1. Understanding Capacity Demand and Flow Essential measures and processes for understanding healthcare

2. Why Capacity and Demand? Context Resources are limited and will remain so Increasing pressure to achieve targets How can we achieve more? –with current resources? Do we really need more resources? Do we know?

3. Roadmap for Continuous Improvement Map and analyse the patient journey Measure Activity, Backlog, Capacity and Demand Redesign the bottlenecks Measure and monitor Identify the bottlenecks

4. Terms Bottleneck and Constraint Demand Capacity Activity Backlog Segmentation vs Carve Out Variation Flow

5. Capacity resource x time it is available to be used Definitions: Queue Waiting list = Queue = Backlog = Work in progress x the time it takes to process a patient Activity number of patients treated x the time it takes to process a patient Demand All requests for service from all sources x the time it takes to process a patient Bottleneck or Constraint Whatever defines the capacity Bottleneck Currently limits activity

7. Measurement Activity Backlog Capacity Demand All in the Same Units

8. Mapping the journey – How long does a scan take? Prepare patient Scan patient Get off scanner Report Films Type Report

9. How long does a scan take?

10. For a sample of 6 weeks, for every 23 scans done 2 took > 20 minutes

11. Measure Activity Keep a daily record...

12. Measure the Queue Convert the queue (waiting list) to time We don’t need to count these every week 21/23 X 20/60 X 1758 2/23 X 40/60 X 1758 637 hours +=+=

13. Measure Capacity Measure available time for each resource

14. Measure Demand Measure all demand from all sources Convert to time One appointment type Every patient gets 20min appointment Only those for certain procedures or from ITU get 40 minutes (2 slots) Demand converted to time

15. Everything in the same units Activity converted to hours Capacity converted to hours Queue converted to hours Demand converted to hours For the same time period

16. Plot everything on the same graph... If activity > demand why do we have a backlog?

17. Monitor progress…

18. Summary Why measure What to measure How to start How to present it