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Patient flow

Predicting patient demand with certainty

By Robin Abrey

Hospitals throughout Canada typically face the same priorities. First, survive the ‘now’, then report on it, and finally spare a moment to plan for the immediate future. As delivery and quality targets become more exacting, extra effort goes into fire-fighting to meet that first priority.

To really make a difference to hospital patient flow and waiting lists, we need to change how we think of, and use, data. Specifically, we need a new approach to capacity planning.

The traditional approach to planning capacity to meet patient demand involves a large element of “gut feel”, supported by spreadsheets and tables on whiteboards. With no helicopter view of the end-to-end system, staff often lack awareness about how their decisions affect another ward or operating room.

This creates delays for patients up and down stream, and often leads to urgent overtime placements or hiring of additional agency staff. As queues form, the focus goes on adding capacity, losing sight of the underlying patient demand.

Yet demand is actually very predictable, and even variations to the long-term mean can be forecast using accepted statistical models. Once we understand demand and subsequent patient flow, capacity can be accurately planned.

Using modern demand and capacity planning, resource decisions become evidence based and better aligned with true patient demand, cutting waiting times, enabling safer staffing levels and reducing stress.

Financial benefits come from meeting performance targets and minimizing use of overtime and agency staff. Employees are more likely to take holiday time, which in turn lowers the organization’s outstanding leave liabilities. Even changing the discharge time of day can increase the available inpatient bed capacity and shorten length of stay.

Demand and capacity planning tools like Emendo’s CapPlan provide the science to support professional judgement. CapPlan integrates automated data feeds from multiple sources including hospital admissions, discharges and transfers as well as scheduling systems. Using a range of proprietary algorithms, patient demand forecasts are produced, allowing the matching of staff and physical resources, including beds and operating rooms, to patient demand.

Unlike staff rostering and scheduling systems, CapPlan enables long term patient demand to be forecast for people and physical resources. It’s possible to plan capacity for a ward, whole hospital or region, for up to five years. Different scenarios can be modelled taking into account seasonal fluctuations in demand so staff can prepare vacation schedules, bed allocations and OR schedules accordingly.

CapPlan helped a British Columbia hospital in planning for the 2010 Winter Olympics, for example. And in the United Kingdom, Bedford Hospital NHS Trust produces winter forecasts and Christmas bed plans that match resources to forecast demand. With bed requirements known well in advance, more staff get to take annual leave and overall staffing costs fall, enabling savings in excess of £600,000 per annum.

Two groups with quite different needs use demand and capacity planning software: operational planners and front line-staff – including nurse managers, patient-flow managers and hospital executives.

Planners typically require in-depth forecasting data to guide decision-making, especially around more complex scenarios involving funding, building and other capital expenditure.

Front-line staff want practical information that provides real-time status against operational plans, giving them sufficient warning to make course corrections. At Middlemore Hospital in New Zealand, hospital occupancy is shown graphically on a large plasma screen in the staff area. Administrators and nurses can easily see in real time current admissions, occupancy, length of stay trends and predicted demand and capacity needs. This allows everyone to see at a glance gaps in a roster or ask why a ward appears to be over-staffed for no obvious reason.

Improving capacity planning is a dynamic exercise and we continue to learn about its impact on staff and patients alike. Royal Adelaide Hospital in South Australia has over three years’ experience using CapPlan for in-patient management and decision making. The hospital originally needed a suitable operational tool to introduce better information for its Patient Pathways strategy, which aims to improve the patient experience and develop capacity without any additional resources.

Royal Adelaide has achieved smoother patient flows by increasing bed availability, reducing outlier patient placement, sharpening patient discharge times, and more precisely forecasting staff requirements. Elective surgery and inpatient activity have been better matched and staff reported a better feeling of “being in control”.

We know that good capacity planning increases confidence that patient needs are planned for. To sustain this, a culture change at all levels within the hospital is required. Some people require an initial leap of faith to accept that computer-generated forecasts can be over 95 percent accurate and they no longer need to schedule an expensive safety buffer. Others may have to adjust to having more ‘head space’ and can focus on renewed collaboration with other parts of the hospital.

In Canada, Vancouver Coastal Health (VCH) is the first region to implement CapPlan, applying it across six hospital sites. CapPlan will directly benefit patients by increasing their access to an acute care bed. VCH is also using it to plan for peak patient usage and recognize recurring patterns as well as help manage occasional events like seasonal closures or H1N1 outbreaks.

To make the most of demand and capacity planning tools, operational processes must adapt, enabling staff to minimize effort and expenditure that doesn’t usefully support the patient journey. Decision-making control has to move with the information, so clinical and operational staff are empowered to coordinate and manage activity on a daily basis.

This requires hospital management to revisit their approach to planning. In this model, hospitals first plan for future demand and only then plan future supply or capacity. Once short-term demand is understood, planners have the option to adjust either the current supply or current demand (through scheduled procedures) to match.

Capacity planning software provides powerful tools for meeting demand and improving the overall patient experience. Planners and operational staff, no longer trapped into getting through just the next 24 hours, can seize new opportunities for collaboration when they have accurate forecasts of patient demand across a whole hospital or region.

Robin Abrey is Canadian Business Development Director for Emendo.

Posted May 5, 2011