Posts Tagged ‘planning’

The whole point of developing a plan for the coming financial year is to resolve, at the outset, the tensions that are pulling your organisation in opposite directions.

So on the one hand you have demand to keep up with, and 18-week waiting times to sustain. On the other hand you have limited money, capacity and staff to do it with. Somehow your plan needs to reconcile those opposing forces.

What if it doesn’t?

Then the problem is effectively handed on for operational managers to resolve. They end up in meetings where the first half is about laying on costly extra capacity to clear the backlog that’s building up, and the second half is about how they need to slow down activity because they’re “over-performing” and the money’s running out.

That agenda, of course, doesn’t solve anything, so the problems fester. In the autumn, following a series of difficult meetings about demand management, some extra money is somehow identified to patch over some of the gaps. But everyone knows that nothing fundamental has really changed.

If life without a proper plan is so unappealing, why do so many NHS organisations begin the financial year without one?

Let’s try this scenario for size: The planning process begins in good time, but it quickly gets complicated. A lot of people need to be involved: general managers, finance, contracting, information, and that’s just from the hospital side. Different people approach the task in different ways, so there is a mix of methods and not all of them are valid. New assumptions are constantly thrown in to try and close the gap, and the model gets ever more complex. A planning analyst gamely tries to hold it all together in a spreadsheet, but it’s massive and people tire of looking at subsequent versions of it. The detail becomes unwieldy and time is running out. Something high-level has to be hammered out at the last minute, just to make the money balance. The detail is then retrofitted pro-rata and the “plan” signed-off.

In short, inclusive bottom-up planning is overwhelmed by complexity, and a top-down settlement has to be imposed instead. If complexity is the enemy, how could the process be simplified and streamlined, so that the bottom-up process can succeed?

Here is how Gooroo Planner solves the problem:

Firstly, we recognise that much of the data going in is a matter of simple historical record (recent activity levels, for instance). These facts can be agreed early on, and there is no need to discuss them further.

Secondly, we’ve taken all those complex calculations and developed them into a single model, based on principles that are widely-accepted across the NHS, fair to all sides, and transparent. So precious negotiating time is not taken up with detailed discussions about method. The calculations cover the whole of the planning period, and also break the plan down week by week so you can meet your objectives continuously through the seasons, and keep your plan up-to-date with events.

Thirdly, all the performance, demand and activity assumptions are laid out clearly and openly for discussion. Ultimately the key to reaching a settlement lies in successfully negotiating these assumptions, so that resources can be released from some areas to relieve pressures in others. So we’ve made it easy to test different scenarios, either item-by-item or by throwing in whole tables of alternatives.

Finally, we provide collaboration tools to get away from those giant emailed spreadsheets. Managed online collaboration means that participants can all see (and where necessary work on) the same plan, in real time, with full audit trails of any changes.

If you’d like to work that way, either to revise your plans for this year or start getting ready for next winter, then get in touch and we will be happy to visit and show you more. Just email info@nhsgooroo.co.uk for a free on-site demo.

With a sigh of relief, you’ve signed off your plans for 2013/14 (or at least you’re about to). Presumably, those plans provide levels of activity that the commissioner can afford, the provider can deliver, and that achieve the 18 week waiting times standards.

Or at least, they achieve those things on average. But what about next month?

The trouble is, it makes a big difference how that activity is profiled through the year. Even if everything goes according to plan, and demand turns out exactly the way you expected, you can still end up with capacity and waiting times problems when winter and the school holidays come around. Your plan should really profile your elective work across the year, to avoid things like trying to bring in lots of orthopaedics in the middle of January, while making sure you won’t breach 18 weeks during the temporary slow-downs.

The planning process already requires this, of course, with monthly activity trajectories to support the overall activity plans. But usually it is hard enough agreeing the overall plan, and the monthly breakdown is just rattled off pro rata to feed the beast. The last time I saw a serious attempt to do this properly in a spreadsheet, it was an Excel monster of 100,000 cells. So profiling activity through the year is a nice idea, but too hard to do in practice, is it?

Well it may be too hard in a spreadsheet, but it’s straightforward in Gooroo Planner. Just click the Profiling icon and it will chart your plan as week-by-week trajectories for activity, capacity and waiting times. It even shows total capacity and RTT waits too, and you can download all the detail for pasting into other documents.

Changing the profile is easy, and we’ve designed it for people who aren’t comfortable manipulating spreadsheet formulae – you can just click any week to change the profile, and immediately see the effects of half terms, Christmas, and pre-winter activity blitzes, right there on the chart. (Now is the ideal time to start planning for next winter, by the way; if you leave it until autumn it’ll be too late to front-load some surgery.)

Want to devolve this kind of planning to the Trust’s operational divisions? Easy; just share the master plan with them using Gooroo’s built-in collaboration tools, and let them edit their bits of it directly. That way they’re all using the same methodology, they’re all using the demand for patient care as their starting point, and they’re all working to the same corporate framework.

Want to collaborate between commissioners and providers? That’s easy too. Providers have all the data required and commissioners don’t, so the provider just pumps it into the model and shares it with the commissioner. That way, commissioners can take a private copy of the plan to test their own assumptions, and then both sides can track agreed changes in the master model with an audit trail every step of the way.

So it’s time to reset your assumptions, because planning is much easier, more powerful, and more collaborative than ever before. If you’d like to learn more about Gooroo Planner with a free on-site demo, just email info@nhsgooroo.co.uk

More and more NHS organisations are using Gooroo Planner, so we’re in a great position to invest heavily in making our software even better than before. Here’s a preview of what’s coming out in the next few months:

Integrated reporting

Currently you navigate around the main Report area using a menu of links. It’s easy to use, but we think it could be a lot better. So we’re going to turn it into a tabbed area that you can navigate around freely, without having to reload the main reporting table every time, or reselect services when editing or drilling down to week-by-week profiles.

Export to Excel

Sometimes you just want your main reports table on paper, or in a table that you can paste into a document. You can do that already, by dragging the mouse across the report table and then copying and pasting it. But that’s a little clumsy, so we’re going to build you an export to Excel button. It will download your whole report into a single Excel table, with all your formatting, sorting, filtering and subtotalling preserved. Then you can easily copy, paste, and print it from there.

Advanced filtering

A lot of people have asked for this, and here it comes. The main report table already has a simple but effective filter box, that narrows your table down to whatever you type in it. The trouble is that sometimes you get matches you don’t need, so if you type “ENT” then you’ll get the specialty, but those letters also appear in “inpatient” so you might get a lot else as well.

The solution will be an advanced filter that lets you choose exactly what you want to see, header by header. So if you want to see both of the specialties ENT and ophthalmology, and only daycases for each, then that’s exactly what you’ll get.

Video tutorials

Instruction manuals are so last century; today, you want bite-sized videos just a few minutes long to show you how to do things. Video is especially good for software tutorials, because it shows you exactly what happens, in context, without you having to wade through pages and pages of screenshots.

Unfortunately nearly all NHS organisations block YouTube (though even the Department of Health has a channel there), as well as other video-sharing, slideshow-sharing, and file-sharing sites. In fact, some NHS organisations automatically block any site that contains streaming video. Dear IT departments: is this really necessary? We’re trying to get some work done here.

Anyway, we’re determined to get video tutorials to you somehow, and here’s how we plan to do it.

First we’re going to set up a new subdomain (video.nhsgooroo.co.uk), and put all our video tutorials on there. So even if your organisation does automatically detect and block video streaming sites, only that subdomain should be affected. Then, because all the content is serious and work-related, you should find it easy to persuade your IT department to unblock it again. Look: no funny cat videos.

Secondly, in case that doesn’t work for everyone, we’ll be able to deliver those videos to your smartphone. This is a bigger task because we’ll have to rebuild much of our website onto a new platform that responds automatically to mobile screen sizes. But then at least you can be sure of accessing the videos somehow.

The genuine, externally-driven demand for healthcare is remarkably stable. But inside the NHS it doesn’t feel like that; managers are constantly responding to new pressures.

Sometimes it is a genuine and sudden spike in demand: an outbreak of flu for instance. Sometimes demand steps-up because of something the NHS has done (like start a new screening programme), which should be predictable.

But most of the time, in most services, nothing really changes very much. And yet the fire-fighting continues.

Why?

Let’s try a few scenarios and see if any of them sound familiar:

Scenario 1: The responsive clinic

The consultants’ clinic sessions haven’t changed in years. Nor have the clinic templates. The Choose & Book ‘polling ranges’ were set years ago to meet 18 weeks, and haven’t changed since.

Every now and again, staff notice that all the clinic slots have filled up so there’s nothing available on Choose & Book. They beg a willing consultant to run an extra clinic in 2-3 weeks time, and it fills up quickly with new Choose & Book patients. That takes the immediate pressure off, but patients are still booking right up to the end of the polling range.

Scenario 2: The helpful orthopods

Waiting times are a long-standing problem for orthopaedic inpatients, but the orthopods are usually quite flexible and manage to keep on top of it. Whenever the TCIs for the coming month are looking set to breach, the consultants manage to run some Saturday morning lists and avoid the crisis.

It costs an arm and a leg in overtime and bank staff, and the consultants are paid handsomely for the extra sessions, but it keeps a lid on it.

Scenario 3: The pragmatic plan

The operational managers know how many consultants they’ve got, how many sessions they’ve got, and how many cases they do in a session. So they multiply all that up, then that’s their plan for next year. Yes, some services are struggling with 18 weeks, but there’s no point in promising the commissioners extra activity when you don’t have the resources.

The solution

All those scenarios have one thing in common: baseline capacity is not based on demand.

There will always be some form of mismatch between capacity and demand, because capacity comes in chunks (consultants, sessions, beds) and demand is more continuous. Over time, the gap between capacity and demand will drift, until after a few years it becomes quite pronounced.

The result is that some elective services have a steadily growing waiting list (and periodic waiting times crises, tackled with expensive ‘extra’ sessions, as they bump along under the target). Meanwhile, other elective services have a steadily shrinking waiting list and either run out of patients or (more likely) slacken off their activity by running short sessions.

The solution, obvious as it may sound, is to align baseline capacity with recurring demand. Then those expensive ‘extra’ sessions are only needed for genuine non-recurring work, and you can pull resources out of any areas that are quietly enjoying a bit of slack.

It isn’t rocket science, but it is fiddly because you have to take a lot of things into account. It’s best to let a professional model like Gooroo Planner take care of it all for you.

You have, I hope, just signed-off with commissioners your plans for 2013/14. This is the perfect time to cross-check them. You’re going to need an internal plan you can believe in, based on what you really think is going to happen to demand, taking account of the knock-ons from outpatients to electives, and broken down week by week so you can meet your objectives all the time and not just at year-end.

Get in touch on info@nhsgooroo.co.uk and we’ll be happy to drop in and show you more. If you decide to go ahead, we can cross-check your plans as part of the initial induction programme.

Gooroo Planner has always allowed you to share your Reports with colleagues, so they can view your analysis even if they don’t have a paid-for licence. Now we have upgraded report sharing, to give you greater control over how your reports are used, and to support multi-user collaboration across your organisation.

As before, you can share a Report by clicking the Share icon beside that report, or by going into the Share manager (from the main Planner menu) and sharing the report from there. In the sharing screen, you will see two new tick-boxes and this is what they do:

Collaboration

The first tick-box is “Allow users to edit this report”, and this enables multi-user collaboration on a single Report.

For instance, let’s say you are preparing your plans for the coming financial year. Corporate information analysts have prepared a single Report covering every specialty in the Trust, and now it is for general managers to check over the specialties they are responsible for. So you tick the box to allow users to edit the report. Now any recipient with a Professional licence can use the Editing screen to change things like their performance assumptions and targets, and use the Profiling screen to adjust activity week by week around winter peaks and holidays. When they save their changes, they are saved back to the original report, and everyone else who is sharing the report can see those changes immediately.

Alternatively you might not want other people to muck about with your report, and then you might untick this box to stop others from editing it. (As the owner of the report, of course, you can still change it as much as you like.)

Copying

The second tick-box is “Allow users to make a copy of this report”, and this allows you to control the onward use of your report.

If you tick the box to allow copying, then the people you are sharing it with can make a local copy of their own; they can edit this copy (if they have a Professional licence) and share with others, as if they had created it themselves.

If you untick the box, then they can still open the report, but they can’t make a local copy for themselves.

Both together

Taken together, those two tick-boxes give you a lot of control over your report sharing. If you want to collaborate with colleagues, but don’t want copies of your report to proliferate around the organisation, then you can allow editing but disallow copying.

Or, if you want to preserve your top copy but allow colleagues to do their own tweaking and tinkering independently, then you can disallow editing but allow copying.

Or you can let them tinker with a copy privately and then reflect their final changes in the master report, in which case you would allow both editing and copying.

Or you might want them just to look at it, and nothing else, in which case you can untick both options.

Now that’s better than emailing round version 7 of a 5MB planning spreadsheet for comments, isn’t it?

In a very welcome last-minute change, the Commissioning Board has just amended the ‘final’ NHS Standard Contract 2013/14 and given top priority to clearing the long-wait backlogs on England’s NHS waiting lists.

There has been a dramatic turnaround in waiting times penalties during the drafting of this Contract. The ‘near final’ draft, published just before Christmas, perversely penalised hospitals for treating long-waiters, but not for allowing long-wait backlogs to build up in the first place (though it did introduce the new backstop penalties for having one-year waiters on the list). The supposedly-final version of the Contract, published on Monday, added new penalties for building up long-wait backlogs but gave them little weight. Today’s version of the Contract correctly slaps the highest penalties on the backlog, and reduces the legacy penalties for treating long-waiters.

As the final Contract stands now (Particulars p.58), any hospital specialty that allows more than 8 per cent of the waiting list (incomplete pathways) to exceed 18 weeks will be subject to a sliding scale of penalties up to 2.5 per cent of elective revenue. The older targets linger on, so that if they try to clear their backlog, and more than 10 per cent of the patients they select for admission have waited over 18 weeks, they face penalties up to 1.875 per cent of revenue. That is perverse, but it isn’t as bad as it sounds. Because the penalties are applied monthly, it is much cheaper to clear the backlog and pay the smaller penalty temporarily, than to let the backlog fester and pay the higher penalty indefinitely.

This fundamentally changes the incentives around waiting times, putting the emphasis firmly on avoiding backlogs rather than managing them. Nevertheless providers need to be aware that it is perfectly possible to achieve the ’92 per cent incomplete pathways’ target every month, and still consistently breach the ’90 per cent admitted patients’ target. When planning the list size that is consistent with sustaining all the 18-weeks targets (as sensible specialties do) it it best to plan against the most demanding one.

All this has felt like a very long journey. Waiting-list-based targets were first announced by Andrew Lansley as long ago as 17th November 2011, but disappointingly weren’t written into the subsequent NHS Standard Contract. Although the Mandate mentioned the waiting-list-based target as well as the treated-patient-based ones, it wasn’t clear about their relative priorities (and the waiting-list-based target was at a disadvantage because it wasn’t enacted in legislation until last week). But now it’s done, and the waiting-list-based targets have finally reached the top of the pile.

Why did it take so long? The main justification is that the incomplete pathways (waiting list) data is much more error-prone than the treated-patients data. When the last Labour Government introduced referral-to-treatment waiting times targets, it was a massive technical challenge to stitch together the waiting times of outpatients, diagnostic patients, and admitted patients, which in most hospitals are held on separate computer systems. It is easier to link the waiting times together towards the end of the patient pathway, once their activity has been coded from the early stages, than to link it together while they are still partway through. Nevertheless, data on incomplete pathways has been collected since August 2007, so I have to say I think the change could have been made earlier.

But we are there now, and it looks pretty good. The main penalties discourage over-18-week backlogs from building up, and in the coming months this should lead to further satisfying falls in long-waiters. We also have hefty zero-tolerance penalties where any patient is still waiting a year after referral, which should at long last bring those extreme long-waits to an end. With the focus returned to the waiting list where it belongs, providers are now encouraged to focus on the fundamentals: keeping the list size down and scheduling patients in the right order. That’s better for patients, better for the service, and much less confusing for the public.

It was only a few years ago that software upgrades were (shall we say) ever so slightly painful. You had to get hold of an upgrade disk, and then go round installing it on every computer that you needed to run the software on.

How much effort is it nowadays? Wait for it… there. That was it. You don’t have to do anything. At all. You just let us put the upgrade on our server and then you get it automatically from any computer. That’s the beauty of being cloud-based: we just keep on upgrading Gooroo and you keep getting better and better software.

So in case you haven’t used them yet, here’s a quick round-up of the upgrades we’ve implemented in recent weeks:

Major upgrades

Profiling: Week-by-week profiling trajectories for your activity, beds, clinics, theatres and waiting times. They’re all interactive and editable on-screen, and designed to be easy for operational managers to use. You can run Profiling via a link from the Reports view. There’s a worked example here; and a ‘how to use’ here.

Editing: After running the main analysis, now you can edit and tweak the data and even keep an audit trail of any changes. Ideal for tracking negotiations with commissioners. You can run Editing via a link from the Reports view. Details are here.

Smaller improvements

You can now see the Dataset Settings and Calculation Settings that were used to create any Report; available as a link from the Reports view.

We’ve tidied up the Templates you use to create new datasets. The Template Wizard now has just two options: “Statistical data” replaces the old “Advanced” and (recognising that it’s the most-used template of all) this is now the default. In the Template Manager we’ve provided two “Getting Started” templates with the most common data items for first-time users. There’s more detail on all the data and results fields in this document (which you can also navigate to from our Publications page).

In the Dataset Manager, the datasets are now sorted automatically with the newest dataset first. So you don’t need to go hunting through the list to find the dataset you just created, or have to click the headers to get it sorted right.

Over in the patient scheduling side of things, you can now download your SimActive files and file them on your own computer, with all the meta-data (addition rates etc) preserved. This makes it easy to switch from one waiting times analysis to another; just upload the new file and it’s all there.

You can also see how your waiting lists would look if they were booked according to Gooroo’s scheduling rules. In SimActive, click Save and then OK, and then you can let the software take over the patient bookings and bring down waiting times. There’s a worked example here.

Bug fixes

Some more minor annoyances have now been fixed:

• You can now use spaces in file names.
• Copying a dataset now copies the weekly profiling data as well.
• Subtotalling a dataset also subtotals the weekly profiling data too.
• The back button works again throughout the Reports wizard.
• You get the correct Dataset Setting if you set a user-editable value and reselect the default.
• The option to display as a percentage is now copied correctly when copying a Report Style.

We hope you enjoy these upgrades. If you aren’t yet using Gooroo software and would like to learn more, then please contact us.

Gooroo Planner has always been good at bulk analysis: load up dozens or even hundreds of service lines, and it will rip through them in a matter of seconds and do all your planning for you. That means you can generate scenarios rapidly, across your whole hospital or health economy, covering all the different activity or performance scenarios you want to investigate.

But sometimes you want to dive into one particular service – usually a big one like medical emergencies or orthopaedic electives – and tinker. What if this was our waiting time target? What if our length of stay was that? If we did some extra outpatients, what would be the knock-on effect for inpatients? In a situation like this you want to be able to fiddle around with the numbers, try this change and that change, and just see what happens. Not so easy when the calculations are all run in batches, but dead easy with the new report Editing screen.

When you’re in the main Report view, there is now a new link at the top called “Editing”. Click it, and now you can tinker and mess with the data, a service at a time, and see instantly “what would happen if…”. Like the week-by-week profiling screen, it’s designed to be easy to use by operational managers and anybody else whose job isn’t necessarily heavy on spreadsheets and databases. Information and planning analysts can load up the main data, and perhaps run the main report too, and then let operational managers seek out that sweet spot between waiting times targets and available resources.

So how do you use Editing? From the main reports view, click the Editing link above the table. The first step is to select the service you want to edit, using the control that looks like this:

 

In this example, the services in your model have been described using three headers: hospital site, specialty and admission type; the models you use in real life may have fewer or more headers than this. In this example the service you want to pick is orthopaedic elective inpatients on the main hospital site. So use the left hand drop-down to select the main site, then click the Specialty button above it to change the drop-down to show specialties, and use the drop-down again to select orthopaedics, and finally click the Admission type button and then use the dropdown to select elective inpatients. When you’ve selected a unique service, the “Run Editing” button appears, so click that.

If this is your first time using Editing, you’ll need to choose the dataset fields (i.e. the data going in) and results fields (i.e. the results coming out) that you want to look at, using these two drop-downs:

You can select as many fields as you like from each list by ticking them. For instance your dataset drop-down might look something like this when you’re selecting the data you want to change:

 

When you’ve finished selecting dataset and results fields, click the “refresh” button (with the green arrows on it) to update the display. Then, depending on which items you’ve selected, you might see something that looks a bit like this:

Now you’re ready to start tinkering with the numbers. You can enter new values in the “New” boxes in the left-hand (Data) section and, when you click the “Calculate” button above the Results section, the new results values will appear under Results. You can also click any line in the Results section to see a waterfall chart showing the effect of successive changes on the result you chose.

It’s worth remembering that everything is calculated using this report’s existing Calculation Settings, including the activity scenario that determines whether future activity is going to carry on at the past rate, or match demand, or achieve targets, or achieve some other objective. So for instance, here we have changed the target waiting time from 9 weeks to 8 weeks, in a report where the activity scenario was set to achieve the waiting list targets; we’ve chosen the list size as the value to display on the waterfall chart:

You can see that changing the waiting time target has reduced the list size required to achieve that target (the red column shows that the list size has reduced). But what (you may be wondering) is the blank space on the chart labelled “Meeting of 20 Nov”? That is there to show what happens when you want to save a bundle of changes that you’ve made. If you click the “Save” button then the changes you have made are written back to the Report, and you can create an audit log describing the change. This audit log helps you keep track of successive changes if, for instance, you are tracking the negotiation between a commissioner and provider, and whatever you enter as the title of the audit log appears on the axis of the waterfall chart. You can revisit previous changes using the “Select a previous change” drop-down (see the top of the previous image); it is clear from this waterfall chart that, whatever was decided on 20 Nov, it did not affect the list size.

If you don’t want to save the changes you’ve made then just change the service selected, or use your web browser to navigate away from this screen. Changes are only written back to the report if you click Save (and the original dataset is never changed at all by the Editing screen). Similarly, your selection of displayed dataset and results fields is only saved when you click Save, so if you change your selection temporarily and don’t want it preserved for your next visit then just don’t click Save.

That’s pretty much it. One more thing… if you are editing a report that has knock-ons switched on (so that, for instance, increases in outpatient activity are reflected in increased demand for elective services) then changes to one service may affect the results for another service. Those knock-on effects won’t be immediately visible on the Editing screen, but a warning that this may happen will appear in the audit log, and you can always see the knock-on effects either back in the main reports view or by editing the affected service.

You don’t have to be technically-minded to do week-by-week profiling in Gooroo Planner, because it’s straightforward with a visual click-and-edit interface. So now senior and operational managers can take control of their own winter and seasonal planning, as in this worked example.

Because profiling is built right into Gooroo Planner’s reports, it runs off all the same data and assumptions that you (or your information analysts) have already loaded in and run through the model. So when you’re viewing a report, just click the Profiling button above the report to reach the profiling screen. When you get there you will see something like this:

Use the controls on the left to select the service you want to profile, and the control on the right to select how capacity should be subtotalled.

Select the service first. In this example, the services in your model have been described using three headers: hospital site, specialty and admission type; the models you use in real life may have fewer or more headers than this. In this example the service you want to pick is orthopaedic elective inpatients on the main hospital site. So use the left hand drop-down to select the main site, then click the Specialty button above it to change the drop-down to show specialties, and use the drop-down again to select orthopaedics, and finally click the Admission type button and then use the dropdown to select elective inpatients.

When you’ve selected a unique service, the “Run Profiling” button appears. But don’t click it just yet, because first you should choose how you want subtotals to be calculated for beds, theatres and clinics. In this example you want to see totals across the same hospital site as the service we selected (which, in which example, is the main site). So in this example you would use the right hand drop-down to ensure that only Site is ticked. When you’ve done that, the controls look like this:

Under the left hand drop-down you can see the service you selected, and the right hand drop-down shows how subtotals are calculated. Now you’re ready to click the “Run Profiling” button, at which point Gooroo Planner will run profiling for all the services that are included in the subtotal, and display the full profiling screen which looks like this:

The controls you’ve just been using are at the top. Next there’s a big chart with green points on it, and you are going to click and edit this chart to change the profile. The values plotted in green are the weekly activity profile numbers that were loaded up into your original dataset. (If you just get a horizontal line here, then seasonal activity profile wasn’t loaded, so ask your information analyst to make sure the dataset includes the demand and activity profiles; see footnote for details.)

The lower big chart shows either activity, beds, theatres, clinics or waiting times, and you can switch between them using the View buttons under the thumbnails at the bottom. Whenever you change the profile using the top chart, the bottom chart and all the thumbnails are automatically updated, so the whole thing is interactive and immediate. (If any of the charts are blank, and shouldn’t be, then ask your information analyst to add the performance data needed to work them out; again, details are in the footnote.)

When you’re looking at beds, theatres or clinics in the bottom big chart (example below), the service you selected is in blue and plotted against the left hand axis, and the totals are in orange and plotted against the right hand axis. Having two y-axes can be a bit confusing at first, but you’ll get used to it; we had to do it this way, otherwise when the subtotals are big the blue line is really hard to see at the bottom.

When you’re looking at waiting times (example below), again the blue line is the service you selected (normally just one stage of treatment) and plotted against the left hand axis. But now the orange total line (plotted against the right hand axis) is not subtotalled like beds, theatres and clinics. Instead it is the end-to-end waiting time for all stages of treatment that include this service, so is normally directly comparable with your referral-to-treatment waiting times target. In this example, for instance, the total waiting time for each week is the sum of the outpatient waiting time, plus the larger of the inpatient and daycase waiting times, for orthopaedics on the main site.

The activity chart (see the whole profile screen shown earlier) doesn’t have any totals on it. Instead, the orange line shows the priority demand for this service (plotted on the same axis as activity) and it’s there as a warning that you shouldn’t reduce activity so low that priority patients would be delayed.

Now that you know what you’re looking at, get stuck in and start changing your activity profile. It’s easy to do: just click one of the green points on the top chart, and a control will pop up that looks like this:

You can drag the slider or type a number into the box: whatever you find easiest. Then click Recalculate. (If you change your mind, just close the control by clicking the X at the top right.) All the charts will be recalculated to take in the change you just made to the profile.

Remember that the green chart is just showing the relative weights used for activity in each week, and the total amount of activity being done in the period does not change. So if you reduce activity in one week, activity will go up slightly in all the other weeks to preserve the total; similarly the waiting times trajectory through the period will change, but the final waiting time achieved at the end of the period remains the same. So the scenario you ran to create your original report stays the same.

If you want to save the changes you have made to the activity profile, then click the Save Changes button which appears after you start moving the green points around. Only the weekly activity profile in this report is changed, all other data (including the demand profile) remains the same, and no changes are made to the dataset that was originally used to create this report.

It’s really easy once you’ve had a play with it. So open up a report, click the Profiling icon, and have a go. You’ll be surprised at how readily profiling brings the numbers to life, and helps you plan for the future with greater confidence.

Footnote for information analysts

To get the most out of profiling, you’ll want your datasets to include enough data to work out beds, theatres and clinics, as well as week-by-week profiles for both demand and activity, for all services. Here is a typical profiling dataset template that includes all that.

When you start using profiling, if you want to get started quickly, you could just get your weekly activity profiles (FutActivWkProfile01 to 52) by counting the activity that was done in each calendar week last year. Gooroo Planner uses the ISO8601 definitions for week numbers but, to save you looking it up, week 1 began on Monday 3 January in 2011, and Monday 2 January in 2012.

Even better, smooth the activity over three years: just add up the activity in each calendar week over the last 3 years. Week 1 started on Mon 5 Jan in 2009 and Mon 4 Jan in 2010.

You can get demand profiles (DemandWkProfile01 to 52) in a similar way. For emergency services the demand is equal to the activity, so you can just copy the activity profile across. For elective services the demand is best measured using additions to the list (i.e. referrals for outpatients, and decisions to admit for elective inpatients and daycases).

Let’s take a look at how week-by-week profiling can help acute providers with winter pressures. We want to maximise capacity utilisation, and minimise the risk of bed crises, cancellations, and 18-week breaches.

We’ll take it in two stages:

1) Preparing for winter: We will look at how emergency and urgent elective demand are likely to vary, week by week, through the winter; then plan routine elective work around the peaks.

2) During winter: As each winter week goes by, we’ll update this profile with outturn demand and activity, so that our plans for the rest of winter can adapt rapidly and continuously to unfolding events.

Preparing for winter

Nobody knows exactly how winter is going to turn out, so we need to make some reasonable assumptions about how much demand is likely to come in, and how it will vary week by week. A good place to start is by looking at what happened last year or, even better, the last three years, and then adjust it for anything else we know is going to happen.

Armed with this information, we’re ready to start working on our plan. Because we’re focusing on the profiles during winter, let’s assume we have already run our strategic plan for the coming months (based on achieving 18 weeks, or filling the available capacity, or whatever scenario we chose). So we have already worked out the overall demand, activity, and capacity for this future period, as well as the waiting list and waiting times we want to end up with. If our dataset already includes demand and activity profiles then we don’t need any more data and can go straight into the week-by-week profiling.

In this worked example the screenshots are taken from Gooroo Planner, where the Profiling screen looks like this:

The large top chart is the interactive activity profile, and we are going to edit this to reprofile elective surgery around the peaks and troughs in emergency and urgent demand. The large bottom chart is interchangeable by clicking for any of the thumbnails at the bottom, so it can show either activity and urgent/emergency demand, beds, theatres, clinics, or waiting times.

Let’s start by zooming in on the bed profile. We start this analysis using data that is based on last year’s demand profile and last year’s outturn activity profile. We’ve picked a major surgical service, and we’re going to see if we can reprofile it to stay out of trouble over winter.

The blue line shows the the number of beds used by our surgical service, plotted against the left axis, and the straight blue line shows the number of beds notionally allocated to this service. The orange line shows the total beds on our whole hospital site, plotted against the right axis, and again the straight orange line shows the physical on-site bed limit. Clearly, we are heading for trouble in January and February, where the number of beds required is far larger than the number available. Looking at the blue line, we can see that we are making things worse by scheduling so much elective surgery during the winter peak; the “red alerts” we experienced last winter are starting to look disturbingly avoidable.

So let’s start by reducing our plans for elective inpatients during the height of the peak. This is a simple matter of clicking and editing the points on the interactive top chart, to reduce the balance of work profiled during January and February until the editable profile looks like this:

After doing that, we get a bed profile that looks like this:

Much better. But what happens to waiting times as a result of this surgical slow-down? A peek at the waiting times chart reveals this:

The blue line shows waiting times just for the elective inpatient stage of treatment, and the orange line shows the RTT wait for this surgical service: that’s the wait for new outpatients, plus the wait for elective inpatients or daycases (whichever is greater). All waits are on a “90 per cent treated within” basis, so the orange line is comparable with the 18 week target. The bad news is that our waiting list is going to spike over winter, rendering the 18 week target unsustainable for 3 or 4 months.

We don’t want that to happen if we can avoid it. So let’s see if we can front-load some surgery to head off the problem. In real life we would have more than one surgical service to reprofile, but for the sake of this example we’ll try to do it all just with this one. So we’ll crack on with as much elective inpatient surgery as possible over the autumn, then slow down for as short a time as possible to keep beds just nicely full over the winter peak (but not too full – we are working to a target occupancy to allow for in-week fluctuations), and then pick things up again in March to deliver the balance of our planned activity towards the end of the year.

When we’ve finished editing the activity profile, it looks like this:

Now our bed profile looks like this:

That’s fine. Waiting times?

That’s fine too: we’ve front-loaded enough surgery to get the list right down before winter, so that even when it spikes we shouldn’t see any breaches. Then the balance of our planned activity is just right to bring us in on target for year end. (In a real hospital you would have several surgical services to play with, rather than just one, so this example is on the extreme side to illustrate the principle.)

That’s our profile done, then, from the comfort of late summer / early autumn. What are we going to do once the snow starts to fall?

Reacting to events during winter

Fast-forward to late January, and it’s cold. Emergency admissions shot up when the GP surgeries reopened after New Year; nothing unusual in that. But last week it shot up again and we had to cancel surgery. How does this affect our plan?

The first thing to consider is this: does this spike mean that the total amount of demand has gone up, or might this peak be balanced by troughs later on? Frankly, who knows? Overall the external demand for healthcare rises stepwise every few years, and if demand happens to have gone up just in the last week then that may mean something, or nothing. If you want to add an extra chunk of demand to your forecast then that is easily done but, if the end result is forecasts that are more volatile but no more accurate, then what is the benefit? Ultimately it’s your call, but a compromise position might be to update the demand forecast every month, not every week, to smooth the volatility out a bit.

On the basis of a week’s worth of data, then, let’s assume it’s a wobble in the profile not an uptick in total demand. We also have outturn data on the activity we delivered for electives, as well as emergencies. So let’s update both our demand profile and our activity profile with the latest week’s data and see where we stand now.

The loss of surgery means that we are now heading for a 21 week RTT wait at the peak in mid-March, whereas before we were expecting to peak at 18 weeks. Perhaps we should have allowed a bit more margin for error in our original plan. However if our assumption about demand (that this spike is likely to be offset by less demand at other times) is correct, then we should have capacity to bring in the displaced patients over the coming weeks to restore the position, as the revised bed profile shows.

And so it goes, week by week, month by month, until the days start to lengthen again. Forecasting demand is not an exact science, especially at a week-by-week level of detail, so our plans for winter are always going to have a large amount of guesswork mixed in with the logic.

In this worked example, January’s spike in demand caused problems with cancellations and the risk of waiting times breaches. That kind of thing is a risk unless we can provide a more substantial buffer in capacity (e.g. in the form of lower bed occupancy) to absorb the variation. Nevertheless, in this example we were in a much better position than we had been the year before, when we had been galloping merrily towards a severe, prolonged, and utterly predictable bed crisis before the winter had even begun.

This worked example was illustrated using Gooroo Planner with integrated week-by-week profiling; you can see a slideshow version of it here. If you are already using Gooroo Planner then profiling is available to you now: look for the profiling button at the top of the Reports view page. If you aren’t using Gooroo Planner already, and would like to take a look, then email info@nhsgooroo.co.uk for a free on-site demo.