Command Centres help tackle operational pressures and cut costs

Nearly all Canadian hospitals now have sophisticated, electronic health record systems, but after years of working with them, the argument could be made that organizations are struggling with operational performance and efficiency more than ever before. Emergency departments are crammed full, waits for beds and diagnostic tests are long, and hospitals are running big deficits.

Many of Ontario’s hospitals operate in the red – according to the Ontario Hospital Association, the province’s hospitals are running ‘a structural deficit’ of $1 billion.

So, after years of believing EHRs would render them more efficient and effective, why are hospitals even further in the hole?

“A lot has been achieved with EHRs,” said Zahava Uddin, principal, GE HealthCare Command Centers. “They capture and generate a lot of important information, serve as a comprehensive system of record, and create tremendous value for health systems and the patients they serve.”

However, as an operational decision-making tool for care orchestration and capacity management, they have their limitations.

EHRs provide visibility into activities occurring within core clinical and operational workflows and organize it into dashboards by drawing on data captured within their own modules, such as the ED, imaging, inpatient units, and the OR. But teams cannot run on visibility alone. They need more intelligent insights to help see around corners, prioritize dynamically and coordinate actions.

They also need a complete picture of enterprise supply and demand. EHRs provide only part of that picture using data native to their solution. Staffing, logistics, equipment and sometimes diagnostics data reside in other systems. Without the ability to analyze and understand it together, decisions can be made without all the relevant data.

What’s missing in hospital systems, contends Uddin, is the enterprise orchestration layer. “Hospitals are incredibly complex organizations. Patient flow, staffing, diagnostics, procedures, bed capacity, discharge planning, transportation, and community services are all deeply interconnected. A change in one can quickly create ripple effects across the others, making it difficult to pinpoint where pressure is building and what actions will have the greatest impact.”

She added, “An enterprise orchestration layer helps by connecting information, workflows, and decision-making across the organization. Rather than teams operating with separate systems, reports, and departmental perspectives, they can benefit from a shared operational view to help anticipate constraints, coordinate resources, and respond proactively before issues compound.”

This type of information and intelligence is at the core of GE HealthCare’s Command Centre programs, something Uddin has been implementing in hospitals for a decade now. Uddin explained how the enterprise orchestration layer unifies data from across different source systems and modules and applies complex algorithms and AI to generate valuable insights that are easily accessible by users, and easy to understand and act on.

And because the insights are routinely updated in real-time, the technology serves as a backstop for busy clinical and operational teams managing the demands of hospital operations around the clock.

Command Centers, she noted, can help with numerous, pressing situations: Which medicine units have projected excess staffing tonight that could be redeployed to support a unit with a forecasted staffing deficit and elevated patient acuity?

Which ICU patients meet all step-down criteria but don’t have a step-down order yet, and which patients almost meet all criteria and may be candidates for step-down? Which patients with discharge orders today or tomorrow also have orders for post-discharge follow-up appointments that are still unbooked?

GE HealthCare’s Command Center Software Platform was developed and named for use in the first hospital command center hub that GE HealthCare helped design and operationalize.

Soon after, Hennick Humber Hospital in Toronto launched its Command Centre and use of the platform quickly expanded into the emergency department, the inpatient units and elsewhere.

Humber reports that it unlocked capacity equivalent to 35 beds, eliminating the need for temporary beds in non-clinical areas and reducing ED wait times by 34 percent.

Humber also reports that, during this time, it sustained patient safety performance that is 60 percent stronger than provincial and national hospital averages, explaining that its use of Command Centre for operational practices contributed to better enterprise alignment on 19 of CIHI’s 31 indicators of hospital harm.

It turns out that many use cases can be transformed by real-time actionable information when put to work throughout the hospital.

Humber is not alone in its work. In 2022, the Nova Scotia Health Authority launched C3 (Care Coordination Centre), a province-wide command centre that coordinates patient flow, capacity, diagnostics, transfers, and discharge planning through regional hubs and a centralized Provincial Command Centre.

NSHA reports there have been significant improvements. Across its 41 hospitals, NSHA reports that it reduced inpatient utilization by approximately 20,000 patient days annually, lowered average length of stay by 10 percent, and facilitated 10,000 additional patient transfers in a recent one-year period.

Uddin said, “C3 demonstrates how health systems can move beyond traditional bed management toward true provincial orchestration, treating capacity as a shared resource. By leveraging command centre technology that integrated data from nine clinical systems at the start, NSHA was able to strengthen collaboration between teams, standardize processes, improve transport and repatriation management, and support seniors and ALC patients more proactively.”

Humber and NSHA’s results are what others seek to achieve. Early in 2026, Tectonic Advisory Services – a high-profile consulting firm – held more than 30 discussions with Ontario hospital CEOs, CFOs, CIOs, and clinical, operational and digital leaders about healthcare sustainability in today’s operating environment.

From Tectonic’s analysis, “Interviewees consistently described a desired future state in which operational pressure is predicted and proactively managed, rather than responded to after it becomes a crisis. Leaders are clear they don’t need more dashboards and reports. What they want is a system-wide view of current and anticipated operational pressures, the factors in play and the actions they can take to minimize the impact on patients and staff.”

So, if command centres and enterprise orchestration technology have proven to be impactful, why aren’t all Canadian hospitals investing in them?

GE HealthCare’s Zahava Uddin offered her thoughts on this question.

She noted that some leaders mistake command centre technology for dashboards. While capacity dashboards can be helpful, their value is often greatest for senior leaders rather than frontline teams coordinating care.

“Dashboards tend to be disparate, one-dimensional, and not fully embedded in the system of daily operating practices and workflows that is happening continuously across the organization. With dashboards, if you see a problem, you likely call a meeting or a huddle. Problem is, everyone is already busy with other things,” said Uddin.

“Command centre insights, on the other hand, have great utility from SLT to frontline teams. They use data from multiple sources, and they are multi-dimensional, cross-functional, easy-to-digest, action-oriented and synchronized through a common data logic, meaning everyone is rowing the boat in the same direction. They are accessible across teams, enabling continuous collaboration and problem-solving.”

Other leaders may hesitate to begin a command centre journey because they perceive the IT implementation effort to be massive. In reality, the lift is moderate, particularly when compared with implementing a new EHR, workforce management system, or another workflow platform.

Uddin explained that the IT effort is driven less by technology installation and more by connecting and validating data feeds from existing source systems.

A core set of integrations is usually sufficient to enable foundational capabilities, the data might already be sending to other applications, and once a data feed is established it can be reused across multiple command centre applications. All of this reduces the perceived IT effort.

In fact, according to Uddin, “operational change management usually requires more attention than the technical deployment.
Incorporating insights into daily operational routines, decision-making processes and escalation pathways, and building a true team-of-teams approach is what takes time. Time that can be repurposed from the many access and flow improvement initiatives that are typically happening across the hospital and usually lacking alignment.

In practice, rather than creating additional work, command centre journeys often become the catalyst that aligns people, priorities, and improvement efforts around a common operational agenda.”

A final misconception by executives is the hospital cannot afford to invest in command centre capabilities, especially while it is under great financial strain. “Command Centres aren’t that expensive. They don’t require large, dedicated spaces with video walls, if any at all, and they don’t cost $15 million to $20 million,” asserted Uddin.

“In fact, if you’re operating unfunded beds daily and running a deficit to keep up with demand, and you’re able to unlock capacity by implementing a command centre function, you might be able to operate fewer unfunded beds or none at all without reducing services. Similarly, if you only have funded beds open, and you’re able to unlock capacity, you could backfill that opened up capacity with additional patients, for no additional hospital cost.”

“The return on investment has been proven over and over again. Increase your volume with the same or fewer resources,” said Uddin. “And you don’t have to treat patients in the hallway.”