Dynamic Capacity Management for Healthcare: Advanced Methods and Tools for Optimization

220 Pages·2010·2.101 MB·English

by  Pierce Story

Dynamic Capacity
Management
for Healthcare
Advanced Methods
and Tools for Optimization

Dynamic Capacity
Management
for Healthcare
Advanced Methods
and Tools for Optimization
Pierce Story
MPHM, DSHS
Productivity Press
Taylor & Francis Group
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New York, NY 10016
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Contents
Acknowledgments ..........................................................................................ix
Prologue: Kenji’s Story ...................................................................................xi
Preface: Blasphemy! ....................................................................................xvii
1 Introduction ...........................................................................................1
A Child of Our Own ...................................................................................2
Dynamic Capacity Analysis, Matching, and Management
(DCAMM): Concept Overview ..................................................................3
A Caveat to the Text ....................................................................................6
Note .............................................................................................................6
2 Variability: Killer of Capacity ................................................................7
The Look and Feel of Variance .....................................................................9
The Deception of the Average ....................................................................12
System Demand, Patterns, and Variability .................................................23
Patterns in Demand Variability .................................................................24
The Importance of Ranges .........................................................................27
Probability of Outcomes ............................................................................28
Variability, Ranges and Patterns, and Predictive Analytics.........................28
Outliers and Break Points ..........................................................................29
Patterns, Demand, and HODDOW WOMSOY .......................................30
Attribute Variation .....................................................................................33
Variability and Evolution ...........................................................................33
Summary: Variability and Demand ..........................................................34
Notes .........................................................................................................35
3 Interdependencies .................................................................................37
Interdependencies ......................................................................................37
Interdependencies in the Current PI Methodologies .................................40
The Missing Elements ...............................................................................40
The Biggest Missing Element: Variability ...................................................43
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vi  ◾  Contents
Interdependencies and Variability: The Origins of Dynamism ...................43
Dynamism and Systems Analysis ..............................................................46
Dynamism and Evolution ..........................................................................47
Why Not a “Live” Test, PDCA, or Kaizen Event? .....................................48
Dynamism in Systems Thinking: An IOM/NAE Perspective ....................49
Tools for Interdependency Analysis ............................................................51
Summary ...................................................................................................54
Notes .........................................................................................................54
4 DCAMM Introduction .........................................................................55
Capellini: The Better Spaghetti ..................................................................55
Capellini and Hospital-Wide Flow .............................................................57
Dynamic Capacity Analysis, Matching, and Management
(DCAMM): Introduction and Refresher ...................................................58
Capacity Entitlements and Acceptance Patterns ........................................60
Optimized versus Excess Capacity .............................................................60
Summary: Why DCAMM Is Necessary ....................................................61
Note ...........................................................................................................62
5 Predictive Analytics..............................................................................63
“Managing To” ..........................................................................................65
Simulation Models: The Tools of DCAMM and DPA ...............................65
A Word about Modeling Assumptions .......................................................69
Resources ...................................................................................................69
So What? ...................................................................................................70
What-Ifs and Model Outputs ....................................................................71
Effective Model Use and Learning from DPA ............................................75
Time Frames ..............................................................................................75
Simulation and the Creation of Creativity .................................................76
Strategic Analysis Using DCAMM ............................................................78
Model Scale ......................................................................................81
The Community Demand ................................................................81
A Word on Real-Time Data and Patient Tracking Systems ........................85
Summary ...................................................................................................88
Notes .........................................................................................................88
6 Demand Components: The Emergency Department ............................91
Communal Demand Recipients: ED as a Source
of Downstream Demand ...........................................................................91
Diving into the Patterns .............................................................................92
Arrivals and the Debates on Predictability .................................................94
The ED and DCAMM: Using Patterns to Manage the System ..................96
Other Demand Patterns .............................................................................99
Contents  ◾  vii
Case Studies and Sample Outputs: Possible Solutions for
ED Flow Issues ........................................................................................100
Eyeball Disposition .........................................................................100
Impact on DCAMM Analytics .............................................101
Physician on the Front End .............................................................102
Result Waiting Area ........................................................................104
Use of Cardiac Markers ..................................................................104
Summary .................................................................................................105
Notes .......................................................................................................105
7 Surgical Services and DCAMM Analytics .........................................107
Surgical Services and Downstream Demand Analysis .............................107
OR TATs and First-Case Starts ......................................................109
Chasing the Rabbit in the OR .................................................................110
Surgical Smoothing and Systems Thinking ..............................................111
Case Length Variation and Analysis ........................................................115
Schedule Analytics, the DCAMM Way ...................................................116
Case-Fit Scoring ......................................................................................120
So What? We Get by Just Fine Doing What We Are Doing ....................122
Downstream Demand and Scheduling ....................................................122
Capacity Entitlement and Surgical Services .............................................125
Surgical Services Demand and Workload Analytics .................................126
Summary .................................................................................................127
Notes .......................................................................................................127
8 Up–Down–Up: Creating a Systems View from a
Component Perspective ......................................................................129
UDU, Processes, and Design Parameters .................................................131
Design and Component Optimization ....................................................135
Facilities, Communities of Care, ACOs, and Capellinis ..........................137
Summary .................................................................................................138
9 Capacity Patterns and Analytics for DCAMM ..................................139
How Much Is Enough? ............................................................................142
Capacity as a Single Number ...................................................................144
Tips on Making Capacity Available .........................................................145
Acceptance Patterns and Capacity Entitlement ........................................146
The Highly Constrained Environment ....................................................147
Discharge by X ........................................................................................150
Outliers within Outliers ..........................................................................150
Bed Huddles, Acceptance, and Entitlement .............................................153
Bed Huddles and the Occasional Outlier (Demand) Day ........................155
Summary .................................................................................................155
Notes .......................................................................................................156
viii  ◾  Contents
10 Dynamic Resource Allocations, Dynamic Standardization, and
Workload Analytics ............................................................................157
The Old Way of Creating Unit Capacity ..................................................160
The New Way ..........................................................................................160
Workload Analysis: Two Activity Boluses ................................................161
From Admit and Discharge to Census .....................................................162
Workload and Workflow ..........................................................................164
A Word on Variability ..............................................................................166
Task Allocation ........................................................................................167
Dynamic Standardization ........................................................................171
Dynamic Resource Allocation .................................................................173
Break Points and Task Allocations ...........................................................174
Summary .................................................................................................176
Notes .......................................................................................................177
11 A Word on Mandated Nurse–Patient Ratios ......................................179
Dynamic Staffing .....................................................................................181
Current Legislative Efforts .......................................................................182
Summary .................................................................................................182
12 Outlier Management and System Balance .........................................183
Outlier Management ...............................................................................183
Outlier Management ...............................................................................188
Dynamic Systems Balancing ....................................................................190
Possibilities ..............................................................................................192
Challenges ...............................................................................................193
Summary .................................................................................................195
Conclusion ..................................................................................................197
Epilogue: Kenji’s Story (Continued) ...........................................................199
Index ...........................................................................................................201
Author .........................................................................................................207
Acknowledgments
Naturally, I want to first thank almighty God for giving me a passion for health-
care, as well as the time and energy to write this text, at His perfect time. Regardless
of how this is received by colleagues and the industry, I consider myself blessed to
have done what I can for an industry I care deeply about.
Of course, I would be remiss to avoid crediting those whose thankless efforts
resulted in the rearing of a son who had the wherewithal to do anything good
in this world, my parents. Moms are always proud, but I’ll bet her copy (free, of
course) gets put on the mantel above the fireplace. (My beloved brother may have a
PhD in chemical engineering and eight patents to his name, but he’s only written
articles. Haha! I win!)
I would also be remiss if I didn’t mention Kristin Meader Story, who tolerated
many lonely weekends of closed office doors, delayed house projects, a shabby lawn,
and mildew-infested roses for the sake of this effort. Her undying support and
insistence that my effort would someday be a New York Times best-seller gave me
inspiration and drive. May she always be one of my biggest supporters.
I would also like to thank the many colleagues and friends who supported this
effort, challenged my thinking, and assisted with the production. Special thanks go
out to Dr. David Eitel, who assisted in the review and critique of these concepts and
ideas. His feedback was and remains instrumental. Dr. Alexander Kolker of the
University of Wisconsin Children’s Hospital also reviewed parts of this text. Andy
Day, the best boss I’ve ever had and one of the brightest people I’ve ever met.
Also, the Society for Health Systems (SHS), a division of the Institute for
Industrial Engineers (IIE), has been instrumental in allowing me to be involved
and engaged with the work about which this text is focused. Without SHS/IIE, this
text would surely never have been written.
Furthermore, the staff at Productivity Press (a division of Taylor & Francis),
and especially Kris Mednansky, have been very supportive and cooperative in this
effort. If ever I take on another such project, I can only hope that I can work with
them again. (I promise the next one will be on time.)
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