Scheduling

Elaine Kemp

National Improvement Lead

NHSIQ Domain 3

Scheduling module looks at -

• Improving the flow of information and patients• Reducing errors/delays• Eliminating unnecessary duplication

…… for the patient as well as for ourselves

Today we will take a high level look at –

• The scheduling game – reminder of how scheduling effects flow

• Demand and Capacity – the balancing act

• Utilisation – why it’s important

• Procedure Times – what do we measure and why

• Rework – removing the waste

Does it sometimes feel like this?

The scheduling game

Goal – reminder of the impact scheduling has on patient

flow, individuals within the process and the opportunity to

review current ways of working to reduce waste

• Groups of 5 people on each of the 4 tables

• Each person choose a role/perspective – Patient,

Nurse, Endoscopist, Clerical Staff, Trust Manager

• Read the scenario and create your 1st schedule –

Discussion

• Create your 2nd schedule – Discussion

• Feedback

What is the ideal scheduling process?

• Demand and Capacity

• Utilisation

• Procedure Times

• Rework – removing the waste

What is the ideal scheduling team?

• Multi skilled

• Defined roles

• Trained

• Valued

Demand and Capacity so what? Demand is due to increase DH

Modelling showed 10-15% year on year lower GI increase over 5 years, by 2016

could mean 75%

If you don’t match the amount of work coming in with the actual ability to do the

work what happens?

Demand is not the measure of how much work you do – it’s the measure of how

much work you are being asked to do

Capacity – is this the amount of work you could do, plan to do, schedule or

deliver?

How many points should we schedule?

How many of each procedure should be scheduled?

161

0

329

383

357

372

387

342

397

333

0

171

0

375 378

345

394

377

313

394

340

0

17

0

34

416

32

10 13

32

50

277

0

253

292

264

299290

229

291

277

0

0

50

100

150

200

250

300

350

400

450

Baseline

2011/12

Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

Ho

urs

Example Trust

Endoscopy Project

Capacity

Demand Actual Capacity Extra Capacity Activity Theoretical Capacity

Demand and Capacity

Top Tips

• Keep it simple to start and keep it consistent• Meaningful, real time, used and displayed• Count it all – inpatients and surveillance• Use your PTL – add a column for points• Policy and procedure - SOP• Predict the predictable – holidays, winter• If your demand is above your capacity be careful of

asking for more resources without checking utilisation• Remember you could reduce demand • Developmental creep – new services• Training and development• Be careful using data – process not people, inclusive,

no surprises

Utilisation

What is the optimum utilisation 80%, 90%, 100%?What do we mean by utilisation?

181

141

94

49

47

42

38

38

35

2624

20 17

5 4

Sessions affected by delaysOn day DNA/CNC

Endoscopist late

Patient unprepared

Slow admission process

Changes to session

Over runs

Cannualtion

Other commitments

Patient information

Courses/Teaching

Waiting for scopes

Sscheduling error

Lack of nursing or BCS

Private activity

Portering delays

Out of 847 sessions - lost 862 hours due to under running and 80 over running

Process Times – What do we measure and why?

Allocate a colour to each step

Process TIME (mins)

Patient booked into Admissions 5

Patient registers in Poplar

Patient gets changed/Toilet 5

Consent 5

Patient taken to ENDOS Suite

OBS checked 5

Procedure undertaken (flexi-sig)** 15

OBS checked 5

Report Completed 5

Scope cleaned & Documented 30

Patient returned to Poplar ward 5

Patient in Recovery(OBS checked etc) 30

Future Mgt and Discharge 5

STAFF MEMBER

Admission Staff

Poplar Nurse

Poplar Nurse

Endoscopy Nurse

Doctor or Nurse specialist

Endoscopy Nurse

Doctor or Nurse specialist

Endoscopy Nurse

Endoscopy Nurse

Endoscopy Nurse

Endoscopy Nurse

Poplar Nurse

Poplar Nurse

Doctor or Nurse specialist

Add a staff member

Red

Yellow

Green

Blue

Green

Blue

Blue

Blue

Blue

Yellow

Green

ID Thurs pm Lists (actual in + out times)1.25 PM 5

1:30 PM 5 Scheduled Time

1:35 PM 5 Waiting in unit

1:40 PM 5 5 Admission Staff

1:45 PM 5 5 Poplar

1:50 PM 20 30 Doctor or Nurse Specialist

1:55 PM Endoscopy Nurse

2:00 PM

2:05 PM 5

2:10 PM 5 5 5

2:15 PM 5 40 5

2:20 PM 5 5 65

2:25 PM 30 30 5 5

2:30 PM 20 5

2:35 PM 100

2:40 PM 5

2:45 PM 5

2:50 PM 5 110

2:55 PM 5 5 5

3:00 PM 5 5

3:05 PM 30 30 20

3:10 PM

3:15 PM

3:20 PM

3:25 PM 5

3:30 PM 5 5

3:35 PM 5 5 5

3:40 PM 30 30 20

3:45 PM

3:50 PM

3:55 PM

4:00 PM 5

4:05 PM 5

4:10 PM 5 5

4:15 PM 30 30 5

4:20 PM 5

4:25 PM 20

4:30 PM

4:35 PM

4:40 PM 5

4:45 PM 5 5 5

4:50 PM 5 20

4:55 PM 5

5:00 PM 30 30

5:05 PM

5:10 PM 5

5:15 PM 5

16/01/2003

Thurs afternoon list- Actual

times ‘in’ & ‘out’ of

Endoscopy room showing wait

times for procedure on unit-

NB this is not procedure time but times

the patient enters and leaves the

procedure room

Removing Waste – rework caused by rescheduling, DNA’s, CNC, rebooking

Do you know what your rework rate is?

A simple calculation how many of the above as a percentage of your activity

Case Study from a Trust - Rework rate of 25%

Identified causes using 5 Why’s

• Patients rescheduling – patients advised by letter of a date, no choice

(particularly the surveillance patients), wrong procedure, redo, abandoned

• DNA’s – patient didn’t understand, incomplete prep, got cold feet, letter not

received in time

• CNC – too short notice, procedure not required, staff or information unavailable

• Schedule – endoscopists alerting the schedule, no notice period enforcement,

other commitments irregular and took priority, adjusting case mix last minute

because of waiting list pressure

• Waiting list initiatives – last minute, clinically staffed no extra admin, not enough

notice for patients, no advantages.

• Urgent demand – rearrange work to allow for 2WW and inpatients

Top Tips

• Review your rework rate occasionally, know your waste rate daily/weekly

• Measure, share, display and act on the information

• Optimum lead in time – 4 weeks

• Access - allow patients choice and ensure opportunity to ask questions

• Phone log/glitch log – who is giving answers about what?

• Regular review of patient information – BY PATIENTS

• Adherence to notice periods and consequence – escalation policy – shared data

• Pooling of lists

• Nurse endoscopists – Consultant endoscopist

• Remove fire fighting – plan 6 weeks ahead recurring

• Use technology – text reminders

• Dig deep for root cause in persistent problems

• Solutions – from other services in your trust or other local endoscopy units

http://www.improvement.nhs.uk

NHS IQ website

NHS Improvement website

If you have a great example let us know …

What scheduling systems are you using and linked to

which unit systems and trust hospital systems?

Link to our website to read the rapid review document :

http://www.improvement.nhs.uk/documents/endoscopyreview.pdf

http://www.nhsiq.nhs.uk/

More Resources