Planning theatre and clinic capacity

Planning theatre and clinic capacity

05/03/2018
by Rob Findlay

Working out the theatre and clinic session capacity you need, and making a comparison with what you have, is one of the most important calculations you will do with Gooroo Planner.

In principle it is straightforward, but in practice things can be rather fiddly. So it is best to approach this exercise in a spirit of enquiry, and recognise that you will be working progressively towards sensible numbers (rather than watching them appear, perfectly formed, at the first attempt).

Session allocations are also something that clinicians care deeply about, so this needs to be done collaboratively with operational managers and clinical leads.

And yet it is very much worth the effort. The allocation of clinical sessions is a primary driver of waiting lists and costs for the whole organisation, and the potential gains from getting this right are very large indeed. So let’s dive into the detail.

Weeks worked per year

The number of working weeks in the year may seem like an odd place to start, but it’s the right one.

Operational and clinical colleagues will be quick to point out that a typical consultant contract provides something like 42 working weeks per year, and consultants with regular emergency rotas might have elective commitments in even fewer weeks. Colleagues might therefore suggest an assumption that 42/52 = 81% of the year is worked, or less in some specialties.

That is all perfectly logical, but it is not necessarily the most helpful basis for planning theatre and clinic capacity at specialty or sub-specialty level. Consultants may well be contracted to work for 42 weeks a year, but that does not mean theatres and clinics are lying idle for the other 10. When one clinician is away, someone else often fills in. With the possible exception of Christmas week, you will probably find that elective activity takes place every week of the year in major specialties.

So it is usually more helpful to base your plans on 51/52 or 52/52 working weeks (so that FutThtYrPC and FutClinYrPC are either 0.98 or 1, in your high level statistical assumptions or exceptions table). And it is worth making this decision at the outset because other numbers depend on this assumption, as we shall see next.

The capacity available

The session capacity that you actually have available goes into the fields FutThtAvail (for theatres) and FutClinAvail (for clinics). It is expressed in hours per week rather than sessions, for the simple reason that everyone agrees how long an hour is.

Gooroo Planner will try to measure these figures from your patient-level data, but they may not be on quite the basis you want. Firstly, they will include any ‘extra’ sessions that happened in the past, which Gooroo Planner has no way of distinguishing from ‘core’ sessions. Secondly, they will apply only to those weeks in which some activity was found, which will produce high hours/week in low-volume services that only operated in a small number of weeks in the year. If this matches your requirements then that is fine, and even if it doesn’t then these measured numbers might still be useful as a coarse error check.

The more common preference is to base the available capacity on ‘core capacity’. For instance if you have 4 clinicians, each working a core commitment of 8 hours/week in clinic for 42 weeks/year, then that would be equivalent to an annualised FutClinAvail = 4 * 8 * 42 / 52 = 25.8 hours/week if FutClinYrPC = 1 (or 4 * 8 * 42 / 51 if FutClinYrPC = 0.98).

If you are working out core capacity like this, you will also need to make sure it is on the same basis as activity. So if your activity includes nurse led clinics, then you need to include nurse led session time in the available capacity. If the activity includes a registrar working in parallel clinic to a consultant, then you need to include session time for both of them. If your activity excludes a particular type of work that is done in real life but not paid for, then that needs to be excluded from the session time available (or allowed for in lower session utilisation).

You may also find that operational colleagues think of capacity at a different level of detail from your Gooroo Planner model. For instance they may lump the available capacity for first and follow-up outpatients together, in which case you can put the combined figure under first outpatients (and zero under follow-ups), and use the report viewer’s ‘Header Grouping’ control to add first and follow-ups together when making the comparison.

Percentage of activity going to clinic and theatre

Gooroo Planner will try to measure the proportion of activity going to clinic and theatre, if the clinic/theatre data is included in the main activity-type file along with the activity data, and if none of the activity has more than one clinic/theatre episode associated with it.

This may work well for clinics. In fact you may be able to assume that every unit of activity represents exactly one attendance in clinic, and set FutClinPCGo = 1 in your high level assumptions table for all first and follow-up outpatients.

However it may not work for theatres. Instead, you may want to take a different approach by uploading activity and theatre episodes in two separate patient-level activity tables, and then preparing a third (statistical) dataset that contains for each service the ratio of theatre episodes to activity. For instance if each spell of inpatient activity in specialty X had an average of 2.6 trips to theatre, then for that service you would set FutThtPCGo = 2.6.

Minutes per patient

If you are uploading patient-level data that includes the number of minutes each patient spent in clinic and theatre, then Gooroo Planner will automatically measure the average minutes per patient for you. Those values should usually be fine to use without adjustment, which takes care of the fields FutClinMin, FutClinMinNon, FutThtMin, FutThtMinNon.

However if you don’t have this data available at patient level (which is likely for clinics), or if you think that average clinic/theatre times per patients are going to change in future, then you can create your own statistical-level assumptions in an exceptions table.

Sometimes this will be straightforward (e.g. all patients get a 15 minute slot, so FutClinMin and FutClinMinNon are both 15). Sometimes you will need to take a weighted average (e.g. two-thirds of patients take 15 minutes, but one-third need a test which takes 30 minutes, so FutClinMin and FutClinMinNon are 2/3 * 15 + 1/3 * 30 = 10 + 10 = 20).

Utilisation

If you are uploading patient-level activity data that includes the necessary clinic/theatre data (session ID, session length, and minutes per patient), then Gooroo Planner will automatically measure utilisation for each clinical service in the model (and use the results to populate FutClinUtil / FutThtUtil).

This measurement takes full account of mixed sessions (e.g. inpatients and daycases together, or first and follow-up outpatients) and again the results should be ready to use without needing adjustment.

If you do not have enough patient-level data available, then you will need to provide your own assumptions about utilisation for your high level statistical assumptions file or exceptions table. It’s up to you what utilisation to assume, but 85% is a popular number, as is 1 – the DNA rate for clinics (for example, if the DNA rate is 9% then you might use FutClinUtil = 0.91).

Here to help

If you have any questions about preparing data for Gooroo Planner, or would like to ask about anything else, then please get in touch and we will be happy to help. And if you would like a free on-site demo of Gooroo Planner then it would be a pleasure to meet you and your colleagues – please get in touch using this online form.

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