1. DCAQ, How to… Kris Wright Improvement & Support Team

2. DCAQ – Back to Basics

3. Demand All the requests or referrals from all sources for a particular service Demand CANNOT be calculated based on past Activity Demand can come from the whole (relevant) population and has NO constraints (theoretically)

4. Lessons in Demand Demand can be hidden –Demand for a service that is currently outsourced is still demand and needs to be counted –Demand can be inpatient, outpatient, returns and reviews and again it all needs to be counted

5. Capacity Capacity is the resources available to perform the work necessary Capacity is not simply the number of appointment slots Capacity is finite and is subject to a number of constraints

6. Capacity constraints Time: there are only 24 hours in a day, and only 7 days in a week Staff: numbers and shifts of staff Equipment: number of certain equipment Rooms available for running services Leave, sickness, study, administration All these have to analysed to find the critical constraint on the service

7. Activity Is all the work done within the service –Activity is subject to capacity constraints Activity does not necessarily reflect capacity or demand –April’s activity may be March’s demand –Problems may arise if you plan April’s capacity and activity on April’s demand when it is March’s demand that is being processed

8. Queue The Queue is the previous demand that has not been processed The queue needs to be understood in as much detail as we understand demand –It is important to count the patient only once in the queue, and not repeatedly for all individual steps within the processes

9. Capacity = what we could do Demand, Capacity Activity & Queue Activity = what we did Demand = All requests for a service = what we should do Waiting list, queue = what we should have done

10. DCAQ Units Units need to be consistent throughout the data, this can be patients, slots, minutes as long as D,C,A and Q are all measured in the SAME unit. Units need to be specified clearly, otherwise false assumptions could be made

11. Time: however measured, needs to be consistent. The smaller the period of time the more accurate the analysis can be and the greater weight can be given to the results –7 days can be added to give one week, but one week cannot be divided by 7 to give 7 days –Weekly data is the lowest resolution recommended DCAQ time units

12. Detail The more detail the better –As long as it is understandable and consistent –Data broken down from weeks to days to hours can be useful and can enable a further level of analysis –There is a trade-off when it comes to detail Depends on how big the problem is? Bigger problems demand more detail to analyse

13. DCAQ Questions Is there a particular area you want to analyse or a problem you want to address Is it prudent to limit the scope of the exercise and grow it once the analysis is verified Can you access the data required historically for ALL aspects of your service Do you have an information contact that can assist you with data gathering

14. Questions in Demand How can you provide demand data –Monthly, weekly, daily, hourly What is your demand made up of –New, return, OP, IP, Emergency, paediatric –Can these be broken down further: urgent, soon, routine

15. Identifying your data sources… SCI Gateway PAS SCI OP PAS HIS COMPAS RIS Unisoft Audiology Labs ECG Physio Orthotics Etc. ECG Physio Orthotics Etc.

16. Questions in Capacity How many sites does the service encompass How many consultants/staff are involved Hours, type, and allocation of appointments How many pieces of key equipment/rooms are there Think about limiting the scope initially

17. Questions in Activity How can you provide activity data? –Monthly, weekly, daily, hourly What is your activity made up of? –New, return, OP, IP, Emergency, paediatric –Can these be broken down further: urgent, soon, routine Are these categories different from the demand categories…problems

18. Questions in the Queue How can you provide queue snapshots –Monthly, weekly, daily What is your queue made up of –New, return, OP, IP, Emergency, paediatric –Can these be broken down further: urgent, soon, routine –What about the un-triaged queue Are these categories different from the demand/activity categories…problems?

19. DD D CC C AA A DD D QQ Q Plan capacity from known demand Waiting time DCAQ interactions

20. DCAQ Exercises

21. DCAQ Exercise Demand = 20 patients Capacity = 18 patients Activity = 15 patients Queue = ??? Demand – Activity = Queue Capacity – Activity = Under/Over Utilisation

22. If average Demand = average Capacity, variation mismatch = queue time Demand Capacity Queue Can’t pass unused capacity forward

23. Capacity Exercise You have been given patient demand for 12 weeks: the maximum demand is 10 and the clinic capacity is 11 each day. Is there a capacity problem here? There is a problem within this clinic…Why?

24. Optimum Capacity Optimum capacity is a figure of capacity designed to cope with the variation in demand Optimum capacity is calculated from demand data using the formula below optimum capacity = min demand + ( 0.8 (max demand – min demand ) )

26. Demand and Optimum Capacity You have been given two strings of weekly demand data, find the optimum capacity figure for both strings. Look at the average demand figures for both strings, what does this tell us about variation and the impact on optimum capacity? What about the Queue? … Prizes?

27. Queue and Capacity When the capacity is set at the value of average demand the queue builds rapidly

28. Queue and Capacity When the capacity is set at the value of “optimum capacity” the queue can be maintained more effectively

29. Exercise Key question exercise From the information given what questions would you ask about the data and the service purely from a DCAQ perspective?

30. DCAQ Questions – ‘Back to Basics’ What is the problem? Understand your service’s D,C,A & Q Measure your service’s D,C,A & Q Understand the interaction of D,C,A & Q Identify resources (i.e. staff) to assist with: –Gathering, analysing and interpreting the data