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Smoothing the Flow: the M25 Dr Steve Kingsbury Dr Ann York

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

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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?

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Capacity: definition again capacity is not a number like 3 staff but 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?

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

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Segmentation Fast, medium and slow lanes

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

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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

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Multiple Hand Offs Every time a patient has to be passed from one task or staff member to another they have to wait for the next task to start. Marylebone road…. Compared to…

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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.

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

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Anticipating Flow Why are fixed assessment or treatment clinics helpful? If we wait for capacity……… Compared to anticipating capacity..

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Smoothing the Flow Once all the eddies and turbulence are removed….

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