Variability

multiple handoffs

Patients vary. We vary. Patients have different problems, backgrounds and needs. We have different skills, energy levels and motivation. These are all areas of natural variation in our system. We tend to think that these things are what affect the flow in our service but, in fact, or research shows that flow is more affected by artificial variation.

For example acute hospitals tend to think it is the unpredictable nature of emergency admissions that changes their workload. However audit usually shows that this rate is fairly predictable and that how they schedule the routine surgery is what produces the variability!

This is things such as the way we timetable in our work, our working hours, leave and room bookings. We could eliminate most sources of artificial variation if we analyse what we do properly.

Another source of variation is the rate at which referrals come in and the way we tend to offer the same number of first appointment slots in a week without taking this into account! It is easier for us as we can make our weekly timetable stable and predictable. But when demand is higher than capacity (more patients than staff) we have demand that remains on the waiting list and when we have more capacity than demand there may not be enough to do. Our August clinic may be relatively empty and our Christmas one developing a waiting list if our busy times are the end of the year!

Action: implement CAPA and flex initial Choice capacity!