Smoothing the Flow: the M25

Dr Steve Kingsbury

Dr Ann York

Topics to be Covered

Demand and capacity definitions Bottlenecks Segmentation and Carve-out Batching and Hand Offs Variability Churn Anticipating Flow

Demand: definition

demand is not a number of referrals it is how much staff time each referral takes to

discharge times the number of referrals e.g. 10 referrals that take 10 hours each are a

demand of 100 hours How much car parking space do we need?

Capacity: definition

again capacity is not a number like 3 staffbut a number of units of time that can be delivered e.g. 3 staff can deliver 3 x 16 clinical hours = 48 hours

How many cars can we park?

Bottlenecks

demand greater than capacity bottlenecks can occur at any step of a process queues form at bottlenecks (Waiting list!)

Segmentation

Fast, medium and slow lanes

Carve-outs

Reserving capacity for a set task e.g. bus lanes inefficient as often under-utilised or constrain

patient flow

Batching

Grouping tasks that is efficient for the task but causes delay for those who were batched first

Traffic lights Those waiting are not happy

Variability

If two or more processes aren't in synch then together they can function very poorly.

Here the two processes are traffic arriving and the traffic lights.

Churn

Over use of priority criteria which moves a section of the demand through the system “churning” leaving the “sediment” behind..

Anticipating Flow

Why are fixed assessment or treatment clinics helpful?

If we wait for capacity………

Compared to anticipating capacity..

Smoothing the Flow

Once all the eddies and turbulence are removed….