Measurement by Matt Tite, Measurement Lead for the AFN

It was great to see you all at our second national event on the 12th of May. We had the opportunity in the measurement session to answer a question I have been asked a lot… “how big should my frailty unit be?” As we discussed, this is the wrong question! What we really want to know is how much demand do we have, so I can plan capacity accordingly. From this we have two ways forward, (1) if there is a gap between our demand and our capacity, then we could get more capacity. (2) We could improve flow and possibly reduce demand, for example send more patients home (safely) from ED to be assessed at home.

We explored the use of the 3 stage model (the slides will be on the website) that allowed to use a process map, overlaid with weekly volume SPC charts and SPC showing timings data of the value and none value adding steps. Enabling the conversion of numbers of patients into time, a common currency in which we need if we are going to improve flow.

The approach brings together some well trusted improvement tools (process mapping, SPC and Pareto) to give a real systems understanding. As you then make your PDSA changes, it is possible to use the same model to assess the effects of your changes.

We looked at using SPC charts to calculate required capacity, if we set our capacity at 80% of the variation in demand, no one would ever wait in the NHS.

Making changes in frailty systems is not easy, but using improvement methodology and simple tools, such as Pareto, process mapping and SPC we can understand the size of the problem, then use the same tools to see if we are making any improvements

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