Increasingly more hospitals recognise the added value of integral capacity management. Yet many hospitals encounter challenges in the implementation of this. How do you deal with this as capacity manager? Maarten van Mierlo and Joleen Blok work together on the implementation of capacity management at the Máxima Medical Center (Máxima MC), which recently started to use HiX for tactical predictions and the OR sessions schedule. “Capacity management requires a different mindset of the organisation."
Joleen Blok joined the Máxima MC as a clinical physicist in 2014 and has been Medical head of the OR for the past 18 months. This portfolio historically also includes the capacity management of the OR. “I am responsible for the basic schedule of the OR and, together with Maarten, we explore options to model the capacity management in a different manner.”
Maarten van Mierlo, manager healthcare logistics, left the planning giant PostNL to join the Máxima MC. His initial task: to optimise operational management and to reduce costs by 15 million euro in a patient-friendly manner. “This was successful, not in the least due to capacity management. We now find ourselves in a phase where we need to scale up, not just within the clinic, but also integrally. In doing so, the primary focus is on the OR with a new session schedule. Our second objective is to optimise the relationship between logistic planning and personnel planning. If we take a lesson from organisations outside of healthcare, we can free up a considerable amount of money to improve the quality of healthcare."
What was your point of departure in this?
Van Mierlo: “I referred to it as 'base stocks'. In those days one was given a budget for 'empty' bed capacity. The staffing was hardly adjusted in relation to the number of patients that were actually there. Hardly any attention was paid to seasonal patterns and variability in occupancy. Outpatients, OR and clinic were managed separately and integral coordination between these chain partners was hardly existent. This was a very classical situation, in which predictions of demand for and matching the supply of care was infrequent and insufficient.
Blok: “The same applied to the OR. Our basic schedule was a product of historical development. At some point there was a certain capacity and each time the production increased, an additional session was occasionally allocated. Over time we gradually grew larger. Yet the relationship with production was more or less lost as a result.
What is your objective now? How do you envisage your ideal hospital in terms of planning?
Van Mierlo: “The ideal hospital has a schedule for patient volumes and utilisation is based on production agreements. However, the real art of scheduling lies in integral consistency, also in terms of periodicity. It also means that, based on proper planning, the correct number of employees should be engaged in such production. Not more, as this costs money and not less, as you would then compromise on the care quality. Unfortunately, the quality of achieving this ambition still lags behind the corporate world. As care sector we have a long way to go. We are doing our utmost to catch up as much as we can. My dream for the future is a level of integral planning that is many times higher than at the moment."
How do you raise that level?
Van Mierlo: “By operating on multiple levels at the same time. At the moment we are working on the volume planning for the clinic and the OR. This will be followed by the continued development of the outpatient organisation. Moreover, with this integral volume planning we aim to improve the connection with the personnel deployment necessary to realise this planning. That will be the next step. The OR planning is an excellent means towards integral production control."
This sounds like the wrong way around, as the patient enters via the outpatient clinic, not the OR.
Van Mierlo: “Quite right. When patients arrive at outpatients and enter the care process, all capacities in the care process have to be organised in such a manner as to minimise the inconvenience of 'internal' waiting lists. When there is no OR or clinic capacity available, we have to be careful that we do not make too much outpatient capacity available. The production agreements with the health insurers determine the extent of the care we can deliver. If this gives rise to waiting lists, it will be outside the hospital doors. By means of integral capacity management we will then ensure that these patients can move through their care process as efficiently and as fast as possible.
Blok: “This also has to do with the financing structure in the Netherlands. We align the OR capacity with the ceiling agreements we conclude, as this gives us a rough estimate about which production is reimbursed. We then adjust the outpatient clinic accordingly."
Van Mierlo: “With regards to deployment of personnel, we will implement a new personnel planning system, with a larger focus on the ratios of the different departments, the capacity utilisation of the OR schedules and holders of consultation hours The volume planning and personnel planning are initially done separately, before being linked together again. If the volumes change, the staffing changes automatically. When we are able to successfully predict the two in unison, this will generate substantial quality improvement and cost reduction."
However, doing so will require a different mindset within the hospital. How do you get people to support you in this new mindset?
Blok: “Very gradually. In 2019 we had a small production surplus. The major contributing factor was that only midway through the year we realised we were heading for a surplus and that we did not have an efficient, gradual adjustment procedure. For this year, you will want to have information earlier and known which buttons you must push to get the desired results. You'll also notice that other people from the organisation ask for this. The question comes from the 'finance side', but also from direct patient care. Good planning is better for the patient, but this also makes it easier for our care professionals. Last year I regularly received the request to revise certain OR sessions, but then I had to decline because the flexibility was not in our timetable. Using Tactical Prediction and OR session schedule optimisation in HiX I can address this, such as by making part of the capacity flexible."
Van Mierlo: "It is also important to get everyone on board, in addition to a good story, a capable team that can realise the objectives. Historically the planners often have a history in care and they don't have a specific planning background or training, while the equivalent departments in corporate life consist of well paid, highly trained professionals."
"As a capacity team, you must show your added value and you need a lot of knowledge for that. You display this value by achieving and sharing results, so that everyone notices the effect of your work. If you can create a sort of space with that, you'll also gain trust. The trust in people with other ideas in health care is low; you don't have it and you have to earn it. That is best done if you make discernible improvements step by steep using a professional planning agency."
Blok: "Many health care professionals indeed have a sort of allergy to a commercial approach. Terms such as 'faster' and 'more efficient' quickly result in resistance. For us, as a capacity team, the challenge is in finding the right balance between the hard and soft side of health care."
Van Mierlo: "We have to ensure that we have steps 1 through 10 of our change process mapped out, but we apply them step by step. I'd also like to share this with other hospitals: don't move too fast, test your results at intervals with the work floor and ensure results so that you don't run through the process iteratively. We can build the content in the attic so to speck, but application in health care is especially exciting."
Blok: "Clarity is a key word in this. Give it to everyone within your organisation as quickly as possible. To give an example: if we want to make ten percent of the OR capacity flexible, so that we can change it between specialities over the year, some specialities think they can work with fewer people or there is the fear that they won't achieve their revenue. While we guarantee that they get the chance to achieve their production. If you provide clarity from the beginning and support it with numbers, they will get from you that it is an improvement."
How important is support from the board of directors for your procedure?
Van Mierlo: "Support is very important. Their trust is expressed in the fact that we get the space to implement our plans. But that comes primarily because we put the board 'at the forefront' and involve them in our ideas and can substantiate our plans well."
Many people think of cutbacks when they think of capacity management. Is that correct, in your opinion?
Blok: "No, I don't think so. I do expect that we can work more efficiently thanks to good capacity management and that there is ultimately a saving that occurs, but that is not the objective. Our objective is to make part of our capacity flexible, to then assign sessions to the specialities that need it to guarantee they achieve their production."
Van Mierlo: "Quality and costs always go hand in hand. Throughout the current market, happily there is the belief that you can only spend a euro one time and that you can only utilize a nursing employee once. The most important thing is how you react to this: do you want to force your decision for central planning on people or make them a part of the change process and make the planning centralized in that way? My experience is that the latter method is a better and safer manner of implementation, because being right and being proven right are two different things."
Where are you now?
Van Mierlo: "I think we are over halfway. All of the puzzle pieces can be understood: we are in the procurement process of a staff planning system and HiX will support us in the tactical prediction and with the OR session schedule. We expect a lot from HiX and have all trust that we will be able to make an enormous acceleration within two years in the area of volume planning. We are convinced of this. And internally, more and more employees have the end point in sight."
Board of directors: "Capacity management is of vital importance"
Marten Kroese, chair of the board of directors of Máxima Medical Centre, places great value on capacity management: "Capacity management is of vital importance for both our patients and our operational management. It is a great step forward that HiX now also supports capacity management.
