NHS Dumfries and Galloway: balancing capacity with demand

The Basic Building Blocks Methodology

The Basic Building Blocks methodology is a systematic approach to the demand and capacity analysis of existing patient pathways. By using this methodology sites will gain:

• Detailed understanding of the existing emergency patient pathways
• Local clinical team engagement with the creation, review and improvement of their stage within the patient journey
• Meaningful data which improves understanding of demand at each stage of the patient pathway, and utilising knowledge of demand to support realistic capacity planning to create a balanced system and improve the quality of care and outcomes for our patients
• Improved understanding of the cause-and-effect relationships in the system and help managers identify the numbers associated with a 'functioning system'

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."