Long wait times are often associated with health care delivery, even under “normal” circumstances. This is a symptom of an organization that: 1. can’t effectively calculate and maintain staff and space requirements that align with patient demand, 2. adjust to “normal” daily volume fluctuations in real-time, and 3. follow staff-developed best practices that reliably produce needed outcomes, provide a sustainable workload and make problems more visible (help to define normal to make abnormal conditions obvious).
Having the capability to match patient demand with capacity (staff/space/equipment) under normal conditions is a critical prerequisite to effective crisis planning. Knowing the time (observed, based upon documented best practices, ensuring a sustainable pace to minimize burn-out) and space needed to treat each patient multiplied by expected patient arrival volumes gives an organization the ability to systematically and accurately model staff, space and equipment needed for crisis conditions. This precision in the modelling phase allows for much more specific contingency planning and exposing and solving for potential gaps in staff or space, BEFORE the crisis hits.
In addition to disciplined, reliable practices to keep patient demand tightly aligned with staffing, space and equipment; organizations also need real-time visibility to how patients are progressing compared to needed pace. This real-time, line-of sight information for the front-line caregivers is critical in allowing the people that deliver the care to see if resources need to be added or shifted to keep up with the “in-the-moment” patient demand.
The last piece to more effectively managing through a crisis is building the discipline to follow best practices, even when it seems like short-cuts or workarounds could help treat more patients. A degree of the “all hands on deck” approach during a crisis will almost always be necessary, however the extent to which we can plan for and minimize this approach will reduce deviations from best practices and the adverse effects of these deviations related to safety, quality, staff well-being, patient satisfaction and rework for downstream processes (more work in the long run).
Building the discipline to use process and technology to staff to demand, manage patient progress in real-time during non-crisis times and follow best practices will GREATLY improve an organization’s ability to plan for and manage through a crisis.
Fortunately, many health systems are working on operationalizing “staffing-to-demand” and managing flow in real-time. Additionally, many efforts are underway to develop and refine technology that supports these two critical components to managing in normal and crisis conditions.
A word of caution… using benchmarks or “industry accepted staff to patient ratios” for calculating needed staffing and space is dangerous and not recommended. Each health care system has different operating conditions (% of value-added vs. waste, downstream bottlenecks that inhibit flow, high turnover, higher acuity, teaching hospital, etc.) that greatly affect the amount staff needed to process their patient demand and maintain flow. Without deeply understanding these factors that are embedded in the organization, we are at risk of under-staffing and putting our caregivers in untenable environments.
COVID-19 is the latest crisis to test our already stressed healthcare system. However, it most certainly won’t be our last. With this in mind, we must continue to focus on systematically strengthening our health care delivery, supporting our caregivers and preparing contingency plans built on realistic workload and volume assumptions. Fortunately, we have the blueprint and supporting technology to do this. Embedding the processes, technology and behaviors described in this article isn’t easy or fast. However, we have no alternative, knowing the current challenges facing our health care professionals and health systems… and that we must continuously be anticipating and planning for the next crisis.
Authors:
Hank Buccella – Executive Consultant – Simpler/IBM
Miki Ferenczy – President – Pangaea Information Technologies (Partner in developing, testing, deploying the real-time flow (andon) management system at Rush)