After decentralized capacity management was started in OLVG, there has been a central capacity department for two years. The reason? More and more admission stops and postponed operations, and the shortage of nursing staff. Capacity software helps the hospital use available capacities more efficiently, says senior advisor on integrated capacity management (ICM) Lars Botman. “We see that there are fewer fluctuations because of this way of working.” The capacity software also proved useful during the budget process.
Botman, who started as a decentralized capacity manager at the OLVG Heart-Lung Center five years ago, comes from the financial world. He didn’t expect healthcare to be so complicated. “The DBC system is quite complex, because there is no direct link between the care provided and the care activities and products this leads to. In addition, you have to deal with many different interests. Departments want to improve and have a tendency to reinvent the wheel themselves, while they often need each other. We are trying to change that with our ICM team.”
Making quick progress
In order to be able to take action quickly two years ago, Performation’s services were chosen. The software was immediately available, but still had to be set up. Botman: “We have the advantage of having a business analytics specialist in our team who was able connect OLVG’s data warehouse and Performation’s software. This way we could quickly make progress.”
Agreements about the production
The capacity software quickly proved useful during the budget process and has since been given a permanent place within OLVG. Because although there is no longer an immediate crisis situation, as there was with COVID-19, it is still a challenge to meet production agreements, especially due to the lack of personnel. To maintain control of the situation, each department draws up an annual capacity plan. The budget per department is translated into the required capacity for the clinic, the outpatient clinic and the operating room.
Botman: “The great thing about the capacity software is that you can test the results against the available capacity and see in advance where things are likely to go wrong. You can then go back to the drawing board to make strategic adjustments, for example by adjusting the budget. Ultimately, you want to prevent waiting times from increasing and you failing to meet your production agreements.”
This strategic adjustment can be done in various ways. If there is overcapacity in the chain, the capacity allocation of OR and beds can be shifted between departments. Moving around between subgroups within a department is also possible. Botman: “When that space is there, you can be creative. You actually want to submit a budget to the health insurer where this check has already been done. Because the better the planning, the less you have to adjust.”
In addition to strategic management, management takes place at the tactical level. There is a hospital-wide consultation each month, for both the operating room and the bed house. Botman: “These are such important shared resources that they must be viewed across departments. Only then can you fairly and objectively allocate the available capacity dynamically based on the realized production.”
In addition, tactical guidance takes place monthly within the departments during the Tactical Plan Consultation (TPO). The important key performance indicators (KPIs) are then evaluated. This includes utilization rates in the outpatient clinic and operating room, access time to the outpatient clinic and production realization compared to the budget. We also look ahead, so that the department knows how much capacity needs to be released in the coming planning period according to the annual capacity plan.
This is done with the help of the Tactical Control Center (TCC); a software tool that monitors the results weekly via a data link. Botman: “The software makes it possible to identify bottlenecks and take action. At the TPO of the departments, two staff members are mandated to make decisions regarding schedule and plan changes. And if a change is implemented, the TCC can be used to see whether it has had the desired effect. Ultimately, this covers the entire PDCA cycle.”
The central ICM department mainly operates on a strategic and tactical level, but also helps build dashboards for operational management. This gives departments an overview of what capacity is currently available and whether adjustments need to be made based on the expected inflow and outflow of patients. A dashboard also makes it possible to look back. For example, whether the staff deployment was efficient and how many ‘foreigners’ were in the clinic.
Right Care in the Right Place
The insights that ICM provides also lead to improvement projects. For example, the project that places more focus on the provisional discharge date through discharge milestones. Botman: “If you do that, it will become clear more quickly what needs to be done before a patient can be discharged. This reduces the chance that patients will stay in bed for too long and unnecessarily take up the already limited bed capacity.” The ultimate goal is to communicate the expected discharge date as early as possible with regional partners of nursing homes, care homes and home care, to promote flow. “Good discharge planning is an important condition for giving patients the right care in the right place at the right time.”
Capacity management adds a new dimension to the pursuit of good patient care, says Botman. “We want to provide good quality care while keeping waiting lists manageable and financially healthy.” A roadmap has been created for the implementation of ICM within OLVG. By the end of 2023, almost all departments must be working with it. Botman indicates that this process goes quite smoothly. “I notice that departments recognize the urgency of this. They also want to get the most out of the available capacity, so that patients are helped in a timely manner and they are able to meet their production agreements.”
And the results are really visible. “Because of this way of working, we see that there are fewer fluctuations. Running and standing still is often the result of a mismatch between the inflow of work and the released capacity. This is not desirable for patients and staff. Every patient at OLVG is unique and deserves a personal approach. It would be a shame if we were no longer able to offer that due to sub-optimal planning. In addition, there must be a healthy working environment for colleagues, so that they maintain their vitality and continue to enjoy their work. Because without them there is no hospital.”
Fotocredits: Audiovisuele Zaken OLVG