03 December 2021

The push to simplify and improve healthcare for certain patient groups
lengthens the waiting times for others. Research from LiU shows that in all
healthcare logistics, it is important to see the big picture – in order to
avoid sub-optimisation and unwanted consequences.

Hospital corridor.
In the thesis combined results from a case study and a quantitative before/after study are used to analyse whether the implementation of standardised cancer care pathways leads to crowding out effects. upixa


Olle Olsson.Olle Olsson.

In his doctoral thesis Managing variation in hospital patient flows, Olle Olsson studies whether standardised healthcare flows lead to crowding-out effects and longer waiting times for the patients with illnesses not included in the uniform healthcare model. The risk of such effects has been discussed for many years, but scientifically confirming their existence has been difficult.

Olle Olsson’s doctoral thesis shows, in a quantitative study, that crowding-out effects actually exist, and which patient groups they affect.

“The effect isn’t particularly big, but it’s clear. The patients who are affected most are the ones who are at the top of the ‘prioritise’ list, but are then bypassed by the patients in the standardised patient flows”, says Olle Olsson.

Several benefits

In standardised patient flows, all patients with a particular disease must be received and treated in the same way, regardless of who they are and which part of the country they live in. The model was originally introduced for cancer, but has subsequently been applied to other diseases. In general, with standardised patient flows, the patients they cover are prioritised higher than before.

“Also, it’s a more convenient method, and it delivers several other benefits for the healthcare system”, says Olle Olsson, adding that the crowding-out effects can, to a degree, be counteracted.

“It’s not easy. But if you’re aware of the problem and include it in the descriptions of the patient flow, you’re off to a good start. I also think it’s important to try to limit the allocation of patients into different priority groups, because average waiting times increase when there are more categories to deal with.”


The doctoral thesis consists of three studies which were conducted at hospitals in Hässleholm, Linköping and Kalmar, where Olle Olsson now works as business developer. In the first study he compares how changes in patient flows affect bed occupancy rates and treatment times at emergency departments and inpatient wards.

The emergency wards are affected least, which indicates that they are more flexible and can more easily adapt their operations to patient volumes.

“It might depend on differences in staffing. At an emergency department there are often more staff when it’s known that lots of patients normally come in, such as after weekends and holidays, but at an inpatient ward, staff are more evenly distributed.”


In the second study, Olle Olsson shows that measures for managing emergency patient flows are more often made at the clinical level than at the hospital level. This is due to the decentralisation in healthcare, which can have many advantages, but can increase the risk of sub-optimisation. As a result, measures at one level can have unwanted consequences at another.

Perhaps the most important conclusion of the research is the need for big-picture perspectives and systematic approaches. The fundamental problem is easy to formulate but difficult to solve: how should healthcare allocate and prioritise all the patients with varying needs and illnesses.

“That's a general lesson from my three studies”, says Olle Olsson, suggesting some possible solutions:

“I don’t think that more centralised management will help. Developments in healthcare will require decentralisation, and whichever organisation you choose, there will be challenges. However there is a need for plans, methods and support from higher up in order to manage these problems.”

Read the thesis

Latest news from LiU

A man in a suit holds a green plant in his hand.

LiU involved in a megastudy on climate behaviour

What is the best way to make people behave in a more climate-friendly way? Researchers at Linköping University and Karolinska Institutet have contributed to a worldwide study on this topic.

Nerve damage from cancer treatment can be predicted

Many women treated for breast cancer using taxanes, a type of cytostatic drug, often experience side effects in the nervous system. Researchers at LiU have developed a tool that can predict the risk level for each individual.

Woman in safety helmet.

Her mission is difficult – but fun and achievable

We are in the midst of a tough transition towards more sustainable development. This requires innovation and knowledge, says Marie Trogstam, a LiU alumna who is now head of sustainability and infrastructure at the Confederation of Swedish Enterprise.