Using the IST capacity and demand tool in practice our experience

Vicki Decroo

Ali Coote

Ipswich Hospital NHS Trust

Background

• We have been using IST tools for C&D work at the trust since around 2009

• We invited IMAS to support us in late 2014 but the work did not start in properly till Feb 2015

• We have also used other in house developed models in the past

Planning • Make sure you chose the right tool for your needs the IST website has all

the current version available along with the up to date versions so when using always start with the current version

• If you get clinical input into the tool it will help you plan any recovery trajectories with more confidence you will also be able to sense check it as you build it

• You will need executive leadership to keep a focus but you also need a nominated operational lead to keep the work on track otherwise you will not drive forward with getting all areas to complete the tools

• Consider which specialities you need to do the tool for. Do you need a trust wide view or just more detail on some specialities before planning your role out?

What tools are available

• Advanced Flow Capacity and Demand Model

• Outpatients Capacity and Demand Model

• Inpatient / Daycase Capacity and Demand Model

• Two Week Wait Cancer Capacity and Demand Model

• Endoscopy Capacity and Demand Model

• Diagnostic Imaging Capacity and Demand Model

• Demand and Capacity Guidance for Cancer Pathways

Key things

• Don’t be scared of the tool read the instructions and make sure you enter the right data

• Make a note carefully of the assumptions your building your model on as when you return to it you will not remember what you put in

• Support from your Information team re. getting the data for the ‘Data’ sheet is vital

• Ensure the Operational lead and the Information lead works closely together to ensure you are not comparing apples with pears

• Ensure your waiting times on the ‘Parameter’ sheet are accurately set as this does change the outputs

• On the ‘Capacity sheet, make sure you use information from receptionists and

nurses in clinic to fill in this detail as well as what your operations leads and medical staff tell you

• Sense check the data and the charts and understand what it is telling you. If its

not clear or you don’t understand ensure you raise these queries with the IST team they are happy to help by email.

• On the ‘Summary’ sheet check for any outliers and understand the reasons

behind these as these could affect your planning for the service • We used challenge and drop in sessions with the operational teams during the

building of the models to give the teams a change to ask questions and raise concern's over the data early – they worked very well, and enabled us as well as IST challenge re the populated models.

• Check and double check your input, if you put the wrong data in it

will not make sense

How else have we used this work • In developing the models we also developed some tools to use in our

operational PTL to support sustainability and translating the outputs of the model we use these triggers for operational management as key indicators / KPI monitoring tool. (our snapshot tool)

• We pulled together a trust wide view for each of the models we compelted for easy viewing at divisional level

• Despite some initial grumbles from the operational leads about time pressures all compelted the work and once having done so and the impact it had for teams - individual staff have been quite positive about the monitoring tool once they got into how it works

• We have used the output from the original models to incorporate the D&C work as part of business as usual and business planning in this planning round, we have already refreshed the DI models and plan to refresh the rest of the models over the next 2 months

One of our overviews IST IMAS FIRST OUTPATIENTS DEMAND & CAPACITY (D&C) MODELS OVERVIEW - IMAGING

WL Size

(with/without

date)

Mean

Requests

Mean

Emergency

Investigations

Mean

ROTT

Mean

Total

Capacity

Net

Weekly

PTL Size

Change

Approx.

Substainable

Capacity

Range

Current

(patients

against

requests)

65th

Percentile

(slots

required)

85th

Percentile

(slots

required)

CT 8,470 260 167 34 422 -12 254 - 293 29 1 38

MRI 16,945 8,735 1,124 320 10,155 52 309 -327 12 19 37

Ultrasound 29,280 393 86 19 416 59 418 - 473 45 88 143

Required Capacity

65th Percentile - setting your capacity nearer to this level would meet your demand most of the time

85th Percentile - for services with high variation in demand it would be advisable to setting your capacity at this level

Required Capacity (per patient)

Comments

Imaging

CDG Speciality

Metrics (weekly) Current Capacity

IST IMAS FIRST OUTPATIENTS DEMAND & CAPACITY (D&C) MODELS OVERVIEW - THERAPIES

WL Size

(with/without

date)

Mean

Referrals

Mean

DNA's

Mean

Waiting

Time

Mean

Total

Capacity

Net

Weekly

PTL Size

Change

Approx.

Substainable

Capacity

Range

Current

(slots

required)

65th

Percentile

(slots

required)

85th

Percentile

(slots

required)

650-Lymphoedema 39 13 0.6 4 13 1 16 - 19 1 3 7

650-MSK 426 188 9.4 4 180 10 211 - 237 11 32 58

650-Neurology 74 10 0.7 12 13 -3 11 - 15 0 0 1

650-Paediatrics 120 27 1.5 9 35 -7 30 - 37 0 0 2

650-Respiratory 20 4 0.5 8 4 0 5 - 6 0 2 3

650-Womens Health 187 33 2.3 5 51 -17 34 - 50 0 0 0

Hand Therapy 651-Hand Therapy 80 30 2.2 5 36 -5 131 - 145 0 0 10

654-Dietetics (Adults) 174 33 3.1 8 28 5 36 - 42 6 8 14

654-Dietetics (Children) 56 13 1 7 13 0 15 - 18 0 2 5

Required Capacity

65th Percentile - setting your capacity nearer to this level would meet your demand most of the time

85th Percentile - for services with high variation in demand it would be advisable to setting your capacity at this level

Metrics (weekly) Current Capacity Required Capacity

Comments

Physio

Dietetics

CDG Speciality

Our snapshot tool

Trust Total 4

13-M

ar-1

6

20-M

ar-1

6

27-M

ar-1

6

03-A

pr-1

6

NonAdmitted

95.15% 95.71% 95.85% 94.41%

Backlog 18+ 325 323 347 370

Admitted

84.15% 88.59% 89.89% 87.93%

Backlog 18+ 318 323 369 381

Total WL 14083 14204 14263 14521

% Incompletes 96.3% 96.3% 95.9% 95.8%

18 week performance %

Select from the drop down list

REFERRAL TO TREATMENT - HEADLINES

Week ending

18 week performance %

0

200

400

6000

2-A

ug-

15

09

-Au

g-1

51

6-A

ug-

15

23

-Au

g-1

53

0-A

ug-

15

06

-Sep

-15

13

-Sep

-15

20

-Sep

-15

27

-Sep

-15

04

-Oct

-15

11

-Oct

-15

18

-Oct

-15

25

-Oct

-15

01

-No

v-1

50

8-N

ov-

15

15

-No

v-1

52

2-N

ov-

15

29

-No

v-1

50

6-D

ec-1

51

3-D

ec-1

52

0-D

ec-1

52

7-D

ec-1

50

3-J

an-1

61

0-J

an-1

61

7-J

an-1

62

4-J

an-1

63

1-J

an-1

60

7-F

eb-1

61

4-F

eb-1

62

1-F

eb-1

62

8-F

eb-1

60

6-M

ar-1

61

3-M

ar-1

62

0-M

ar-1

62

7-M

ar-1

60

3-A

pr-

16

Admitted backlog - 18 week breaches

Trust TotalAdmitted TolleranceAspirational Target

0

500

1000

1500

02

-Au

g-1

50

9-A

ug-

15

16

-Au

g-1

52

3-A

ug-

15

30

-Au

g-1

50

6-S

ep-1

51

3-S

ep-1

52

0-S

ep-1

52

7-S

ep-1

50

4-O

ct-1

51

1-O

ct-1

51

8-O

ct-1

52

5-O

ct-1

50

1-N

ov-

15

08

-No

v-1

51

5-N

ov-

15

22

-No

v-1

52

9-N

ov-

15

06

-Dec

-15

13

-Dec

-15

20

-Dec

-15

27

-Dec

-15

03

-Jan

-16

10

-Jan

-16

17

-Jan

-16

24

-Jan

-16

31

-Jan

-16

07

-Feb

-16

14

-Feb

-16

21

-Feb

-16

28

-Feb

-16

06

-Mar

-16

13

-Mar

-16

20

-Mar

-16

27

-Mar

-16

03

-Ap

r-1

6

Admitted pathways that have waited 10-18 weeks

Trust Total

0500

100015002000250030003500

02

-Au

g-1

50

9-A

ug-

15

16

-Au

g-1

52

3-A

ug-

15

30

-Au

g-1

50

6-S

ep-1

51

3-S

ep-1

52

0-S

ep-1

52

7-S

ep-1

50

4-O

ct-1

51

1-O

ct-1

51

8-O

ct-1

52

5-O

ct-1

50

1-N

ov-

15

08

-No

v-1

51

5-N

ov-

15

22

-No

v-1

52

9-N

ov-

15

06

-Dec

-15

13

-Dec

-15

20

-Dec

-15

27

-Dec

-15

03

-Jan

-16

10

-Jan

-16

17

-Jan

-16

24

-Jan

-16

31

-Jan

-16

07

-Feb

-16

14

-Feb

-16

21

-Feb

-16

28

-Feb

-16

06

-Mar

-16

13

-Mar

-16

20

-Mar

-16

27

-Mar

-16

03

-Ap

r-1

6

Admitted waiting list size

Lower Limit Clearance Time Upper Limit Clearance Time

Trust Total Avg Admitted WL Size

88%

90%

92%

94%

96%

98%

100%

02

-Au

g-1

50

9-A

ug-

15

16

-Au

g-1

52

3-A

ug-

15

30

-Au

g-1

50

6-S

ep-1

51

3-S

ep-1

52

0-S

ep-1

52

7-S

ep-1

50

4-O

ct-1

51

1-O

ct-1

51

8-O

ct-1

52

5-O

ct-1

50

1-N

ov-

15

08

-No

v-1

51

5-N

ov-

15

22

-No

v-1

52

9-N

ov-

15

06

-Dec

-15

13

-Dec

-15

20

-Dec

-15

27

-Dec

-15

03

-Jan

-16

10

-Jan

-16

17

-Jan

-16

24

-Jan

-16

31

-Jan

-16

07

-Feb

-16

14

-Feb

-16

21

-Feb

-16

28

-Feb

-16

06

-Mar

-16

13

-Mar

-16

20

-Mar

-16

27

-Mar

-16

03

-Ap

r-1

6

% Incompletes

Trust Total Target 92%

What would we do differently when we do it again • Lead with the message to teams that the timetable is not movable.

• Be even clearer on the assumptions you make when you fill in the tool and make sure they are fully documented.

• Get more clinical input.

• Would push to get it done as the outputs have helped show the evidence in areas we are having problems but could not justify a good business case for investment into the services – these models have supported case development.

In Summary

• Don’t be scared of the tool read the instructions and make sure you enter the right data

• Make a note carefully of your assumptions your building your model on as when you return to it you will not remember what you put in

• Support from your Information team re. getting the data for the ‘Data’ sheet is vital

• Ensure the Operational lead and the Information lead works closely together to ensure you are not comparing apples with pears

Result