1st Edition

Dynamic Capacity Management for Healthcare Advanced Methods and Tools for Optimization

By Pierce Story Copyright 2011
    226 Pages 33 B/W Illustrations
    by Productivity Press

    While hospitals can learn from other industries, they cannot be improved or run like factories. With work that is more individualized than standardized, and limited control over volume and arrivals, even the leanest-minded hospital must recognize that healthcare systems are more dynamic than nearly any work environment.

    Written with the creativity needed to navigate the rapidly changing landscape of healthcare, Dynamic Capacity Management for Healthcare: Advanced Methods and Tools for Optimization presents the unique new tools, methodologies, and thinking required of healthcare systems that want to survive and thrive in a reduced reimbursement, higher-cost world. Demonstrating his approaches and recommendations through case studies specific to the complex issues of healthcare delivery, Pierce Story, a long-time and passionate healthcare operations expert, shows how hospitals and health systems can make leaps in performance in an environment in which both financial and human resources are shrinking as expectations for clinical perfection continue to rise.

    Through its unique approach to the dynamic management of complex care systems, this volume raises the bar for what is possible. This text presents an excellent opportunity for healthcare’s change agents to meet the challenges and responsibilities of our day.

    Prologue: Kenji’s Story
    Preface: Blasphemy
    1. Introduction
    A Child of Our Own
    Dynamic Capacity Analysis, Matching, and Management (DCAMM): Concept Overview
    A Caveat to the Text
    2. Variability: Killer of Capacity
    The Look and Feel of Variance
    The Deception of the Average
    System Demand, Patterns, and Variability
    Patterns in Demand Variability
    The Importance of Ranges
    Probability of Outcomes
    Variability, Ranges and Patterns, and Predictive Analytics
    Outliers and Break Points
    Patterns, Demand, and HODDOW WOMSOY
    Attribute Variation
    Variability and Evolution
    Summary: Variability and Demand
    3. Interdependencies
    Interdependencies in the Current PI Methodologies
    The Missing Elements
    The Biggest Missing Element: Variability
    Interdependencies and Variability: The Origins of Dynamism
    Dynamism and Systems Analysis
    Dynamism and Evolution
    Why Not a "Live" Test, PDCA, or Kaizen Event?
    Dynamism in Systems Thinking: An IOM/NAE Perspective
    Tools for Interdependency Analysis
    4. DCAMM Introduction
    Capellini: The Better Spaghetti
    Capellini and Hospital-Wide Flow
    Dynamic Capacity Analysis, Matching, and Management (DCAMM): Introduction and Refresher
    Capacity Entitlements and Acceptance Patterns
    Optimized versus Excess Capacity
    Summary: Why DCAMM Is Necessary
    5. Predictive Analytics
    "Managing To"
    Simulation Models: The Tools of DCAMM and DPA
    A Word about Modeling Assumptions
    So What?
    What-If’s and Model Outputs
    Effective Model Use and Learning from DPA
    Time Frames
    Simulation and the Creation of Creativity
    Strategic Analysis Using DCAMM
    Model Scale
    The Community Demand
    A Word on Real-Time Data and Patient Tracking Systems
    6. Demand Components: The Emergency Department
    Communal Demand Recipients: ED as a Source of Downstream Demand
    Diving into the Patterns
    Arrivals and the Debates on Predictability
    The ED and DCAMM: Using Patterns to Manage the System
    Other Demand Patterns
    Case Studies and Sample Outputs: Possible Solutions for ED Flow Issues
    Eyeball Disposition
    Impact on DCAMM Analytics
    Physician on the Front End
    Result Waiting Area
    Use of Cardiac Markers
    7. Surgical Services and DCAMM Analytics
    Surgical Services and Downstream Demand Analysis
    OR TAT’s and First-Case Starts
    Chasing the Rabbit in the OR
    Surgical Smoothing and Systems Thinking
    Case Length Variation and Analysis
    Schedule Analytics, the DCAMM Way
    Case-Fit Scoring
    So What? We Get by Just Fine Doing What We Are Doing
    Downstream Demand and Scheduling
    Capacity Entitlement and Surgical Services
    Surgical Services Demand and Workload Analytics
    8. Up–Down–Up: Creating a Systems View from a Component Perspective
    UDU, Processes, and Design Parameters
    Design and Component Optimization
    Facilities, Communities of Care, ACOs, and Capellinis
    9. Capacity Patterns and Analytics for DCAMM
    How Much Is Enough?
    Capacity as a Single Number
    Tips on Making Capacity Available
    Acceptance Patterns and Capacity Entitlement
    The Highly Constrained Environment
    Discharge by X
    Outliers within Outliers
    Bed Huddles, Acceptance, and Entitlement
    Bed Huddles and the Occasional Outlier (Demand) Day
    10. Dynamic Resource Allocations, Dynamic Standardization, and Workload Analytics
    The Old Way of Creating Unit Capacity
    The New Way
    Workload Analysis: Two Activity Boluses
    From Admit and Discharge to Census
    Workload and Workflow
    A Word on Variability
    Task Allocation
    Dynamic Standardization
    Dynamic Resource Allocation
    Break Points and Task Allocations
    11. A Word on Mandated Nurse–Patient Ratios
    Dynamic Staffing
    Current Legislative Efforts
    12. Outlier Management and System Balance
    Outlier Management
    Outlier Management
    Dynamic Systems Balancing
    Epilogue: Kenji’s Story (Continued)


    During his 20+ year healthcare career, Pierce Story has dealt with complex systems redesign, operations improvement, and performance analysis throughout hospitals and health systems. Pierce brings years of experience, unique perspectives, and new concepts to chronic disease management, capacity management, patient care, and health system redesign. Having developed several new applications and toolsets for the analysis and redesign of key clinical operations and patient care capacity strategies, Pierce understands the needs of the industry and the failings of traditional solutions. His vision is a new way of managing the provision of healthcare in the United States.

    Pierce has a Masters Degree in Health Policy and Management from the Muskie School of Public Policy in Portland, Maine, and is trained in both Six Sigma and Lean methodologies. Pierce is also a Diplomate, Past President, and active member of the Society for Health Systems, a volunteer organization of over 900 healthcare performance improvement specialists and engineers. He is a member of the Leadership Council of the American Society for Quality’s Healthcare Division.

    Pierce Story has added an important chapter to the growing body of literature on healthcare performance improvement. His theme of managing effectively to actual demand is compelling, and the contention that healthcare leaders should not be dogmatic about the methods or tools of continuous improvement is right on target.
    —Pat Hagan, President and COO, Seattle Children’s Hospital

    Why does every healthcare improvement project we undertake fall short of our intended goals? We have tried all the techniques and tools of other industries and still cannot achieve the desired outcomes. Despite heroic efforts, patients wait – that is the end result. They wait everywhere – and costs, counted on a variety of scales, continue to mount. What element is missing? The answer is dynamic demand capacity matching and management. Within this book, you begin the journey of understanding how the protean interdependent relationships unique to healthcare delivery, each with their own variability, combine to form an intricate ballet that is actually predictable and manageable. This book is a must-read for anyone engaged in healthcare improvement, whether you work in a clinic, hospital, or healthcare system.
    —Keith Messner, MD, MBA, BSN , Emergency Physician, Healthcare Transformation Medical Director, Cape Fear Valley Health System. Fayetteville, North Carolina

    Healthcare is facing a huge challenge in reforming delivery predicted on changes and incentives in payment. Without revamping dynamic delivery systems to reduce and to reallocate current costs, chaos and disruption will likely occur. We need the analytical tools and creative mindset outlined in this book to help guide us on the path to reform. Thanks for the knowledge and for the encouragement to get it done.
    —Mike Sack, CEO, Hallmark Health