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 (e.g. patient punctuality), and unnatural/artificial variability, caused by the organization (e.g. the agenda planning of departments). 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 pressure for staff. Applied to the entire care chain within a hospital, this is referred to as Integral Capacity Management (ICM).
ICM build on three principles: (1) better forecasting of workloads, (2) capacity flexibility, and (3) organizational change.
(1). Since 10 years, research group CHOIR at the University of Twente, is developing mathematical models for forecasting natural and unnatural demand on the intermediate term (6-12 weeks), and assesses them within Dutch hospitals, therefore, iCope will collaborate with CHOIR.
(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 agenda/block planning of hospital departments is notoriously 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. ICM aims to break through the siloes by flexibly aligning department capacities along the care chain.
(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.
This concept will be embedded, validated and tested in Norwegian hospitals to achieve the project aim and innovation, and show an improved increase in productivity, improved quality and timeliness of care, and improved quality of labor, while containing costs.
After Covid-19 delays, we have started to implement the concept for Ålesund Hospital (HMR HF) for the orthopedic department. The culture change requires effort and is not as easy to get implemented in the hospital. Most of the time we have assisted digitally, also in 2021. In 2021, we conducted interviews across organizational structures and mapped major planning challenges. We have started working with Ålesund sykehus via an Operational Planning Meeting (OPM) where we map the last week and next week with challenges for operating room planning. In parallel, we have worked to put in place the data required for tactical planning dashboard. This means that all data is washed, arranged and produced. A few parameters are not available, but most are relevant and can be retrieved. During the first quarter, all dashboards will be up, which also makes it possible to roll out the Tactical Planning Meeting (TPM). Data extraction has also given us the basis for being able to produce a report that shows what data, and why we need it from the Health Platform when it is rolled out during 2022. So that the data that we now extract can also be extracted in the future after the system change. We have published a report regarding drivers and barriers to implementation at the system level and have not found major obstacles to being able to implement ICM in Norwegian hospitals. The change in the hospital is slower than desired, but the will is present to make the major changes that the project requires. At the end of 2021, we have taught many who are involved in the planning to be able to proceed in rolling out ICM in everyday life.
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.