Understanding Variation and Setting Capacity

1. Understanding Variation and Setting Capacity

2. Why do we get backlog and queues? • Because demand exceeds activity • Because we want to be efficient • Because we do not take account of variation • variation in demand • variation in capacity • the interaction between the two

3. Staff Process Patients motivation age unclear motivation skills disease guidelines differ holiday illness education race training shifts sex complications anaesthetics GP Discharged! machines not the same transcription transport supplies 80% is under our control rooms not the same applications Information Kit Sources of variation in a clinical system

4. What variability? • GP • Number of patients • Number of problems • Investigations • Length of appointments • Outpatients • Number of referrals • Number of staff • Investigations needed • Length of consultation

5. What variability? • Ward • Length of pre-admission stay • Length of post-op stay • Intensity of nursing required • Staffing levels • Theatre • Number of cases • Length of cases • Anaesthetic time • Recovery time • Turnaround time

6. Sources of variation activity • Identify examples of variation in your specialty

7. Variation in Discharge - By time of day - By day of week - Seasonal variations Variation in patient pathways and processes. E.g. in Length of Stay Variation in Admission Patterns - particularly for Elective Care Bed availability - an example of the problem of variation ADMISSION IN-PATIENT STAY DISCHARGE

8. Variation in Discharge - By time of day - By day of week - Seasonal variations Variation in Admission Patterns - particularly for Elective Care “We always bring our hips in on Tuesday !” ADMISSION IN-PATIENT STAY DISCHARGE Variation in patient pathways and processes. E.g. in Length of Stay

9. Variation in Discharge - By time of day - By day of week - Seasonal variations Variation in patient pathways and processes. E.g. in Length of Stay Variation in Admission Patterns - particularly for Elective Care “We’re too busy in the morning and haven’t time to think about discharges. They all get done in the afternoon. ADMISSION IN-PATIENT STAY DISCHARGE

10. Understanding demand and capacity by hour of the day

15. Queue Demand Capacity time Variation mismatch = queue Can’t pass unused capacity forward to next week

16. How should we set capacity? • Set capacity to average demand? • Set capacity to maximum demand? • Something else?

17. Capacity set as average demand Wait Seen Setting capacity to Average demand 100% utilisation each day = very efficient as long as there is a queue Lots of energy shuffling the queues High risk if we get it wrong (clinical and financial)

18. Capacity set as maximum demand Wait Seen Poor utilisation Large amount of wasted clinic time Very inefficient use of resources Setting capacity to max demand

19. But how do we cope with the variation in workload from day to day? See today’s work today Solution:Flex Capacity

20. Or Step 1: Understand why capacity and demand vary. Find the root cause Step 2: Reduce the variation Step 3: Set capacity to the 80th percentile (not the average) Step 4: Flex capacity to match demand Solution:Reduce variation

21. Mean 80th percentile 50th percentile (median) Highestvalue Lowestvalue Variation 80th percentile...

22. 80% of what? • 80% of the demand falls below the line: • sort the patients/clinics into order • draw the line where 80% of the demand will fall below, and 20% above the line • Quick equation: minimum demand+ ((Maximum demand – minimum demand) x 0.8) = 80% of variation in demand

23. A model of variability... “The Variation Model” For model go to www.steyn.org.uk/models/demand analysis.xls

24. A new definition of capacity... • Capacity is not activity • Capacity is not “100% utilisation of every resource” • Capacity is maximising utilisation of the constraint • Capacity should be set at the 80th percentile of the demand