1. Modernisation Skills - the basics

2. To be covered: Modernisation methodology Why measure capacity and demand How to measure capacity and demand Summary of the steps to matching capacity & demand

3. Modernisation Methodology Mapping PDSA cycles Capacity and Demand

4. The importance of mapping the patients journey All the frustrations within the system will be highlighted Gain understanding of what happens to the patient at all key stages The volume of patients coming via different routes into the system will be quantified Shows the demands on the service and how this impacts on other services Shows gaps/bottlenecks and where the system is letting everyone down

5. Mapping may raise some of these questions: Are the access targets being met at all the key stages? Are appointments pre-booked? Are MDT protocols in place? Do patients receive adequate and appropriate information throughout their care? Does capacity match demand?

7. Demand and Capacity Demand: requests for a service Capacity:resources and time available Backlog:waiting list – what is requested but not yet done (previous demand) Activity: what has been done, how many patients seen Constraint: what prevents you meeting demand Bottleneck: place where waiting list builds up

8. Demand Waiting list = queue = backlog = work in progress Capacity Activity Constraint = kit or skill? Bottleneck Capacity = how much kit how much skill is being supplied Sigh Delay Definitions All the requests for a service from all sources

9. Equilibrium Evaporation River flows in River flows out Water level stays the same Activity DNAs Cancellations Deaths Demand

10. Measuring demand: Number of patients referredx time it will take to see them ……….at the bottleneck Demand and Capacity should be measured:

11. Measuring Capacity (examples): Equipmentx staff available to operate equipment For barium enemas: For outpatients: Number of staff available to see patients x time available to see patients

12. Measuring Backlog: Number of patients in the queuex time to process them

13. Types of system for managing demand & capacity Forced booking X Carved out capacity X match capacity to demand (try to see patients according to common need and common process – do this weeks work this week)

14. Forced booking

15. ? ? ? Carved out capacity

16. Golden Rule There are only two ways to make improvements at a bottleneck: make changes to reduce demand or make changes to increase capacity Improvement Leaders Guide to Matching Capacity and Demand NHS Modernisation Agency

17. Summary: Identify a bottleneck Map the process in detail at the bottleneck –Are all the steps necessary, can it be streamlined? Measure: –The number, type & source of requests –Time taken to do each type –Number of staff & hours to supply the service = capacity –number and type of requests waiting –How long it will take to do them Find the REAL constraint –How many of each type of patient can you fit in = scheduling –Where is the real constraint? – Work on maximising the use of your most valuable assets (whether machine, doctor, etc) demand } backlog }

18. Think about – reducing demand: –Should we see all these patients? – implement protocols –Who is appropriate to see them? – provide alternatives –Can the patient pathway or the process at the bottleneck be streamlined? (do we need to do all these steps?) –Reduce waiting lists - reduce the demands they create –Prevention, patient education Think about – increasing capacity: –Use scheduling to find and ease the constraint –Reduce the number of appointment types to reduce complexity / carve out! –Work differently – flexible hours, w/e, pre-plan and cover annual leave, extended roles, etc –Bids for resources only when constraint is equipment or staff and working differently will not help