Outcomes on record
The consultancy that has already fixed this exact problem at six other hospitals like yours.
Hospital CEOs staring down CMS penalties. CNOs losing nurses to burnout faster than they can hire. Board chairs who just read another damning quality audit. We walk in, read the building, and hand you the playbook.
Throughput Methodology
Eighteen-hour ED boarding is not a volume problem. It is a flow problem. We have solved it thirty-one times. Here is how the framework works.
Demand Signal Mapping
We pull 24 months of arrival patterns, acuity distribution, and disposition data before we step inside the building. By the time we walk in, we already know where the bottleneck lives.
Constraint Identification
Throughput problems look like capacity problems but rarely are. We locate the true constraint — usually a handoff failure between ED and inpatient — and stop treating symptoms.
Rapid Cycle Redesign
90-day sprint with embedded consultants, not slide decks. We redesign bed request protocols, discharge triggers, and transport workflows in real operating conditions.
Hardwire & Sustain
Every change is embedded in your huddle structure, EHR workflow, and leadership accountability system before we leave. The metric holds because the process holds.
Implemented at
Staffing Model Redesign
The staffing crisis is not a pipeline problem. It is a deployment and retention problem. We have rebuilt the model at nineteen health systems. The nurses are already there.
Predictive Demand Scheduling
We rebuild your core schedule off 18-month census patterns, not historical averages. Nurses know their schedule 6 weeks out. Agency use drops 40–60% within the first quarter.
Internal Float Pool Architecture
Most health systems have a float pool. Few have a float pool that works. We redesign incentive structures, cross-training protocols, and deployment triggers so internal staff fills the gap agency was filling.
Burnout Early Warning System
Charge nurse observation data, overtime patterns, and PTO utilization mapped into a 90-day burnout risk score by unit. You see the problem 3 months before the resignation.
"We had tried three agencies and two consulting firms. Rounds walked in, looked at our charge nurse deployment data for 48 hours, and found 14 nurses we were systematically scheduling off-service. We had no idea."
CNO, 620-bed Regional Medical Center · Pacific NorthwestStaffing model redesign delivered at
Margin Recovery Framework
CMS penalties, avoidable readmissions, and ED diversion are not line items. They are symptoms of operational dysfunction with a precise dollar value. We recover it without cutting headcount.
CMS Penalty Exposure Audit
ImmediateWe quantify your exact HRRP, VBP, and HAC penalty exposure before we propose a single intervention. Most systems are surprised by the number. The audit takes 2 weeks.
Avoidable Cost Identification
90 daysExcess LOS, avoidable readmissions, and ED diversion carry a specific dollar cost at your system. We calculate it to the unit level and build a recovery roadmap against it.
Payer Mix Optimization
6 monthsThroughput improvements change your payer mix exposure. Faster ED throughput captures commercially insured patients who would have left. We model this before implementation.
Sustainable Margin Architecture
OngoingOperational changes that improve margin but exhaust staff are not sustainable. Every financial recommendation is co-designed with your clinical operations leadership.
Every engagement includes a pre-intervention financial baseline, 90-day progress reporting tied to margin impact, and a 24-month sustainability audit at no additional cost. Board-ready documentation included.
Margin recovery delivered at
Take the Playbook With You
The full document goes further than this page. Diagnostic checklists, protocol templates, and the exact frameworks we use on day one of every engagement.
What's inside the playbook
- ED Throughput Diagnostic Checklist (22 items)
- Bed Request Protocol Template
- Float Pool Deployment Framework
- CMS Penalty Exposure Calculator
- 90-Day Sprint Implementation Guide
- Board Presentation Template
About Rounds
Rounds was founded by former health system operators — not management consultants. Every principal has run an ED, managed a nursing floor, or sat in a budget meeting explaining an avoidable readmission to a board. We know what the building feels like at 3 AM.
We do not sell software. We do not sell training programs. We embed, redesign, and leave behind operational infrastructure that holds without us in the room.