Disrupting the post-COVID hospital doom loop starts upstream

Hospitals across the world are caught in what many leaders now recognize as a post-COVID hospital doom loop — a cycle of workforce strain, rising patient complexity and growing capacity constraints. In a recent Inside Angle post, my colleague Shannon Garrison outlined how potentially preventable hospital returns (PPHR) offer a clearer way to understand where post-discharge care breaks down. That insight is critical — because those returns are also a key driver of the doom loop itself.

A recent Economist article described two forces pushing hospitals deeper into this cycle: declining workforce productivity and increasingly sick patients. These pressures are not temporary, and they are not confined to one country or health system type.
 

A sicker, older population — and system-wide consequences

Across nearly all income levels, patient populations are aging and managing more chronic disease. Older, sicker patients often require longer hospital stays and more intensive care. Downstream effects show up everywhere: crowded emergency departments, extended boarding times, delayed elective procedures, and worsening patient experiences.

Even well-resourced hospitals are struggling to keep pace.
 

Where can hospitals start to break the cycle?

To disrupt the doom loop, hospitals must look upstream — specifically at patterns of care that lead patients back into hospital settings when those returns might have been avoided.

This is where the PPHR methodology comes in. Rather than focusing solely on all-cause readmissions, PPHR examines clinically related returns across emergency department (ED) visits, inpatient admissions and observation stays, using claims data to highlight which encounters may have been preventable given the clinical context.

That distinction matters.
 

From broad metrics to actionable focus

Most quality teams agree that hospital returns should be reduced. But broad measures rarely translate into effective action — especially in an environment of workforce shortages and limited time.

PPHR gives teams a targeted starting point.

With a defined, high-risk population, clinical and quality leaders can apply traditional improvement methods more effectively: chart reviews, frontline interviews, and observation of care transitions. Patterns emerge — whether related to overnight admissions, weekend discharges, service-line access issues or breakdowns in follow-up, medication access or social support.
 

Small breaks, compounding benefits

Breaking even one link in the doom loop delivers compounding returns: improved throughput, reduced inefficiency, lower variable costs, and better experiences for patients and clinicians alike. Most importantly, it preserves inpatient and ED capacity for patients who truly need it.

In a post-pandemic reality, hospitals cannot improve productivity by simply asking people to work harder. Disrupting the hospital doom loop requires smarter targeting, upstream insight, and focused action. PPHR provides the analytic foundation to make that possible.

Travis Bias, DO, MPH, FAAFP, is a family medicine physician and deputy chief medical officer of health information systems at Solventum.