Intelligence on demand, capacity and activity change ideas

Below are the changes that can be made to your system which should help you use intelligence on demand, capacity and activity. Prioritise which change ideas to implement first based on what you have learnt whilst understanding your current system.

Understanding demand, capacity and activity

Set up routine access to demand, capacity and activity data: Work with the local business intelligence team to be provided with monthly run charts showing:

• Capacity, as defined by the number of appointment slots that could theoretically have been provided given the staffing, for a single type of appointment for example, new/return appointments.

• Activity,  as defined by all booked appointment slots of a single type, regardless of whether the patient attended or not. Cancellations that are successfully reallocated should not be included as the capacity was utilised as activity. Those cancellations that are not reallocated should be considered similarly to those who did not attend (DNAs) for the purposes of this measure (capacity that is not utilised as activity).

• Percentage of capacity that was used to deliver direct clinical care as the activity/capacity.

Use a Pareto chart to understand core demand: Present demand data in a pareto chart to help ensure that all staff in the service have the skills to be able to meet demand. The service can flexibly meet the majority of its demand and deploy an amount of inflexible specialist capacity to meet non-core demand.

• Use the QI Zone guide and template for a pareto analysis.
• Use the chart below from “Why do we get Queues and Waiting Lists?” by K Silvester and R Steyn to gain a better understanding of how a service can identify its core demand and arrange its skills mix around this.

Using a capacity calculator: this can help to understand time available for the main work activity, for example seeing patients or managing a service. The capacity calculator, is an excel spreadsheet that calculates this from the time spent on activities other than the main work activity, thus providing opportunities to reallocate work and achieve “contracted” capacity.

Matching capacity to demand

Match the amount to the need: unless you can measure your demand and your capacity you have no way as a service of getting the balance right.

• Track demand over time and consider seasonal effects at the annual (for example summer vs winter months) and weekday level. Services that can estimate their expected demand within a range can adapt their capacity in anticipation of periods of high demand.
• Aim for a level of capacity that would be able to provide enough appointments to meet 80% of the range in expected demand (80% of the range = minimum expected demand + 0.8*(maximum expected demand – minimum expected demand)). Adjust this range for seasonality.
• Seek to understand and reduce sources of variation in demand, both seasonal and non-seasonal. By reducing variation, a better estimate of expected demand can be reached. If using the 80% rule above, reducing variation will move the 80% of the range in demand closer to average demand, which means using less capacity for the same result.  

  The charts below show how capacity can be measured against demand. A simple range can give a reasonable estimate of the required capacity (please see the 'Referrals to service (Demand) chart') although this estimate can be refined and improved by introducing seasonality and more sophisticated statistics such as confidence intervals. 

When capacity is expressed as a percentage of the range in demand, negative percentages indicate that there is not enough capacity to meet even the minimum expected demand. Percentages above 100% indicate that capacity exceeds the maximum anticipated demand. If there is a waiting list for the service then this surplus capacity can be allocated to removing some of this backlog. 

Service footprint

Reduce the number of components: A key change that will result in more streamlined processes and achieved through redesign and standardisation.

Plan how many of each type of session you need to deliver as a service to meet projected demand. Think clinics (all kinds including phone and virtual), theatre or procedure lists. Think about who could staff each session:

• just like clinical time, admin time scales with the volume of demand, so include this within your service footprint
• plan for delivering these over 50 weeks of the year
• consider seasonal variation
• plan for regular cover and backfill for both planned and unplanned leave, and
• build in prospective cover.

Your change ideas

If you have developed your own change ideas that could be included in this change package then get in touch through the feedback form or by emailing us at his.accessqi@nhs.scot.