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HELSEVEL-Gode og effektive helse-, omsorgs- og velferdstjenester

iCope - Integral Capacity and Operational Planning for Efficient healthcare services

Alternative title: iCope - Integral Capacity and Operational Planning for Efficient healthcare services

Awarded: NOK 6.7 mill.

The project aims to provide timeliness of care, improve the quality for the patient while containing costs. The project's main innovation is to break through the silo-ed organization of hospitals by introducing a tactical level planning layer that enables integral planning and control of care chains. In hospitals there is both natural variability, with external causes, and artificial variability, caused by the organization. If we can anticipate variation in workload, we can adjust capacity levels accordingly, thereby reducing waiting time for patients, increase patient flow, and reduce workload for staff. Applied to the entire care chain within a hospital, this is referred to as Integral Capacity Management (ICM). ICM builds on three principles: (1) better forecasting of workloads, (2) capacity flexibility, and (3) organizational change. (1). The research group CHOIR at the University of Twente, has been developing mathematical models for forecasting natural and artificial demand on the intermediate term (6-12 weeks), and assesses them within Dutch hospitals, therefore. (2). Many hospitals perceive workload fluctuations during operations as fire-fighting, because capacity adjustments are impossible in the short term. This requires the inherent flexibility on the tactical (intermediate-term) level of control, which is typically overlooked. The block planning of hospital departments is rigid, i.e. are often repeated every week of the year. Moreover, hospitals are silo-ed systems, where departments manage and optimize themselves. Consequently, much of the tactical level flexibility is lost. (3). Achieving (1) and (2) requires organizational changes. ICM necessitates an overarching organizational unit that has tactical capacity allocation autonomy in all departments along the care chain. Experts need to be trained, data analytics must be advanced, performance dashboards and decision support tools need to be developed. The project goal was to embed, validate and test this concept in three Norwegian hospitals. We started to studie the Norwegian and Dutch healthcare systems to determine what factors could hinder the implementation of ICM in Norway. We published the study called “Drivers and Barriers for the Implementation of Integral Capacity Management in Norwegian Hospitals”. We concluded two things. The economic incentives to plan smarter are lower in Norway than in the Netherlands. Norwegian geography hampers the possibility to share patients among hospitals. This implies that Norwegian hospitals need to deal more with natural variability. There is still great potential for improving the planning by using ICM in Norwegian hospitals. Two partners withdrew from the project to the pandemic. We therefore re-defined the use cases of the project to: 1) Elective care chain in Ålesund sykehus 2) Emergency Department (ED) in Ålesund Sykehus 3) Helseplatformen (HP) We began implementing ICM at the operational level by starting the Operational Planning Meetings (OPM), where we mapped the last week and next week challenges. We introduced a Lean improvement board in meetings where staff focused on daily problems. At the tactical level, we carried out some Tactical Planning Meetings with Ear, Nose and Throat (ENT), where we discussed how capacity could be allocated to the outpatient clinic, day surgery or main surgery to reach their budget. To execute the TMPs, we built a tactical planning dashboard containing data about production, sessions and waiting lists, the physician schedules and specialty budget for each activity. At the strategic level, we worked on comparing the budget to the activity budget to if they had enough physicians for the activity in the budget. We analysed the workload of patients in the ED and compared it to the nurse care hours. For that we developed a dashboard to give insight on how well staffed the ED was in the past (retrospective analysis). Then we designed different alternatives for nurse shifts to ensure that nurse capacity matches the patient demand for care at any time. This work continue in 2023 We specified what data is needed from Helseplattformen and its structure. But it was not possible to finish this use-case due to the high workload at HP. The work will continue in 2023 The project has had severely delayed due to covid, and it takes time for an organizational change and to to obtain and validate data. The progress of the project has been slow but positive. The managers and staff in the hospital and the health region believe in this new way of planning, and that is why the project owner has invested funds in continuing the project in 2023.

Empirical evidence The project’s goal to implement ICM in three hospitals was not achieved, because two hospital partners withdraw from the project due to capacity issues, also related to the pandemic situation. We tried to replace these with another hospital, but we did not manage to define a proper use case in time. Instead, we decided to focus on the one remaining use case (the hospital in Ålesund) and go in depth there. It took considerable time to define the right planning problems to focus on, get the main stakeholders involved and create a willingness to implement the organizational changes that are required. But in the last year things have started to move and we are now seeing empirical evidence of the benefit of ICM. We expect more to come when ICM is more broadly implemented in the hospital. Toolbox As part of the implementation of ICM in the hospital in Ålesund, several dashboards were developed in order to visualize production data and forecasts. Roadmap Because the number of implementations of ICM was reduced, we did not get enough empirical data to describe a well-founded roadmap. Though, from an innovation perspective the project results are, we think, very promising. The management and healthcare personnel that has been involved at the hospital in Ålesund, is determined to develop their new ICM-practice. They are strongly motivated to continue this development. In addition, Helse Nord-Trøndelag HF are now stepping up and request our involvement in developing ICM-practice with their hospitals. Helse Midt-Norge has developed this agenda further with SINTEF and NTNU: NTNU, SINTEF and Helse Midt-Norge RHF arranged a seminar … It was a big success and we see a stronger research and innovation community growing within the field of recource and capacity planning in hospitals. Helse Midt-Norge RHF has decided to finance further development after the project, and we see this as a major result from the project. The experiences of implementing it in Ålesund have been presented in several settings. It could be that describing the steps to follow will be one of the activities in the follow-up of iCope.

ICM provides a means to reduce and manage workflow variability in care chains. Empirical evidence from the Netherlands demonstrates a great potential for improving productivity, quality of care and service, and quality of labor. Our main hypothesis is that the methodology and tools developed in the Netherlands with regards to ICM are also applicable in Norway. However, there are differences between the Dutch and Norwegian healthcare systems: 1. Cost structure: Norway is a publicly funded market, while the Netherlands is a semi-privatized market, with insurance companies as a main actor. 2. Decision making & politics: more hierarchical levels are involved in decision making in Norway. Political steering of the health system is strong. 3. Case mix: Hospitals in the Netherlands have been able to differentiate their case mixes, moving away from the situation in which every hospital provides all types of care. Due to geographic differences between the Netherlands and Norway, this is harder if not impossible in Norway. As a result, the case mix of Norwegians hospitals will be different from Dutch hospitals, and might have a bigger natural variability. 4. Organizational structure & planning: there are small differences between how Norwegian and Dutch hospitals are structured, planned, and controlled. 5. Legislation, unions and privacy: Unions have a stronger position in Norway, privacy is more strictly enforced, and legislation is slightly different, also with respect what to report to health authorities (Norway) versus to insurance companies (Netherlands). We will apply ICM in Helse Møre and Romsdal as our use cases, while taking into account the differences between the two healthcare systems. The use case implementations must give insight into the benefits of ICM for Norwegian healthcare, as well as into how the implementation in healthcare practice can best be done.

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HELSEVEL-Gode og effektive helse-, omsorgs- og velferdstjenester