More than an optional skill set, capacity planning should be as critical to business as performance, writes Rob Findlay
NHS performance reports are great at saying things like, ”Oh look, we did 3% better than last year”. But that leaves a big, important question hanging: ”Was it enough?”
There is only one way to answer this. You need a plan that describes ”enough”. Then you need to compare that with what actually happened.
However, at this point many NHS hospitals run into the practical difficulty that they don¹t have an up-to-date plan that operational managers believe in. So that big, important question remains unanswered.
But if we could answer it, what might the answer look like?
You need a plan that describes ”enough”. Then you need to compare that with what actually happened.
Let’s take performance against elective waiting time targets as an example, because it’s a major performance measure that is rather complex to track. Most hospitals simply track the measures handed down to them in national targets, but unfortunately these measures don’t reveal the cause of any problems, nor give enough advance warning if pressures are building.
Waiting times are a function of two things: the size of the waiting list, and the order in which patients are scheduled. Patient scheduling is adaptable and can be improved quickly without cost. So the more important thing to track is the size of the waiting list, because it takes time and resource to turn that around.
Is it that easy then? Do we just need a chart like this (complete with a nice little zoomed-in version for clarity)?
But this doesn’t tell us very much. All right, the waiting list is getting bigger, but perhaps we expected it to grow over winter anyway? Is it growing faster than we expected, or slower? Basically, are we on track with our plan?
That’s right, we need to compare against plan. Or, even more helpfully, we need to compare it against a selection of scenarios so that we can see which one we are closest to delivering. Like this:
Now we can clearly see that this waiting list is in trouble. Not only is it much bigger than our favoured plan - in green - which is to clear the backlog in preparation for constant capacity and achieving targets consistently from October. But it is also soaring above our maintenance plan to keep up with demand, and our backstop plan which is simply to repeat whatever happened last year.
We know we’re off track. Now we want to know why.
Is it because demand is higher than expected?
No, that isn’t it. Demand is pretty much as expected.
Is it because we didn’t do enough activity?
Yes, that’s it. Activity is falling below all our planning scenarios, even the ’backstop’ that simply repeats last year’s activity every week. Now we know what to do: we need to refresh our activity and capacity plan and then deliver the necessary activity to get back on track.
If we had simply tracked performance against the national waiting times targets then we wouldn’t know any of this. We might not even know there was a problem coming our way. Even if we did, we wouldn’t know if it was caused by scheduling or the size of the waiting list. And even if we knew it was the latter, we wouldn’t know if that was caused by demand or activity.
It’s time for planning to become a routine part of performance monitoring.
This is all critical information so that we can see the problem coming and take the right action to deal with it. As Annex 1 to this year’s planning guidance rightly said, ’Demand and capacity planning should be regarded as business-critical rather than an optional skill set.’ It’s time for planning to become a routine part of performance monitoring. Then everyone can answer the question: ’Was it enough?’.
Rob Findlay is director of Gooroo and a specialist in NHS planning, patient scheduling and waiting times