COORDINATED PLANNING AT HJERTECENTRET
CASE: Rigshospiltalet
Data-driven, coordinated planning leads to reduced waiting time, and historically low cancellation rate Over a longer period, waiting times and the number of cancelled operations have been steadily rising at Hjertecentret in Denmark’s capital region. However, with the benefit of increased management insight, and a coordinated planning model based on activity data, it has been possible to reverse this negative development. In the third quarter of 2017, average waiting time at Hjertecentret was 45 days. It has now been reduced to an average of 30 days. Similarly, cancellations that peaked last year at 36% have also been reduced to 5%. A pilot project titled “Koordineret planlægning i Hjertecentret” lies ahead, and must subsequently be implemented within the entire capital region. Based on data activity, and data pertaining to operation and patient-types, Hjertecentret and 4IMPROVE collaborated to develop a model that coordinates optimal distribution of operations and patient care. This model ensures improved planning, increased optimisation of capacity, and thus a reduction in both waiting times and cancellations. BALANCE BETWEEN ACTIVITY AND CAPACITY The first step was to collect and analyse Hjertecentret’s activity data. The analysis indicates where bottlenecks occur, and where
THE CHALLENGE: THE SOLUTION: THE RESULT:
capacity has either not been utilised, or has been overloaded as a result of insufficient insight into actual staffing needs. In addition to this, the analysis describes the connection between patients, personnel and the flow of patients between departments. Hjertecentret’s capacity plan has been analysed in relation to these parameters, and irregularities in the plan have been successfully identified. On the basis on this, it has been possible to sketch out recommendations that have subsequently been implemented by Hjertecentret, and which now yield benefits. Niels Würgler Hansen, Director of Hjertecentret, says: ”Hjertecentret is a question of life or death. For this reason alone, our personnel need to be fully convinced that new ways of thinking are good ways of thinking.”
The previous planning process was highly complex, and was insufficiently supported by a chain perspective, data, tools and processes. The consequence was cancellations, increased waiting times, etc. Planning based on actual employee capacity, rather than standard ideas. Match load (number of patients, time in the chain, staffing needs), with actual capacity. Data-driven, user-friendly planning toolbox that ensures a coherent planning process with balance between operations and available resources. Historically low cancellation rate, reduced waiting lists and optimised resource utilisation through coordinated staffing plans.
DATA-DRIVEN, DYNAMIC PLANNING TOOLBOX Based on data from operation and patient-types, it is possible to calculate the amount of time a patient will typically be admitted to the various departments. From this, data emerges on how much manpower is needed from the point of surgery to being admitted to intensive care, and then transferral to the patient ward before being discharged.
Through this modelling, it is possible for Hjertecentret to simulate effects, depending on capacity utilisation in the operating theatre, and thus visualise how the entire chain’s departments are booked with patients. Hjertecentret can now undertake the most efficient planning for heart surgery, balanced with available nursing resources, thus enabling optimal planning of operations and staffing rotas.
Hjertecentret’s planning toolbox is dynamic. It takes into account the type of patient and their condition, the surgeon’s experience, and standard time used in surgery. It also ensures coherent planning, with a balance achieved between planned/ acute operations, and the actual patient-focused care capacity throughout the chain.
The results are fewer cancellations, reduced waiting lists and better utilisation of resources, through coordinated staff planning. Niels Würgler Hansen, Director of Hjertecentret, explains: ”All implemented initiatives have been data-driven. Everyone at Hjertecentret has wanted to make improvements, and clever use of data has allowed us to do just that.”
After a longer period of time where waiting times and heart surgery cancellations in the capital region were steadily increasing, the tendency has suddenly changed. In the 3rd quarter last year, the average waiting time was 45 days. That number has now been reduced to an average of 30 days. Furthermore, where cancellations last year peaked at 36%, the latest figures from May this year show that cancellations are down to 5%. Chairman of the Captial region’s Health Committee, Christoffer Buster Reinhardt (Kons), explains: “The figures for last year were highly unsatisfactory. However, we can now see remarkable improvements over a relatively short time – and I would like to fully acknowledge that.” The negative development in waiting times and cancellations at Rigshospitalet’s Hjertecenter in 2017 led the region’s politicians to adopt concrete political initiatives in the last half of the year. Such initiatives include the expansion of “fast track” capacity, the founding of two acute beds and the introduction of a “guarantee clinic” for patient clarification. Both management and personnel at Hjertecentret have also contributed to solving the challenges by, amongst other things, implementing a balanced and flexible planning process for operations and bookings, as well as increased flexibility when organising operations. Meeting times have also been differentiated, such as providing beds, so operations can be undertaken until 20.00 on weekdays.” Berit Andersen, Journal of Health Policy, 7th June 2018.
THE FUNDAMENTAL IDEA:
Improved planning of activities and increased OP capacity utilisation. Balance between activity level and actual patient-oriented capacity. User-friendly planning toolbox that assists with balancing both operations and capacity.
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