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

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

3. 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?

4. 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?

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

6. Segmentation Fast, medium and slow lanes

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

8. 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

9. 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…

10. 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.

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

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

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