Roemer’s Law: How Hospital Bed Expansion Drives Inefficiency

Residency Reflections #8

Author

Jared Dashevsky, MD
September 10, 2024 • Estimated Reading Time: 6 minutes

RESIDENCY REFLECTIONS

Roemer’s Law: How Hospital Bed Expansion Drives Inefficiency 

A few years ago, I read Who Shall Live by Victor Fuchs, one of my favorite healthcare books. In it, Fuchs discusses Roemer’s Law:

A bed built is a bed filled.

This principle highlights how hospitals, by increasing supply, can induce their own demand—essentially, if a hospital builds more beds, they’ll inevitably get used, often driven by the need for revenue. Roemer’s Law is typically used to critique hospital expansions, where adding more beds is seen as a solution to inefficiencies.

I’ve been seeing Roemer’s Law in action firsthand. Not so much in the literal sense of building more beds, but more in how we open beds. Inpatient care, for example, constantly pushes for discharges to increase throughput. Fair enough—it makes sense to keep things moving. But as soon as a patient is discharged, that bed is immediately filled, often without addressing the root cause of the bottleneck.

From an efficiency standpoint, the first solution to an inefficiency should never be to simply “add more resources.” In this case, that means beds. The focus should be on identifying and addressing bottlenecks in the system before adding resources. Streamline the process first, then see if more resources are really needed.

The first issue is an operational frustration, but the second is a major cost concern. Expanding resources without addressing the root cause of inefficiency is expensive—and often ineffective. Take emergency department overcrowding, for example. The problem isn’t that there aren’t enough beds in the ED. The real issue is boarding: patients are stuck in the ED because there are no available beds upstairs, often due to delays in discharge to post-acute facilities operating at capacity.

Simply building or expanding more beds sounds good on paper, but it won’t solve the problem. In fact, it often just increases patient volume without addressing the systemic inefficiencies at play.

Enjoy this Reflection? Share it with your colleagues:

INSIDE THE HUDDLE

Huddle+
Inefficiency Insights

Huddle+
Huddle #Trends

Huddle+
Huddle University

Healthcare Providers
Residency Reflections

COMMUNITY SPOTLIGHT

In The Huddle, we have a thread where we share things that really annoy us in healthcare. Fellow Huddle+er Sunjay shared something that we can all relate to: too many clicks in the EHR!

Reply

or to participate.