Case Study

This programme was designed to support the Cardiology team at an NHS Trust in the south west region in tackling a critical challenge of understanding and addressing the gap between demand and capacity across three key service areas:

• Outpatients
• ECHO
• Cath Labs

Four Eyes Insight set out to determine if more efficient and effective care delivery could be achieved by balancing patient requirements with available resources through practical productivity improvements.

Our method included a thorough evaluation of existing procedures and practices in addition to in-depth analytics.

Determining Capacity

Through a robust analysis of floor plans, rotas, and templates, we were able to determine capacity. We gained a better understanding of usage from historical activity data. Discovering the need was made possible by referrals, growth, and backlogs. Following the identification and validation of the demand-capacity mismatch with the service, a range of scenarios were modelled to illustrate the potential impact on productivity.

To assess the recommendations’ practicability and identify potential roadblocks to change, we conducted observations and interviews with departmental operational and clinical leaders and team members.

The data reveals a clear imbalance, with demand exceeding capacity across the Cardiology service, however opportunities to enhance productivity and reduce the need for additional capacity were identified.

27 recommendations were made to support the service to close the gap, with key ones being:

Outpatients:

• Aim to reduce variance in the volume of slots between clinicians completing like-for-like activity
• Review clinical pathways for follow-up patient management (considering new to follow-up ratios, community/PIFU opportunities)

ECHO:

• Ensure adequate nursing resource and ring-fenced beds to protect procedure room capacity

Cath Lab:

• Consider extended recovery time to allow for greater flexibility of scheduling stents.
• Dedicate portering to the service to increase flow and reduce delays.
• Undertake a workforce plan for lunch relief so that Cath labs can undertake run-through lists.
• Work with BIU teams to improve data quality, providing more reliable productivity data.

Anticipated results

Our data and analytics team identified the following anticipated results:

Outpatients:

• Utilising the new outpatient model recommended could improve the DNA rate to 5% and reduce the gap by 60 patients per month.

ECHO:

• • If the TOE service provided the capacity to see an additional one patient per clinic, they would have sufficient capacity to meet demand, and the backlog would be cleared within 22 months.
  • Running half-day weekend sessions and adding two additional sessions per weekend would enable an additional 33 patients to be seen each month.

Cath Labs

Several scenarios were modelled and found that:

• By realigning capacity across the two labs to provide one full lab for angiography and one full lab for pacing, there would be sufficient capacity to clear Angio waits within 15 months.
• By realigning capacity and improving productivity to provide one full lab to angiography and one full lab to pacing, while improving utilisation of capacity to 80% in both labs, Angio backlogs could be cleared within 14 months, and Pacing growth would reduce to 6 patients per month.

Contact us to learn about how we can support the understanding of Demand and Capacity in your organisation.