A patient admitted to the emergency department waits hours for a bed, the hospital full, the ward she needs already over capacity. When a bed finally opens, it is because someone was discharged earlier than ideal, their need for space displacing their need for complete recovery. A surgical patient has her operation cancelled because no ICU bed is available should she need one post-operatively. A nurse works a unit where every bed is full and some patients are in hallways, the workload impossible, the care compromised. A hospital administrator juggles capacity daily, moving patients between units, delaying admissions, discharging when possible, managing a system perpetually at or beyond capacity. A flu season surge overwhelms a hospital designed for average demand, not peaks. A government announces new hospital beds, but the beds are years from opening and staff to run them are not guaranteed. Hospital capacity, the number of beds and the staff to operate them, determines how many patients can receive hospital care. How capacity is planned, funded, and managed shapes whether hospital care is available when needed.
The Case for Capacity Expansion
Advocates argue that hospital capacity must increase. From this view, current capacity is inadequate.
Hospitals are overcrowded. Running at or over capacity is normal for many hospitals. This creates patient safety risks and staff burnout. More beds are needed.
Demand is growing. Aging population and increasing complexity mean more hospital care is needed. Capacity must expand to meet growing demand.
Surge capacity is inadequate. Flu seasons and pandemics overwhelm hospitals designed with no margin. Buffer capacity is needed to handle inevitable surges.
From this perspective, hospital capacity should expand through new construction, adding beds to existing hospitals, and ensuring staff to operate additional capacity.
The Case for Appropriate Use
Others argue that capacity is only part of the solution. From this view, how hospitals are used matters as much as how many beds exist.
Many hospital patients don't need to be there. Patients awaiting long-term care, those who could be treated at home, and others occupy beds better used for acute care. Reducing inappropriate hospital use frees capacity.
Flow matters. How patients move through hospitals affects capacity. Efficient discharge processes, better community alternatives, and optimized patient flow can increase effective capacity.
Building hospitals is slow and expensive. Capacity expansion takes years and costs billions. Optimizing existing capacity may provide faster, more affordable improvements.
From this perspective, capacity solutions should emphasize appropriate use and flow improvement alongside any expansion.
The ALC Problem
Alternate level of care patients occupy acute beds while waiting for other placement.
From one view, ALC is symptom of inadequate long-term care and home care. Patients waiting in hospitals for nursing home beds represent capacity trapped by system failure. Expanding long-term care would free hospital capacity.
From another view, some ALC is inevitable. Transitions take time. Perfect coordination is impossible. Some hospital days for ALC patients are unavoidable.
How ALC is addressed shapes hospital bed availability.
The Staffing Constraint
Beds without staff to operate them are not capacity.
From one perspective, staff shortages are the real capacity constraint. Building beds without ensuring staff is pointless. Workforce investment must accompany facility expansion.
From another perspective, staff go where work is. Building capacity can attract staff. The workforce will develop if positions exist. Build it and they will come.
How staffing and capacity interact shapes actual available beds.
The Planning Horizon
Hospital capacity takes years to change.
From one view, long-term planning is essential. Hospital construction takes a decade from conception to completion. Planning must anticipate needs years ahead.
From another view, predictions are unreliable. Healthcare needs change in ways planners cannot anticipate. Flexibility and adaptability may serve better than fixed long-term plans.
How planning is approached shapes future capacity.
The Efficiency Trade-offs
Operating at high capacity is efficient but risky.
From one perspective, some spare capacity is necessary. Hospitals running at 100% cannot handle surges. Safety margins are needed. Efficiency should not mean perpetual overcrowding.
From another perspective, empty beds represent unused resources. Some level of high occupancy is appropriate stewardship. Perfect availability is not the goal.
How efficiency and capacity are balanced shapes operations.
The Canadian Context
Canadian hospitals frequently run at or over capacity. Occupancy rates often exceed 90% or even 100% in some units. ALC patients occupy significant proportions of beds. Capital investment in new hospitals is ongoing but slow. Staff shortages affect bed availability. Surge capacity is limited. Hallway medicine persists. Wait times for admission can be long. Provincial approaches to capacity vary. The capacity challenge is recognized but solutions are difficult and expensive.
From one perspective, Canada must significantly expand hospital capacity.
From another perspective, appropriate use and flow improvements should accompany any expansion.
How Canada addresses hospital capacity shapes whether beds are available when needed.
The Question
If hospitals are overcrowded, if demand is growing, if surge capacity is inadequate, if building takes years - what should we do? When a patient receives care in a hallway because no room is available, what dignity is preserved? When surgeries are cancelled because beds aren't available, what planning failed? When ALC patients wait in hospitals for placements that don't exist, whose problem is that? When we build hospitals without staff to run them, what have we accomplished? When we speak of hospital investment, how do we account for the decades required? And when someone needs a hospital bed, what determines whether one is available?