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Optimising existing services -
Understanding Capacity, Demand and Flow
Lesley Wright – Quality Improvement Consultant
Approaches to optimising services
3 key activities:
• Understand capacity, demand and flow
• Improve data quality
• Maximise capacity
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85% of the reasons for failure to meet customer expectations are related to
deficiencies in systems and process rather than the employee. The role of
management is to change the process rather than badgering individuals to do
better”
“ If I had to reduce my message for management to just a few words, I’d say it
all had to do with reducing variation” – W Edwards Deming
‘Foster wholeheartedly the growth and development of all staff, including
their ability and support to improve the processes in which they work’
A promise to learn a commitment to Act:
- Prof. Don Berwick – President , Founder IHI
Understanding Capacity, Demand: definitions
Capacity: Resources available to do the work.
Equipment (kit) AND the skill (people) to do the work.
Measure: multiply number of pieces of kit (rooms) and staff available to do procedure in minutes. e.g.
2 CT scanners staffed 9am – 5pm (8 hours) = 960 minutes of capacity per day
Demand: Work you are requested to do.
All the requests / referrals coming from ALL sources.
Measure: multiply number of patient requests/referrals by the time in minutes to do procedure
Timings: from the patient entering the examination room to leaving (80% of the time)
20 referrals x 15 minutes (time to perform procedure) = 300 minutes demand
NB. Measuring appointment time will over estimate demand.
20 referrals given a 20 minute scheduled appointment = 400 minutes demand
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Understanding Capacity, Demand: definitions (2)
Activity: Work carried out by staff.
Measure: Multiply number of patient requests/referrals by the time in minutes to do procedure.
Timings: from the patient entering the examination room to leaving (80% of the time)
Activity should be measured in same time allocations as demand
1 X15 minutes demand = 1 x 15 minute activity
Backlog: WL: – what you should have done.
Backlog is the demand not dealt with because all appointments are taken. With enough capacity they would have been seen.
Measure: Multiply number of patient requests/referrals by the time in minutes it takes to do procedure.
20 referrals waiting x 15 minutes (time taken to perform procedure) = 300 minutes WL/backlog
Planned waits/ deferred demand: are requests that MUST be included in backlog as they
will become demand and require capacity
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Activity is NOT demand
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Source: Imaging & Oncology 2016
Improving data quality
Why is good data important
• Operational management
• Business case development
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Vitals Flow Charts ©
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Vitlal's Charts for St Elsewhere's Endoscopy Deoartment
demand activity WiP = cumulative diff
WIPDemand and activity
© Slide courtesy Dr. Kate Silvester www.improvementscience.net
Collect: All patients requested after beginning 19/01/15
Examined before end 18/01/16
Patient 1
Patient 3
Patient 4
Patient 5
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Patient 2
Want patients
below19/01/2015 18/01/2016
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Activity
Demand
Demand & Activity
In WIP
Conventional intuitive way request data
Information window 19th Jan 2015 – 18th Jan 2016
© Slide courtesy www.improvementscience.net
Miss:
Activity, Demand &WIP
Lead times distorted
Request
receivedPatient
Scanned
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Demand, Activity & WIP: CT Jan 2015
Daily demand Daily activity Cumm. Diff. betw. Demand and activity (WIP)
Incorrect (intuitive) data collection
Data Window19/01/2014 01/11/2016
19/01/2015 18/01/2016
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Correct way: Counter-intuitive request
and examined after 19/01/15All patients requested before end 18/01/16
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request
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Information window 19th Jan 2015 – 18th Jan 2016
Correct way: Counter-intuitive request
© Slide courtesy www.improvementscience.net
Request
received
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Demand &
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Demand &
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Demand &
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WIP
Include:
Activity, Demand & WIP
Lead times reflect reality
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CT: Demand, Activity & WIP - 19th Jan 2015 - 18th Jan 2016
demand activity Cumm. Diff. betw. Demand and activity (WIP)
Correct (counterintuitive data collection)
Homerton CT Patients: Demand, Activity WIP 19th Jan – 31st Jan 2015
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Days CT; Request - Exam wc 19th Jan - 31st Jan 2015
BaseLine 1.20.010
Understanding Flow - Impact of ‘carve out’ on capacity
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63 queues
• Balanced Capacity & Demand will not be sufficient if ‘carve out’ slots or sessions www.steyn.org.uk/
Impact of ‘carve out’ simulation
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demand waiting list waste
For model go to www.steyn.org.uk/models/demand analysis.xls