Improving patient care and performance with Demand and Capacity Management

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Demand & Capacity Management

Problem

Managing patient flow through the facility is critical to a hospital's operations. Blocked patient flow and ED overcrowding has consequences such as ambulance diverts, longer patient wait times, staff and customer dissatisfaction, compromised patient safety, lost revenue, etc. JCAHO established leadership standard (LD.3.15) to manage patient flow and prevent overcrowding. It focuses on the importance of identifying and mitigating impediments to efficient patient flow throughout the hospital, not just in the ED.

Since 1910, healthcare has evolved in silos, however, modern patient care involves several units working together. To provide appropriate and timely care units need to be aware of each other's demand loads and capacity (resource) constraints. It is imperative for the administration to foster collaboration and break down the silos. It is also important for the administration to ensure that they are pursuing strategies and actions that will enable them to achieve their strategic, quality-of-care and financial goals. Measuring, evaluating, and tuning operational performance with respect to these expectations is crucial to most successful acute care organizations.

Solution

JCAHO suggests in its recent publication "Managing Patient Flow: Strategies and Solutions for Addressing Hospital Overcrowding" that a Demand Capacity Management System (DCMS) can be used as a tool to assess, track and improve patient flow by appropriate use of limited resources. An effective DCMS measures and helps mitigate stress loads at multiple levels. Using a common language to communicate, it provides a frame of reference for all units to understand levels of stress and demand/capacity mismatch and respond consistently to such situations. It empowers staff and diffuses best practices, quite akin to having the best, most experienced charge nurse leading the floor on every shift. Finally, it creates institutional memory to enable the hospital administration establish processes for continuous improvement.

Vistaar has developed a demand and capacity management system called ACOMS that is delivered as a complete business solution, including software, consulting and implementation services and support. The software suite consists of multiple modules: Demand Capacity Manager (DCM), Administration & Configuration Module (ACM), Interface Module, Alerts Module and Reports Module.

The DCM module of ACOMS enables clinical and administrative staff in a hospital to systematically record, review, analyze and share in real time vital operational information across the facility.

DCM is organized as a system of interlinked departmental dashboards. Each dashboard includes an overall 'status-board' for all the units within a facility (see the image above). Multiple facilities are shown as tabs in the left pane (Health System version). The criteria are classified under two demand categories: Census and Acuity; and two capacity categories: Other and Staff. Census describes what that unit "counts" to determine its workload volume. Acuity includes criteria that determine the complexity of workload. Other includes criteria specific to information systems, equipment and supplies. Staff includes criteria that represent the capacity of a unit in terms of labor or human resources. Each criteria has a color-coded status to indicate the severity of the demand and capacity mismatch:

Green indicates optimal functioning, where capacity matches the patient or procedure load;
Yellow indicates some demand to capacity mismatch due to common cause variation and the need to trigger proactive interventions;
Orange represents escalating demand without readily available capacity, due to special cause variation invoking aggressive interventions to avoid system overload and ultimately gridlock;
Red represents system gridlock, calling for deployment of the organizational disaster plan.

Key Features

Intuitive and common user interface for updating and viewing criteria
Well organized display of color-coded status of categories/criteria
System generated and manual interventions for appropriate target units
Customized alerts that are delivered to users' pagers/PDAs, cell-phones or desktops
Status, Trends and Analysis reports
Broadcast ticker
Demand/Capacity Protocol modeling and customization
Interfaced data from hospital's other systems such as ADT, Bed Control, Staffing, etc.

In summary, the communication and collaboration features provided by ACOMS enable a hospital's administration to improve patient flow and achieve operational efficiency. The overall program establishes best practices and serves as a platform for specific performance and process improvement projects.

Benefits

The real-time communication and collaboration built into ACOMS makes it an ideal platform to be your operations control system. There are a number of areas where you derive benefits from the use of ACOMS.

New Capabilities

Collaboration across the entire facility and system
Access to best practices and institutional memory
Staff empowerment
Demand visibility & predictability
Continuous and sustainable performance improvement

Qualitative Improvements

Improved communication, quality, & safety
Improved patient, staff, physician satisfaction
Improved workload management
Improved bottleneck mitigation capabilities
Increased accountability and empowerment