Bank holidays are peak times for out of hours and other urgent health services. In the run-up organisations work hard to plan capacity to ensure that available resources meet demand.



But does increased investment for peak times deliver the real benefit in terms of improved quality?

Over the last year we have worked hard to define relationships between capacity, demand and quality in order to better understand how quality may be delivered. One rather surprising result from this work has been the growing awareness that simply having in place the capacity to service demand does not necessarily drive quality of delivery as expressed by the Department of Health’s national quality standards.

The first graph shows demand for telephone consultations and face-to-face visits together with home visits at the healthcare provider TCN. As you might expect holidays increase demand, driven by the extra day or two of weekend-like contacts. What does not change is the proportion of demand in each of the three categories - they remained stable at 48 per cent telephone triage, 36 per cent base visit and 10 per cent home visit. The other 6 per cent is made up of calls that do not require a direct clinical consultation.

The second graph shows the outcomes of contacts with TCN in terms of admissions to acute providers. It shows that where we do have increased demand from bank holidays, any increase in referrals is still contained within the statistical process control limits.

The third graph shows volume of contacts and clinical performance for telephone contacts. The figures reveal that capacity planning is working well and even with the unprecedented demand over Christmas, quality in terms of national quality requirements delivery remains good.

Demand for service

Many organisations would be familiar with this type of presentation describing a system working well. However, clearly these charts tell us nothing about the nature of the demand hitting the service or our clinical response to it.

Over the past year we have focused hard on improving the consistency and predictability of our service across the range of quality requirements. However, is it time to consider a more customer-centred set of metrics which would offer to understand more about the nature of the demand hitting a service and the clinical requirements? Our collective focus on simply matching capacity to expected demand perhaps misses opportunities to improve efficiency through a measured approach to understanding customer satisfaction.