, you throw it away, do a new one. Can't do that in healthcare. That is the physics behind lean. It's getting rid of that stuff, and you can't do it. But you can adapt the thinking process. And if you look at it as a complex system where the people can influence what happens next based on the context of the environment, the house is full. We're holding four patients. We're gonna behave differently than if we're quiet and there's nobody waiting. all of these, called practices or the way it's always been, we need to start questioning, these things with a Let me give you a story instead. Okay. I have a G-- I have a GI clinic as a client. They have a three-month wait in a children's hospital for a GI colonoscopy. My kid needs that kind of care. Let me tell you something, that's serious, right? Abdominal pain on a, on a little kid. I don't wanna wait three months for that. And the, uh, advice, if it's an emergency to go to the ER, is not helpful. Why does it take three months to get an appointment? Because they cover the entire pre-op on this scheduling call. So in the middle of the day, you get a call to schedule, and you're on the phone ninety minutes hearing three months from now, little Johnny can't come to the-- can't get his procedure done if he doesn't eat popsicles for dinner the night before, so what happens next is that now they have to do two calls, the scheduling call and then the reminder call. And the capacity of these people to do all these calls, that there were a lot of callbacks, blah, blah, blah. In other words, the entire thing stopped because of this pre-op in the scheduling call. So our solution was to just take the appointment, schedule the appointment, and then call them the night before or the day before to do pre-op. And man, that was the best day of their life in that clinic. They calling people who thought they were gonna wait for three months. They got an appointment the next week, and everything was wonderful. That was lead thinking Anyway. Yeah. I, yeah, ex-- and it's huge, right? And not only is it for the patient, I mean, not even for... Uh, I'll say not e-- it's not just for the system, right? But it's like if you look at individual patients and how that impacts an individual life, an individual family, I mean, that's, that's amazing. It-- I, I completely agree. It, and I had one CEO tell me, "This is the most unexpected result I could have imagined from the people I didn't expect it from." And it, it actually opened the man's eyes to the frontline staff really knows what's going on here. And despite the bazillion dollars we spent on technology, the word on the street is the word that needs to be shared and exposed to the rest of the organization. 'Cause you were talking about people putting, freestanding centers in the community because they couldn't get an appointment. And I mean, you're talking about a huge impact on a crazy idea of let's just schedule it, and we'll worry about the rest later. Yeah, most definitely. So I wanna shift a little bit to AI. It's a huge topic in healthcare. From your perspective, how can artificial intelligence help manage the flow of patients through the hospital from admission to bed assignment to discharge? And even what happens after patients leave the hospital because, you know, in that care coordination and when it goes wrong, we know that there's gonna be a bounce back, right? We're gonna have more cost and, you know, then more patients coming into the hospital. So, um, how can AI help us here? Well, AI's potential is that it can look faster than real-time. It can look around a quarter. It get information from disparate or disconnected systems. So as an example, what if you knew at triage that you're likely to admit the person that just walked out of triage short of breath? That gives... That would give bed control a real head start, couple hours. 'Cause, yeah, especially if you're got a busy ER. You could have just given bed control four hours to find a bed It's that kind of thing that AI is gonna help with. It's going to be able to grab up information, poorly formatted, unstructured, not in the record, right? The word on the street. Somebody just-- somebody-- we've just triaged our fifth person who's likely to be admitted, and there's nobody, there's no rooms in the ICU. Whatever you're gonna do about that at eight o'clock at night when people are starting to get really antsy, what if you could do it at four o'clock in the afternoon? What if you could call the intensivist and say, " we need these beds. You got somebody worse off holding in the ER." If you had a four-hour head start on that, what would happen? I could tell you what would happen in Atlanta. They went from four days of diversion to zero in five days. By Friday, they broke their streak of ambulance diversion, four days to two days in five days Just by giving people a heads up. That's the kind of potential we could have here with AI. Because AI could get information from anywhere I think the money we're spending on pilots and tests are cool tech people who Or solving problems that people don't have. I s- I watch Alexa go into a patient room It becomes the biggest problem in the room. Alexa isn't listening to the patient. I, I mean, you know, I gotta tell Alexa six times to change the channels. It's just... Why are-- And then, and then you say, " this failed because the nurse is busier now." Yeah, 'cause now the nurse gets to debug Alexa. She's not that good at it. You know, if it, if it isn't a reminder or a timer, you know, Alexa's useless to me, so. Yeah. I, yeah, yeah, I agree. So I mentioned, and again, in the, in the, um, in the intro that you have been known for helping hospital teams achieve significant improvement in days instead of months. Everybody wants things fast, fast, fast. Do you think change in healthcare gains more momentum, more momentum when it happens fast? And if so, why? I would say that people like to win or that they like to go fast. It's just that going fast and you're winning is sort of the, the recipe there. The combination. I find that if you could get the frontline staff, not the consultant, not the process improvement person that's been assigned to the, the deal, the Six Sigma black belt. But if you get people in a room that say, "Listen, we have a problem. How do we fix it?" I'll give you another one from Children's Hospital. They have aspirin that they put in, uh, water in, for a syringe to put in to the kiddo. Aspirin. That aspirin goes bad, according to the pharmacy, in fifteen minutes. Pharmacy mixes it. They have 15 minutes to get up to the unit So one nurse says, "Why are we doing this? Why are we waiting and spoiling these doses? Not to mention the fact that we have to redo them all when I can mix medicine myself. Come on, it's aspirin, right? Send the powder here. Put it in a Pyxis. Let us do it." And you know what? They did. And voila. Fifty percent of the calls to the pharmacy with missing meds go away. Mm-hmm. And the chaos in the pharmacy goes away. And so now, instead of waiting on the pharmacy the pharmacy could go do their work. Yeah. So that was a fast thing from the people who could do things fast Yeah, I love that, and I love those stories really to bring it home. and I-- what I get and I-- when I talk to clinicians and, and other people in healthcare is that all these protocols, algorithms, use of AI in healthcare could make it feel more rigid and, you know, I think a lot about soft skills in healthcare and how important they are. So in your experience, can frontline staff feel, still feel empowered and engage with patients even when they have structured protocols and AI tools guiding decisions? The one thing about structured protocols that especially frontline staff doesn't appreciate is that they think it takes away autonomy, but the opposite is true. Because protocols can reduce the cognitive load on these people. They like give them a roadmap. So the key is the protocol should support thinking, but not repl- not replace it. So once it becomes so prescriptive that they feel like they gotta work around it, that's when you know that you've got a bad protocol. The protocols themselves aren't bad. It's making sure that the respect is paid to the fact that these aren't machines. The p- the patients aren't machines, they're not products. They are human beings, and they will have a reaction to what you're doing, good or bad. And so if the protocol causes a reaction that says, "Why the heck would we do this?" Then it's not a good protocol Yeah. And I agree with that. And, um, yeah, it's, it's a really, um... It's an interesting thing. And, yeah, it, it's just funny. I was just recently, doing some background research. I'm doing a presentation on Plan, Do, Study, Act, and I feel like- Yes ... like, that's the best place, you know, to utilize these tools. That's right. And you know, the, uh, the AI, uh, prompt engineering people will tell you you need the intent. What do you want to have happen here? And if, you know, if you prompt AI to say, " I want to know what I should do about this situation." My intent here is to get them to come home. That One little skill might be all the difference to making AI a useful tool on the front line or a pain in the butt Yeah. So my last question I ask a, an i-iteration around this question to all my guests. Y-you spent decades studying how hospitals actually function. If you were put in charge of fixing healthcare in the United States, what is the very first problem you would tackle, and how would you start solving it? The first thing I would do is I would make sure that it was widely known who in this hospital can move Number one. And two, why haven't they moved yet? What are we waiting on? I would have the-- I would have every case manager, every transporter, housekeeping, dietary, all of it. Everybody would know. The outpatient radiology department would know who upstairs is waiting for a bed or waiting for a chest X-ray to go home. Provisional X-ray to go home before they're cleared. I would make sure everybody knew that. It would be-- I would end every huddle. I would end all that communication about information that could be in a text message. But I would have that as my first thing, and then I would build an action center. And that action center would have who's gonna fix this Who-- when are they gonna do it? And what barriers do they need removed in order to do it? And that's it. I'd turn that on. I'd give it eight weeks How simple and fabulous is that? It's, it's fabulous. Yeah. As I tend to be. So if people wanna find more information about who you are and what you do, how can they do that? Well, I have just launched Johnnie, J-O-H-N-N-I-E D’Alesandro. Uh, they'll probably have to get that off the, off your link. Yes. We'll link it in, in, yeah, underneath the podcast. Yeah. But, uh, that's where I, that's where I'm at. My company is amplify.com, which is a, uh company that offers the handholding to get these very simple systems folded into the way you do work It's amazing, and it, it's transformational, and I really enjoyed learning about it. I appreciate that very much. I, uh, as a manufacturing guy walking around in hospitals, you know, very often it's quite helpful if somebody with an MD says, "You know, that makes sense." John D’Alesandro, thank you so much for joining me today. I really enjoyed the conversation. Thank you. I enjoyed being here.

Thank you for tuning in to Taking Healthcare by Storm: Industry Insights with Quality Insights Medical Director Dr. Jean Storm. We hope that you enjoyed this episode. If you found value in what you heard, please consider subscribing to our podcast on your favorite platform.

If you have any topics or guests you'd like to see on future episodes, you can reach out to us on our website. We would love to hear from you.

So, until next time, stay curious, stay compassionate, and keep taking healthcare by storm.