艾昆纬-医院容量管理：充分利用现有资源（英）-2023-15页-WN7.pdf

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1、White PaperHospital Capacity Management:Making Best Use of Available Resources Using effective capacity management to thrive in a time of resource scarcityMEIKE MADELUNG,Engagement Manager EMEA Thought Leadership,IQVIATable of contentsIntroduction 3Health systems under stress 4Post-pandemic fallout

2、4Healthcare workers are an increasingly scarce resource 5Effective capacity management as a route to better resource utilization 6Why variability matters 7Drivers of variability 7IQVIA Health Flow as a fully integrated capacity management solution 9Conclusion 12References 13About the author 14 |3The

3、 pandemic in many ways showcased the extraordinary capabilities,commitment,and responsiveness of healthcare systems and healthcare workers,but it also mercilessly exposed the underlying vulnerabilities that had been building up for years.Hospitals and hospital workers were at the forefront of the ba

4、ttle and are now facing the long-term fallout of treatment backlogs,exacerbated staff shortages,and tight budgets due to lost revenue and increased costs.The wider perspective is challenging as well.Underlying long-term trends of demographic change and more advanced,but also more expensive,therapies

5、 test the affordability of healthcare systems,and the post-pandemic fallout along with a global economic downturn mean governments will have little spare cash for healthcare budget increases.For hospitals,this means they not only have to maintain high standards of care,they also have to compete as e

6、mployers and provide a good patient experience all with the current level of resources.To prevail,hospitals will have to become considerably more efficient in the way they operate.Effective capacity management is one of the key components that hospitals will need in their toolkit to achieve peak res

7、ource efficiency and thrive in this harsh environment.Introduction4|Hospital Capacity Management:Making Best Use of Available ResourcesHealth systems under stressHealth systems globally are under severe stress resulting from the global economic crisis,understaffing,post-pandemic fallout,and budget c

8、onstraints.Although the global economic outlook has improved with energy and food prices dropping from 2022 highs,economic recovery remains fragile with significant downside risks.Governments will have to contend with higher costs driven by inflation as well as reduced growth prospects affecting tax

9、 revenue while having to provide support for those most affected by the downturn,leaving little money to spare for increased healthcare budgets.These developments take place against a background of ongoing issues driven by demographic change and medical advances which challenge the overall affordabi

10、lity of healthcare systems.Figure 1:Healthcare systems under stressCritical understaffing Across Europe,shortage of healthcareworkers(HCWs)and a rapidly aging workforcewas already a problem pre-pandemic The added pressures of the pandemic contributed to many healthcare workers leaving the profession

11、 Number of newly trained HCWs insufficient to make up the loss3Post-pandemic fallout puts further pressure on healthcare systems Global projected cost of COVID vaccinations and treatments 2020-2027 is$500bn US$2 Patient backlog of undiagnosed cases and deferred treatments has not yet been fully addr

12、essed Unknown number of Long COVID and Post-COVID cases Rising healthcare expenditureThe pandemic has caused a noticeable uptick in healthcare spend as%of GDP,with the US leading with 15.9%in 2020,up from 13.8%1Across Europe and the US,initiatives to contain healthcare spend are being put into place

13、Global economic downturn While energy prices have normalized,inflation remains high and growth slowHigher budget demands for assistance programs and lower tax revenue leave little money to spareCost of living crisis has negative impact on mental and physical healthOngoing challenges to the affordabi

14、lity of healthcare systemsIncreasing costs due to aging populations and more advanced,hence more expensive therapies Advanced therapies place higher demands on healthcare systemsHealthcare systems in crisisSource:1Our World in Data;2IQVIA Institute Report“Global Use of Medicines 2023”3WHO“Health and

15、 care workforce in Europe:time to act”Post-pandemic falloutThe pandemic has caused a noticeable uptick in government healthcare spend as percentage of GDP,with the US leading with 15.9%in 2020,up from 13.8%.For Germany,the figures are 11%in 2021 and 9.8%in 2019,for the UK 9.9%and 7.8%.2The post-pand

16、emic fallout puts further pressure on healthcare systems.The global projected cost of COVID vaccinations and treatments until 2026 is 251bn US$,with cost for medicines 133bn US$higher than the pre-pandemic estimate.3 Developing treatments for COVID and Long COVID can be expected to divert resources

17、away from other areas of unmet need.There is also the backlog of undiagnosed cases as well as deferred treatments and surgeries still to be fully addressed.Due to the delays caused by the pandemic,patients present at more advanced stages of diseases,with worse treatment outlooks and potentially high

18、er cost.For many hospitals,the pandemic has caused severe budget deficits.Deferred and cancelled routine treatments such as elective surgeries caused revenue shortfalls while the measures taken to avoid the spread of COVID-19 among patients and staff,as well the often long drawn-out and care-intensi

19、ve treatment of COVID-19 patients,placed not only additional stress on healthcare workers but also generated considerable |5Healthcare workers are an increasingly scarce resourceHealthcare systems were already reporting staffing shortages before the pandemic,but this has been exacerbated by the pand

20、emic which took a massive toll on healthcare workers,with high physical and mental pressure sometimes resulting in workers leaving the sector and also,tragically,high death rates.The wellbeing of those healthcare workers who stayed in the profession has also suffered,with many struggling with burnou

21、t,psychological and physical manifestations of stress and overwork,reduced motivation,and other issues.Hospital staff will also be affected by the wider disengagement of healthcare providers observed in primary research surveys.Among the prime stressors reported by a majority of Healthcare Professio

22、nals(HCPs)are the workforce shortage,the increased workload resulting from the post-pandemic patient backlogs,and the lack of work-life-balance.Worryingly,HCPs report that this has had a negative impact on their ability to care for their patients.4According to the WHO,not only have many healthcare w

23、orkers left the sector,many more are considering leaving which will increase the pressure on those who remain.At the same time,newly trained healthcare workers are entering the sectors in insufficient numbers to make up for those leaving or retiring.5National statistics support this picture.In Septe

24、mber 2022,the NHS in England reported 133,446 vacancies representing a 9.7%vacancy rate against 103,800 vacancies representing 7.9%the previous year.6 At the same time,the number of people on waiting lists for hospital treatments has been increasing since 2012,with a sharp upturn during the pandemic

25、,and has now reached 7.2 million in January 2023.Similarly,the number of people waiting longer than four hours in hospital A&E and over 62 days for starting cancer treatment(measured from urgent GP referral)have reached record highs.At the same time,although NHS vacancy rates have increased,so have

26、staff numbers,with 24%more hospital staff since 2010 and with an increase of 37%for doctors and 16%for nurses.7 The situation in Germany is similar:most hospitals struggle with staff shortages and high staff turnover as well as a high level of sick leave.According to the German Hospital Institute(DK

27、I,Deutsches Krankenhausinstitut),in 2022,there were 20,600 vacancies for nursing staff on general care wards,a vacancy rate of 8%,and 9,500 vacancies on intensive care wards,a 14%vacancy rate.Both figures had increased compared to 2021 when vacancy rates were 6%and 12%respectively.8 But in Germany,t

28、oo,hospital staff numbers have increased while the numbers of hospitals and hospital beds have For many hospitals,the pandemic has caused severe budget deficits.Deferred and cancelled routine treatments such as elective surgeries caused revenue shortfalls,while the measures taken to avoid the spread

29、 of COVID-19 among patients and staff as well as the often long drawn-out and care-intensive treatment of COVID-19,placed not only additional stress on healthcare workers but also generated considerable cost.6|Hospital Capacity Management:Making Best Use of Available Resourcesshrunk,increasing the s

30、taff-to-patient ratios.Since 2010,overall hospital staff numbers have increased by 22%,doctors by 37%and nursing staff by 22%.Meanwhile,the number of hospital beds has dropped by 4%,from 502,749 to 483,606.9 These statistics suggest that it is not just staffing levels which are the problem but also

31、internal inefficiencies,high administrative load,lack of an integrated IT infrastructure and other factors which lead to overworked staff,long wait lists,and insufficient care levels for patients.Resolving these inefficiencies must be a high priority for hospital management everywhere,especially giv

32、en the WHOs prediction on the future numbers of available healthcare workers.Resolving these inefficiencies must be a high priority for hospital management everywhere,especially given the WHOs prediction on the future numbers of available healthcare workers.Effective capacity management as a route t

33、o better resource utilizationNot surprisingly,capacity planning is a major activity for hospitals but also one which for many organizations presents a significant challenge due to the multiple variables involved.It has moved far beyond mere nurse-to-patient ratios and patient classification systems

34、which were found to be insufficient predictors of demand;instead,multiple indicators at patient and ward level are required to adequately forecast workload and staffing requirements.10 In addition,adequacy of staffing levels is perceived differently by the various stakeholders within the hospital or

35、ganization nurses will have a different perspective based on their day-to-day work experience from schedulers or nursing management.In order to ensure a satisfactory definition and implementation of adequate staffing,these divergent perspectives must be taken into account.Finally,a prerequisite for

36、effective capacity management is a solution that encompasses the entire organization since it is often the transitions between different organizational units that create delays in the patient flow and therefore unforeseen peaks in demand for instance,if a patients discharge is delayed,that bed is no

37、t available and incoming patients cant be admitted as planned.Similarly,if planning for diagnostic procedures is not aligned with treatment schedules,patients stays are unnecessarily extended,and bottlenecks occur.A prerequisite for effective capacity management is a solution that encompasses the en

38、tire organization,since it is often the transitions between different organizational units that create delays in the patient flow and therefore unforeseen peaks in |7Managing variabilityWhy variability mattersCapacity and quality management are intricately linked to variability.In fact,managing vari

39、ability and patient flow are key not only for quality and safety of care,but also for a good patient experience as well as a satisfactory work environment,and,last but not least,efficient resource use.While in an ideal world,hospitals would be able to staff for peak demand,this is not feasible finan

40、cially,nor are there sufficient numbers of healthcare workers available.At the same time,demand troughs mean resources are underutilized.So,while hospitals tend to staff to meet average demand,reducing variability is crucial to minimize the stress and loss of quality of care that comes with excessiv

41、e demand peaks while not letting valuable resources go idle.In addition to improving patient outcomes and the work environment for hospital staff,the capacity gains realized through lower variability also benefit hospital budgets since patient stays are shorter and more patients can be treated with

42、the same resources,resulting in increased revenue and lower costs per patient.Managing variability is not just a question of staffing levels but of matching demand for the various resources available;in addition to medical and non-medical staff,these include surgery theatres,diagnostic capabilities,

43、patient beds,etc.Accurate capacity forecasting is the key to the effective planning and scheduling of these resources which in turn minimizes variability.Drivers of variabilityClosely linked to the problem of variability management is the issue of patient flow,since inadequately managed patient flow

44、s are a major factor in variability and uneven resource utilization.In fact,inefficient capacity coordination and inefficient patient transfer processes are among the leading causes of delays in moving patients through the hospital efficiently.Underlying causes are not only staffing issues,but also

45、inadequate planning as well as insufficiently defined process routines,lacking IT functions and alignment between diagnostic and imaging facilities and treatment teams.Process and planning improvements are therefore key to increased hospital productivity.The first step to realizing these improvement

46、s is pinpointing variability and capacity misalignment.An IQVIA analysis of selected wards at several major hospitals in Belgium,Switzerland,and the Netherlands investigated variability by admission type(emergency vs planned)and weekdays vs weekends and found that variability at hospital level can r

47、ange from under 10%to as high as 40%.At ward level,however,the variability is considerably higher.The analysis at ward level in a number of different nursing units including surgery,orthopedic surgery,internal medicine,cardiology,and pediatrics found that there is a considerable range of variability

48、 not only between nursing units but also within units depending on days of the week and planned admissions versus emergency admissions.At the high end,variability for planned admissions is 48%during weekdays and on the same ward 79%if weekends are included.The lowest variability is 29%for planned ad

49、missions during weekdays and 31%if weekends are included.Managing variability and patient flow are key not only for quality and safety of care,but also for a good patient experience as well as a satisfactory work environment,and,last but not least,efficient resource use.8|Hospital Capacity Managemen

50、t:Making Best Use of Available ResourcesHospital A(Belgium)13%27%10%11%24%9%0%10%20%30%TotalPlannedEmergenciesVariability by admission typeincl weekendexcl weekend36%64%Avg share of beds weekdays onlyPlannedEmergenciesHospital B(Switzerland)8%28%9%8%26%9%0%10%20%30%TotalPlannedEmergenciesVariability