In recent years, more systems are turning to command centers or mission control programs to manage throughput amid rising demand.
Centralized patient flow command centers have emerged as a key strategy to enhance operational efficiency and ease capacity strain. For many systems, these command centers are relatively new or still evolving, however some systems have been building their command centers for over a decade.
Becker’s talked to leaders at five systems about structuring their command centers. Here’s how they organize their programs, and the successes and challenges they’ve seen since launching it.
5 ways to structure command centers
1. Baltimore-based Johns Hopkins Hospital has one of the oldest command centers, launched in 2016. Called the Capacity Command Center, its primary role is to manage that hospital’s capacity, though it also manages patient flow for four other hospitals in the regional network and direct care across Johns Hopkins Medicine, April Taylor, COO of Johns Hopkins Hospital, told Becker’s. The command center is headed by the chief medical officer and COO, and staffed by four main teams: the Hopkins Access Line, which handles intake calls across the region and calls from other hospitals statewide looking to transfer patients; the bed management team and admissions team, which handle internal flow and tasks; the Lifeline EMS team, which coordinates transports; and the Systems Engineering and Analytics team, which manages forecasting and predictive analytics for all functions of the center.
2. Portland-based Oregon Health & Science University’s Mission Control, which launched in 2017, serves the system’s four hospitals. The center coordinates interhospital transfers, direct admissions from clinics, ED admission, and surgical and procedural admissions. But if a patient can’t be placed within the system, the case is escalated to the statewide command center.
During the pandemic, leaders at OHSU realized their mission control needed more regional and statewide coordination. This led to the creation of the Oregon Medical Coordination Center, which serves the entire state. Any hospital or ED can contact the center for placement assistance and the center has created real-time communications across all large health systems in Oregon to make placement swifter, Mattias Merkel, MD, PhD, senior associate chief medical officer for OHSU Health, told Becker’s.
3. Altamonte Springs, Fla.-based AdventHealth has one of the largest systemwide command centers, which was established in 2018.
“Designing the command center required a lot of strategic foresight — we were essentially building for the unknown: who we were, what we could be, and where we might go,” Penny Porteous, executive director for capacity management, EMS and flight services in the central Florida Division at AdventHealth, told Becker’s. “The design is agile and customizable, which has been crucial as we’ve evolved.”
In the last few years, the command center has grown into a 12,000-square-feet hub that holds 60 monitors and seats up to 75 staff. The command center oversees 22 EDs, with plans to add three more by the end of 2025. Inside the center, there are teams that manage the transfer center, dispatch and communications, patient placement, behavioral health intake, women’s and children’s, same-day direct admissions, readmission oversight, registration, support staff such as IT, and clinical expediters for the entire system.
4. Durham, N.C.-based Duke Health’s CARE hub launched in 2019. The hub, run by four to 10 people, is a system service line that handles patient placement, clinical expediting and dispatch for EVS and patient transport. The hub is still in a temporary space as they continue to transform the program and build out operations. Recently, the hub started offering virtual shifts to some of its staff, Kristie Barazsu, president and COO of Duke Health Lake Norman Hospital, told Becker’s.
5. UC San Diego Health launched its mission control in April 2024, which oversees three hospital campuses, with support from the Joan and Irwin Jacobs Center for Health Innovation. The mission control is run by six to eight people who represent physicians, nurses, radiology, environmental services, information services and analytics. Mission Control’s initial purpose was to address patient flow and hospital capacity at its La Jolla campus, where demand is highest. Staff reroute patients to its two other campuses, proactively prevent discharge delays and use predictive analytics for up to 10 days in advance proactively manage surgical schedules and transfer center intakes, Brian Clay, MD, associate chief medical office at UC San Diego Health, told Becker’s.
Building successful centers
Each command center or mission control has a unique function and reach, but the building blocks to creating a successful program are the same.
“Stakeholder engagement is absolutely critical,” Dr. Clay said. “Mission Control can’t unilaterally change workflows. We’ve had to work closely with clinical teams, operational leaders, IT, and strategy to get where we are. Whether it’s trying to change ED referral patterns or explore chronic disease management tools, we need partnership.”
Clear executive leadership and governance is also vital for change management on a large scale, as is defining the protocols and accountability needed to make decisions systemwide, Ms. Porteous said. This clear chain of command is necessary both inside the center, and outside to ensure front-line staff can effectively escalate issues.
“Trust is the ‘secret sauce,'” Dr. Merkel said. “We’ve built credibility so that when anyone in the system needs reliable capacity data, they turn to us. We provide the same unbiased view to all service lines and ensure consistency.”
Creating that trust comes in a number of ways, including creating a huddle structure, escalation paths for front-line staff, systemwide meetings, setting expectations and creating consistent follow through.
Ultimately, data is at the heart of a command center’s success. This means picking the right analytics to monitor, ensuring transparency around KPIs and creating predictive analytics.
“We’ve seen other systems struggle without those building blocks in place,” Stephanie Gilliam, RN, director for OHSU Mission Control, told Becker’s.
Biggest wins
Command centers have been linked to a number of big wins:
1. At UC San Diego Health, the command center has made a reduction in front-line calls for discharge-related delays, and helped maintain hospital length of stay data amid growing case mix index and overall volume — including growth in admissions, procedures and OR activity.
“In other words, we’re moving more patients through the same number of beds without sacrificing quality. That’s a win,” Dr. Clay said.
2. At Duke Health, the CARE hub has improved length of stay, reduced agency expenses and reduced CAUTI cases by more than 75% in 60 days.
3. For AdventHealth, the command center reduced inefficiencies, increased throughput and preserved high-level services.
“Our biggest win was shifting the culture from a campus-based to a system-based mentality,” Ms. Porteous said. “Instead of one hospital drowning while another had beds available, we could shift resources and patients accordingly. This let us preserve our high-end tertiary and quaternary care beds for those who truly needed them — improving community access to care and resource utilization. Ultimately, we stopped thinking in terms of ‘this campus’s patient’ or ‘that doctor’s patient’ and began thinking in terms of AdventHealth patients and systemwide service delivery.”
4. The Johns Hopkins Hospital has seen increases in productivity, real-time and coordinated bed management, improved situational awareness, discharge planning and discharges before noon, length of stay, ED boarding time, and intake coordination.
5. At the hospital level, OHSU has seen improvement in their case mix index, reduced length of stay for targeted populations and increased number of patients without expanding bed count. Statewide, its command center has cut average ICU placement time for unplaced patients to just 4.5 hours. It also improved transfer to community hospitals, preserved capacity for high-complexity cases, and allowed hospitals to operate a full census without being out of beds.
Common challenges to overcome
Command centers are a large undertaking that come with many challenges.
For newer centers, the major challenge tends to revolve around awareness.
“We invested in a lot of outreach through weekly newsletters, leadership presentations, and even open invitations for tours of the space,” Dr. Clay said.
For established command centers, challenges tend to be external, such as the COVID pandemic or transitioning to a new EHR.
“That was a monumental challenge,” Ms. Porteous said about their transition to Epic. “Our region is structured under one Medicare license and one medical staff, which complicated Epic’s implementation and required customized workarounds. But now that the dust is settling, we’re finally optimizing workflows and understanding the data Epic provides.”
There can also be a moral challenge for command centers and hospitals during surges:
“You want to help everyone, but logistical delays — moving patients, opening beds — create stress. That emotional toll needs to be actively managed,” Dr. Merkel said. “What’s helped is the sense of collective effort: a feeling that we’re all in it together.”
But across the nation, one challenge is consistent regardless of how long the command center has operated: the lack of beds and funds. Many hospitals and systems are facing demand that outpaces their supply of beds. Command centers are working to improve access to beds, but the need for more beds remains. Although many systems are working on expansion projects or building new hospitals, these projects take years.
“Some patients require complex, long-stay care with lower reimbursement,” Ms. Gilliam said. “Getting partner hospitals to share that burden equitably has been difficult but necessary.”
But beyond the lack of beds there is a funding crisis.
“Command centers are growing across the U.S., and that’s encouraging,” Dr. Merkel said. “We must advocate for sustainable funding. These centers offer the most effective tools for managing not just everyday flow but emergencies, disasters and surges. If we wait until the next disaster to stand them up, we’re already too late.”
Want to create a command center?
Want to make your own command center or are in the early stages of planning? Here are four pieces of advice from those already doing it:
1. Ms. Porteous: “Start with clear governance and a defined purpose. Make sure all stakeholders — from front-line staff to executives — understand and buy into the role of the command center. It’s all about intentionality and communication.”
2. Dr. Clay: “First, figure out what problem you’re trying to solve. At UCSD, it was La Jolla’s overcrowding. For others, it might be optimizing tertiary referrals or increasing access to specialized care. Your goal determines who needs to be at the table. Second, empower your team. Give them authority to make change within clearly defined parameters. Without the ability to adapt and improve workflows, the team will be limited in what they can accomplish.”
3. Ms. Taylor: “Don’t just focus on the room and technology. It’s easy to get excited about screens and dashboards, but that’s just the structure. Prioritize process design and think about workflows from end to end. Consistency is key. Standard huddles, communication workflows, and escalation paths allow a command center to scale and sustain success.”
4. Ms. Barazsu: “Every day that you don’t take action is a day of opportunity lost. We have a great opportunity, even obligation, to continue to find ways to continually improve the ways we deliver within our industry. ‘Improve’ here is an intentionally nebulous word because some days it could feel like care delivery is the opportunity, other times organizational engagement, or cost of delivery — the fact of the matter is it is all of them, all the time, and more.”
