Q:  Can demand capacity management be used in the mental health spectrum for inpatient, outpatient or a combination of those settings in both public and private systems?          

A: We have been working with whole hospital systems that include various units and the tools introduced during this seminar are applicable to any unit or clinical setting. Flow is about matching capacity and demand so demand capacity management can be used in any setting where you are dealing with patients coming in and patients going out.

Q: How would we calculate capacity and demand at our organizations after this seminar? Would these calculations require us to rely on information systems staff at our organization or are these calculations something that could be done manually in 10 minutes or so at the start of the day?

A: We mainly talk about a non-technology based real-time demand capacity* tool that can be deployed in a relatively short amount of time. As the system develops and spreads, this tool can easily fit into an electronic system that may already be in place. 

*By real time, we don’t mean you’ll be reporting your data to a utilization person every 20 minutes. Faculty will be talking about what happens when you collect information at 8:00 o’clock in the morning, and how to predict your demand and capacity for the next 4 to 6 hours. Interestingly, how well you do in the next 4 to 6 hours will have a tremendous impact on what is going to happen to the stresses and the strain on the system in the next 18 hours.

Q: Have you applied this framework for improving flow since you developed it and can you quantify for us the gains you’ve seen? 

A: We’ve seen organizations set long term goals around ED door-to-floor times and other things of that nature. Over the past year, we’ve introduced intermediate measures that have to do with transition times within the hospital itself (e.g. ICU to step down), so organizations are able to show improvements in about 6 to 9 months. Some organizations have started to show improvement in the average time of day of discharge as part of the natural consequence of meeting the admissions needs from surgery, etc.

Q: Have organizations you’ve been working with provided any type of financial numbers, such as, “We’ve saved this much money by improving the discharge time and the length of stay”, etc.? 

A: The first objective is to improve delays. A secondary objective is to quantify the financial impact once delays have been reduced. Some organizations that have reduced delays have shown reduction in costs through better matching their staff to actual admissions. Other organizations have been able to increase revenue by recapturing patients diverted and those that leave the ED without being seen.

Q: Are forecasting calculations based on historical data or are calculations done ‘on the fly’?

A: We recommend looking at calculations primarily on the fly. Some historical data may be part of the information you want, but a week’s worth of historical data may be all you need to start figuring in some of your formulaic calculations. We won’t focus on setting up a schedule for staffing using historical patterns; most organizations already have a way for doing that. This process does, though, lead you to understand where mismatch in scheduling capacity to match demand exist.

Q:  Will improving the perioperative area be included in the smoothing process discussion?

A: The perioperative area falls under the real-time demand capacity work we will describe during the seminar. We will discuss very robust changes for improving and optimizing surgical flow. Smoothing of the elective surgery admissions is important, but there are ancillary methodologies that could be, depending on the mix of surgeries in your hospital, easier to implement.

Q: Our organization is an acute care setting with semi-private rooms and we are also looking at having to isolate our patients who come in from nursing homes and other areas with MRSA. Does your demand capacity framework take these types of things into consideration?

A: Absolutely! The demand capacity framework is customizable to your organizational requirements and the things that affect your organization. It is not a predetermined system – you determine how you are going to use the system. The demand capacity framework can be used as a tool to place patients more appropriately throughout the hospital. By making thoughtful adjustments, the percentage of patients being cared for in the most appropriate units should increase.