The Aukahi Center is the culmination of a multi-year effort to improve communication, optimize bed utilization, and align operations.
As home to Hawaii’s only Level 1 trauma center, The Queen’s Health Systems plays a vital role in providing care across the islands, from preventive services to complex inpatient treatment. Yet in recent years, growing emergency department (ED) volumes and longer hospital stays were straining the system, particularly at its 575-bed acute care facility in Honolulu.
Over a four-year span, ED boarding increased by 129%. Queen’s struggled to accept transfer patients, and staff faced mounting pressure to coordinate care amid resource constraints.
The root causes were widespread: staffing shortages had closed 300 community post-acute beds, physician shortages created care delays, and inconsistent leadership had disrupted patient flow processes. Operational inefficiencies weren’t just causing friction. They were creating system-wide barriers that made it harder for patients to access care when and where they needed it.
Two long-time emergency care leaders stepped forward to help guide change from the inside.
Ashley Shearer, LCSW, CSAC, began as a licensed social worker in the ED, then took on several clinical operations roles, and now serves as Senior Director of Care Coordination and Patient Flow. She partnered closely with Matt Ing, MD, a former emergency physician and emergency department medical director, and now Vice President of Medical Affairs and Chief Medical Officer. They worked together, along with other system leaders, to take on the systemic patient flow issues impacting care delivery.
“We had to stop treating length of stay as a financial issue and start seeing it as a clinical issue,” said Shearer. “Once we made that shift—with backing from the CEO and CFO—we could begin to make real progress.”
A strategic shift from reactive to proactive
Queen’s began by confronting longstanding communication and accountability gaps, including a lack of urgency around resolving operational patient throughput and discharge issues. With no central mechanism for managing patient flow, care teams often worked in silos, making it difficult to match capacity with demand or escalate issues in real time.
To address these barriers, the organization implemented a series of interconnected initiatives:
- Established Patient Flow Governance to drive enterprise-wide visibility and coordinated decision-making. By engaging stakeholders across disciplines and leadership levels, Queen’s created a culture of ownership around patient flow and built sustained engagement in improvement efforts.
- Launched Multi-Disciplinary Discharge Rounds (MDRs) to surface and resolve discharge barriers in real time. These tightly run, 90-second-per-patient discussions are anchored by a Discharge Planning Report that helps the care team align on next steps for faster, safer discharges and a reduction in avoidable delays.
- Developed a Capacity Management Plan with clearly defined surge protocols for each area of the hospital. This gave staff a shared playbook for how to respond when units reach capacity, supporting proactive decompression and reducing the risk of ED boarding and care delays.
- Optimized Bed Utilization through standardization and proactive planning. Using structured workflows and real-time data, teams can more effectively match patients to the right bed type and location. That reduces bottlenecks and improves flow across units.
- Created a “Virtual” Command Center as a pilot for centralized coordination. A dedicated phone line allowed staff to report barriers and escalate flow concerns in real time. This early model broke down communication silos and demonstrated the value of a centralized approach, paving the way for the physical command center.
- Evolved the role of Patient Flow Administrative Coordinators from reactive house supervisors to proactive leaders overseeing flow at both local and system levels. With greater authority and clearer responsibilities, these leaders became instrumental in driving daily coordination and increasing workflow standardization across sites.
This foundation paved the way for enterprise-wide accountability, stronger interdisciplinary collaboration, and faster decision-making. It also created a shared language and structure for managing capacity. When the Aukahi Command Center opened, teams already had the habits, tools, and relationships needed to make it effective on day one.
“We put the scaffolding in place first,” Shearer said. “Then, we could leverage the command center to align our teams and unlock efficiencies.”
Launching the Aukahi Command Center
In early 2024, Queen’s opened the Aukahi Command Center, a 13,000-square-foot hub located on the Honolulu campus. The center serves both the flagship 575-bed Level 1 trauma center and a 120-bed community hospital across the island.
Designed to bring together technology, teams, and operations in one location, the Aukahi Center provides real-time situational awareness, supports centralized decision-making, and aligns patient intake and discharge processes across facilities.
“We see the Aukahi Center not just as a command center, but as a commitment to quality patient care,” said Ing. “It brings our systems and people together in a way that allows us to sustain progress and continuously improve.”
Outcomes: Faster flow, better access, cost savings
In the months immediately following the launch of the Aukahi Center, Queen’s saw measurable improvements in patient flow, care coordination, ED throughput, and patient access—all without adding beds.
Command Center technology played a critical role, giving teams the real-time visibility and actionable insights needed to make faster, smarter decisions.
By integrating predictive insights with frontline operations, the Command Center empowered staff to prioritize discharges, streamline ED throughput, and accept more transfer patients while maintaining quality and safety.
Key results include1:
- 1.07-day reduction in average length of stay (LOS) in ten months
- 41.2% decrease in ED Admit LOS (a 248-minute reduction)
- 63.9% reduction in ED boarding, with 503 fewer patients waiting for beds in the tenth month vs the first month
- 22.2% increase in acceptance of patient transfers, improving access to care across the state
- $20 million in annual savings, based on year-over-year LOS reductions
“We’ve made a pretty significant impact in a short amount of time by doing our due diligence and focusing on using real-time technology to help make the patient experience better, improve quality, and improve access,” said Jason Chang, President and CEO of The Queen’s Health Systems.
Lessons for other health systems
For Queen’s, the success of the Aukahi Center wasn’t about the technology alone. It was about readiness.
By investing in governance, discharge planning, communication tools, and leadership engagement ahead of the launch, Queen’s was able to turn its command center into a strategic hub for ongoing performance improvement.
“It took many months of planning for the Aukahi Center to be an overnight success,” Ing said. “Now, the technology gives us visibility into areas where we can be more efficient, and we have the structure and processes we need to make sustained improvements.”
You can download a more detailed case study here.
[1] *All metrics provided by The Queen’s Health Systems. Length of stay, ED Admit LOS, ED Boarding, and Transfer metrics are based on data from January 2024 to October 2024. Savings calculation is based on YoY ALOS metrics from 2023 to 2024 and assume a $1200 cost per patient per day.
- All metrics provided by The Queen’s Health Systems. Length of stay, ED Admit LOS, ED Boarding, and Transfer metrics are based on data from January 2024 to October 2024. Savings calculation is based on YoY ALOS metrics from 2023 to 2024 and assume a $1200 cost per patient per day. ↩︎
