Understanding Variation and Setting Capacity. Why do we get backlog and queues? Because demand...
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Transcript of Understanding Variation and Setting Capacity. Why do we get backlog and queues? Because demand...
![Page 1: Understanding Variation and Setting Capacity. Why do we get backlog and queues? Because demand exceeds activity Because we want to be efficient Because.](https://reader035.fdocuments.us/reader035/viewer/2022062519/5697bfc01a28abf838ca3dd3/html5/thumbnails/1.jpg)
Understanding Variation and Setting Capacity
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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
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3
GP Discharged!
Staff
skills
illness holiday
motivation
trainingshifts
Patients
Kit
Process
rooms not the same
supplies
machines not the same
age
sex
race education
motivation
diseaseunclear
guidelines differ
complications anaesthetics
80% is under ourcontrol
Information
transcription
transport
applications
Sources of variation in a clinical system
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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
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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
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Sources of variation activity
• Identify examples of variation in your specialty
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Bed availability - an example of theproblem of variation
IN-PATIENT STAYADMISSION DISCHARGE
Variation in patient pathways and
processes. E.g. in Length of Stay
Variation in Admission Patterns
- particularly for Elective Care
Variation in Discharge - By time of day- By day of week
- Seasonal variations
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IN-PATIENT STAYADMISSION DISCHARGE
Variation in patient pathways and
processes.E.g. in Length of Stay
Variation in Admission Patterns -
particularly for Elective Care
Variation in Discharge - By time of day- By day of week
- Seasonal variations
“We always bring our hips in on Tuesday !”
![Page 9: Understanding Variation and Setting Capacity. Why do we get backlog and queues? Because demand exceeds activity Because we want to be efficient Because.](https://reader035.fdocuments.us/reader035/viewer/2022062519/5697bfc01a28abf838ca3dd3/html5/thumbnails/9.jpg)
IN-PATIENT STAYADMISSION DISCHARGE
Variation in patient pathways and
processes.E.g. in Length of Stay
Variation in Admission Patterns
- particularly for Elective Care
Variation in Discharge - By time of day- By day of week
- Seasonal variations
“We’re too busy in the morning and haven’t time to think about discharges.
They all get done in the afternoon.
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Emergency Demand - Decision to admit/hour
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Understanding demand and capacity by hour of the day
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Discharged patients/hour
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Emergency & Elective Admissions April-November 2002
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time
Demand Capacity
Queue
Can’t pass unused capacity forward to next week
Variation mismatch = queue
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How should we set capacity?
• Set capacity to average demand?
• Set capacity to maximum demand?
• Something else?
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Setting capacity to Average demand
Wait
Seen
Capacity set as average demand
100% utilisation each day= very efficient as long as there is a queueLots of energy shuffling the queuesHigh risk if we get it wrong(clinical and financial)
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Setting capacity to max demand
Poor utilisation
Large amount of wasted clinic timeVery inefficient use of resources
Wait
Seen
Capacity set as maximum demand
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Solution:Flex Capacity
See today’s work today
But how do we cope with the variation in workload from day to day?
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Solution:Reduce variation
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
Or
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80th percentile...
50th percentil
e(median)
80th percentil
e
Variation
Lowestvalue
Highestvalue
Mean
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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
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A model of variability...
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demand waiting list waste
“The Variation Model”For model go to www.steyn.org.uk/models/demand analysis.xls
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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