Healthcare logistics for service improvement and a new understanding of patient flow. Presented by Delia Dent, CSC, at HINZ 2014, 11 November 2014, 11.37am, Marlborough Room

1. Healthcare logistics for
service improvement and
a new understanding of
patient flow
Delia Dent, CSC
HINZ 2014, Innovation in Practice

2. Logistics definition
Merriam-Webster dictionary
The things that must
be done to plan and
organize a
complicated activity or
event that involves
many people.
© 2014 Computer Sciences Corporation 11/19/2014 2

3. The Problem
Poor Logistics in Healthcare
• Limited view of demand and capacity
– difficult to match demand to capacity
• Poor access to care
– long waiting lists leading to worse outcomes
• Fragmented resource planning
– Not supportive of integrated care initiatives
• Patients are regularly inconvenienced
– uncertainty, uncoordinated appointments, delays, limited choice
• Variable and error prone processes
– resulting in wastage and poor outcomes
© 2014 Computer Sciences Corporation 11/19/2014 3

4. The Solution | Healthcare Resource Management
CSC UltraGenda
General
Practitioners
• Correct specialist
• View of availability
• Better access to
secondary services
Hospital Based
Clinicians
• Electronic referral triage
• Clinically driven
scheduling
• Predictable sessions
• Convenient access to
patient information
Patients
• Faster access to care
• Convenience & choice
• Self-booking
Hospital
Managers
• Capacity utilisation data
• Load balancing controls
• Process standardisation
• Administrative efficiency
• Reduced waste
Booking Staff
• Standardised order sets
• Multi-resource
appointments
© 2014 Computer Sciences Corporation 11/19/2014 4

5. Learnings
© CSC 2012 November 19, 2014 5

6. Heart of England NHS Foundation Trust UK
Case study
Patient Flow Challenges
• Outpatient Did Not Attend (DNA) rate
of 14%
• No mechanism to reliably deliver
patient pathways within time frames
• Overbooking appointments
• Different booking processes at each
facility
• Inefficient and labour intensive
booking process
© 2014 Computer Sciences Corporation 11/19/2014 6

7. Heart of England NHS Foundation Trust, UK
Case study
Patient Flow Improvements
• DNA rate reduced to less than 10%
• Patients seen in the correct chronological
order and within timeframes
• Standardised processes and better use of
trust resources
• Improved billing accuracy with reduced
administrative effort
• Improved monitoring of referral to treatment
times (pathways)
• Capacity increased 50% without additional
resources
“We did some analysis with our
respiratory department. Just by
helping people to look
systematically at what was
available and without making
any changes at all to the
service we were able to
generate an additional 50 per
cent capacity.” Andrew Laverick,
director of IT, Heart of England NHS
Foundation Trust
© 2014 Computer Sciences Corporation 11/19/2014 7

8. Heart of England NHS Foundation Trust, UK
Case study
Patient Flow Improvements
• Better management of clinician non-availability
• Removed generic appointment types – now clinically driven
• Inpatient and outpatient activities separated for visibility of patient position
on pathway
A Futuristic Enterprise. Health Service Journal, supplement 28, June 2012.
http://www.hsj.co.uk/Journals/2012/07/09/m/h/z/Long-Term-Conditions-supplement-2012.pdf
Heart of England UltraGenda Case Study
http://www.csc.com/health_services/success_stories/102077-
heart_of_england_approach_to_enterprise_scheduling
Heart of England Approach to Enterprise Scheduling, eHealth Insider
http://www.ehi.co.uk/features/item.cfm?docId=380
© 2014 Computer Sciences Corporation 11/19/2014 8

9. Tan Tock Seng Hospital, Singapore
Case Study
Patient Flow Challenges
• High volume inpatient and outpatient loads -
efficiency is vital
• Old booking system was electronic but process
was slow and not clinically driven
• Could take up to 2 minutes to find available
appointment slots – making it difficult to offer
patient choice
• Appointments were unlinked which made it
difficult to manage changes and to ensure that
patients receive required care and follow-up
© 2014 Computer Sciences Corporation 11/19/2014 9

10. Tan Tock Seng Hospital, Singapore
Case Study
Patient Flow Improvements
• Appointment searches reduced to around 3
seconds
– patient choice and convenience
• 20% of patients with multiple appointments
now on care pathway protocols and
accessing same day appointments
• Many high volume and complicated
appointments now booked using
standardised order sets or multi-resource
appointments
• Use of linked appointments
Transforming the Outpatient Journey, Today Online, Singapore – October 22, 2014
http://m.todayonline.com/daily-focus/health/transforming-outpatient-journey
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11. Healthcare Logistics
NHS Recommendations for Avoiding Delays
• See and treat patients in order, this reduces maximum waiting time
– Seeing patients out of order results in variable wait times and has knock-on
effects
• Eliminate steps that don’t add value - time is precious
– for example, double handling appointment bookings
• Reduce unnecessary waits
– for example referral requests reviewed in batches and referral letters printed
and sent to patient in batches.
• Match capacity to demand - waiting lists are avoidable
– as most waiting lists or back logs are quite stable, evidence suggests that
patient delays are caused by temporary mismatches in due to variation in
capacity and demand.
Seven Ways to No Delays. NHS, Institute for Innovation and Improvement. January 2010.
http://www.mstrust.org.uk/competencies/downloads/7%20ways%20to%20no%20delays.pdf
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12. Unique opportunity to transform
• Underpin coordinated care initiatives with healthcare logistics
• Integrate care across settings and around patient
• Potential to move planning and decision making up in process
• Not isolated or incremental improvement – this is about profound system-wide
change
• Isn’t it time that healthcare caught up to other industries and started making use
of operational management techniques?
© 2014 Computer Sciences Corporation 11/19/2014 12

13. Delia Dent
ddent@csc.com
+61 410 575 213