Royal Adelaide Hospital

Adelaide, Australia

Australia’s Royal Adelaide Hospital (RAH) was founded in 1840 and today manages over 650 beds, 3000 staff and 61,000 emergency admissions a year.

The hospital is committed to delivering safe and quality patient care. But in 2004, faced with increasing demand for services, high occupancy, and significant cost constraints, RAH recognised they needed to apply different approaches in the way staffing and resources are planned and managed.

To address these issues RAH senior management developed a significant change improvement strategy called Patient Pathways - aimed at improving the patient experience and developing capacity within existing resources.

To support the initiative RAH needed a suitable operational tool that would enable them to smooth patient flow by increasing bed availability, reducing outlier patient placement, improving patient discharge times, and more accurately forecasting staff resource requirements.

Director of Patient Pathways at RAH, Dr Kathryn Zeitz, explains: “Although the RAH had the ability and expertise to meet many of the challenges, they did not have the time or the capacity to take on additional improvement work. The Patient Pathways initiative was established to support existing expertise to conduct targeted service improvements. We knew we had issues and we were prepared to make changes, but significantly we needed information technology tools to support us.”

CapPlan by Emendo was one such tool. The software is an operational decision making solution that improves operational performance and patient care in hospitals through the unique combination of forecasting, information and analyses.

Following a successful pilot in 2006/2007, CapPlan was rolled out across the RAH from July 2007. The roll out was delivered and transitioned from project to operational status, and has been extended and enhanced every year since.

Zeitz says, “We were operating in an environment with minimal information technology support. As there was no transparency about patient flow, we couldn’t forecast capacity. When we evaluated CapPlan it was obvious that it would offer us a number of opportunities. Before CapPlan we lived day to day. It’s so obvious now and essential. There’s no way we could go back to being without such transparency around out patient journeys”

Nick Burns, Founder and Director Sales & Marketing at Emendo, says: “With CapPlan, RAH has proven to be advanced in its forward planning capability during regional planning meetings when compared to other hospitals and is recognised as a leader in this field.”

“While it is difficult to isolate the exact benefits that CapPlan has alone been responsible for, there is financial evidence that CapPlan has saved in the region of $600k to $1.1m in the first year to May 2008, and a further $1.8 to $2.5m in the second year to May 2009,” he says.

In addition to operational benefits CapPlan is also providing a number of hospital-wide benefits. For example, with a unified access view of the operational status and the ability to identify trends down to a low level of detail, Operational Executives can now recognise and deal with issues early as they emerge. Also, with easy and immediate access to data and information, management can quickly answer queries from the Health Department.

Other benefits include:

  • Increase in cross hospital awareness/uptake of patient flow opportunities
  • Required beds are better aligned with patient demand per unit
  • Despite increased occupancy levels, staff report a better experience of “being in control”
  • There has been better matching of elective surgery strategy to inpatient activity, and
  • RAH has improved resource and bed matching during special event periods such as Christmas and winter periods.

Burns says, “The adoption of new operational processes and decision support tools such as CapPlan is, by its nature, something that is a “journey”, as opposed to a “big bang” approach. Typically assimilation of CapPlan into a hospital involves a 5-step approach including Understand Demand Variability, Special Event Planning, Short-term Planning and Reporting, Matching Resourcing to Forecast and Annual Planning Support. RAH is presently assimilating the latter two steps into its operation.”

We have already witnessed considerable planning by the clinical service unit for special event periods such as Christmas and Easter, and there is increased focus on planning seasonal periods, such as bed management in winter.”

“We anticipate that CapPlan will continue to provide RAH ongoing benefits from the areas already identified. And, as new initiatives are implemented and innovative features exploited, RAH will continue to experience opportunities to derive significant additional value,” he says.