BACKGROUND
At Revant, the expertise center for Medical Specialist Rehabilitation in West-Brabant and Zeeland, the accessibility and affordability of care is under pressure due to an increasingly complex and larger demand for care on the one hand, and a shortage of care professionals on the other. This makes it extra important for Revant to use the available personnel capacity efficiently.
In rehabilitation care, efficient use of capacity is challenging due to the interdisciplinary nature of the care provided: a patient in rehabilitation is treated by therapists from various disciplines, whereby the order of appointments may be important, multiple disciplines must be present during the treatment (combination appointments) and/or multiple patients are treated simultaneously (group therapy).
In addition, the demand for care is difficult to predict. This is because various target groups are served and (partly because of this) various standard treatment programs are offered. The treatment plan for a revalidation patient is also often customized and adjusted during the treatment process according to the development of the revalidation patient. Because the demand for care is difficult to predict, it is extra challenging to use capacity efficiently.
APPROACH
We have mapped out the current performance and underlying bottlenecks in the area of planning and management for Revant at the Child and Youth Rehabilitation care unit. Based on this, we have formulated an improvement approach and outlined the contours for the position and mandate of capacity management in the Revant organization.
We did this based on a combination of interviews (with planners, medical secretaries, doctors, therapists and management), observations on location (watching the planning process and during treatment) and data analysis (of efficient use of capacity, but also of explanatory factors). Regular contact with the shop floor has been crucial to understand processes, identify bottlenecks and interpret data. The insights from the interviews and data analysis formed the basis for the advice.
RESULT
At the same time, the care unit experienced a stagnant inflow and throughflow of rehabilitation patients and lower utilization of capacity than desired. There was also a high no-show, doctors experienced a high workload, and significantly fewer treatment appointments were carried out than prescribed. On the days when the presence of therapists was greatest, there was also the most free space in the agendas. There was extra waiting time for rehabilitation patients because (plan) tasks were not carried out on time and there were many plan changes.
Although bottlenecks usually manifest themselves at the operational level (when scheduling individual patients), the solution is often to make smarter decisions at the strategic and tactical level (when allocating capacity and scheduling groups of patients).
In the improvement approach, we have therefore introduced an integral management cycle, with which care demand and capacities are coordinated at strategic and tactical level, based on strategic frameworks. This means, for example, that periodically, in conjunction with the expected development of care demand and the deployment of other capacities, active decisions are made about the deployment of capacity: who works where, when and on which activities? This means that instead of reacting, changes in supply and demand are anticipated.
In addition, the improvement approach includes a number of projects to increase planning flexibility and predictability of care demand, which increases decision-making space and the quality of decisions. The approach also focuses on optimising operational processes and the required management information. As a result of this improvement approach, the bottlenecks found are expected to occur less frequently and capacity will be used more efficiently.
We have made a start with the positioning of capacity management in the organization, in which we have outlined the mandate, consultation forms, staffing and division of tasks and responsibilities. Finally, in a roadmap we have described the activities around capacity management for the coming year and a half.
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