Dynamic Capacity Management for Healthcare : Advanced Methods and Tools for Optimization book cover
1st Edition

Dynamic Capacity Management for Healthcare
Advanced Methods and Tools for Optimization

ISBN 9781439819753
Published December 8, 2010 by Productivity Press
226 Pages 33 B/W Illustrations

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Book Description

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.

Table of Contents

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)

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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