NHS Dumfries and Galloway case study: balancing capacity with demand

Establishing a Baseline

Dumfries and Galloway Royal Infirmary began by establishing a baseline, using the 6 Essential Actions Basic Building Blocks methodology.

To establish a baseline, Dumfries and Galloway Royal Infirmary undertook an analysis of the medical pathway using the previous year's data. The aim was to identify if capacity met demand in terms of numbers per day, per week and by hour of day. It revealed that, although the hospital was reasonably balanced each week, significant imbalances occurred on specific days, with most discharges happening on Fridays and very few at weekends.

Figure 1: Dumfries and Galloway Royal Infirmary Medical Pathway Average Weekly Demand and Capacity

Figure 2: Dumfries and Galloway Royal Infirmary Weekly Balance of Demand and Capacity by Day of Week

Figure 3: Dumfries and Galloway Royal Infirmary Cumulative Percentage Demand Profile

The data confirmed that the hospital's discharges were not keeping up with the demand for admission through the day. Figure 3 shows that Dumfries and Galloway required 39% of its capacity before noon, however only 8% of discharges were taking place pre-noon.

It was clear that the hospital needed to create capacity earlier in the day by discharging sooner if it was to align capacity with demand. Health Intelligence Analyst for Dumfries and Galloway Royal Infirmary, Bill Mitchell said:

"The data has always been readily available via the dashboard, but seeing it in front of them in black and white really brought home to staff the urgent need for change."