Principles of capacity management, applied in the mental health contextKathryn Zeitz A B D and Darryl Watson A C
A University of Adelaide, Adelaide, SA 5005, Australia.
B Health Outcomes International, PO Box 2065, Glynde Plaza LPO, Glynde, SA 5070, Australia.
C Central Adelaide Local Health Network, Adelaide, SA 5000, Australia.
D Corresponding author. Email: email@example.com
Australian Health Review - https://doi.org/10.1071/AH17007
Submitted: 22 January 2017 Accepted: 1 May 2017 Published online: 22 June 2017
Objective The aim of the paper was to describe a suite of capacity management principles that have been applied in the mental health setting that resulted in a significant reduction in time spent in two emergency departments (ED) and improved throughput.
Methods The project consisted of a multifocal change approach over three phases that included: (1) the implementation of a suite of fundamental capacity management activities led by the service and clinical director; (2) a targeted Winter Demand Plan supported by McKinsey and Co.; and (3) a sustainability of change phase. Descriptive statistics was used to analyse the performance data that was collected through-out the project.
Results This capacity management project has resulted in sustained patient flow improvement. There was a reduction in the average length of stay (LOS) in the ED for consumers with mental health presentations to the ED. At the commencement of the project, in July 2014, the average LOS was 20.5 h compared with 8.5 h in December 2015 post the sustainability phase. In July 2014, the percentage of consumers staying longer than 24 h was 26% (n = 112); in November and December 2015, this had reduced to 6% and 7 5% respectively (less than one consumer per day).
Conclusion Improving patient flow is multifactorial. Increased attendances in public EDs by people with mental health problems and the lengthening boarding in the ED affect the overall ED throughput. Key strategies to improve mental health consumer flow need to focus on engagement, leadership, embedding fundamentals, managing and target setting.
What is known about the topic? Improving patient flow in the acute sector is an emerging topic in the health literature in response to increasing pressures of access block in EDs.
What does this paper add? This paper describes the application of a suite of patient flow improvement principles that were applied in the mental health setting that significantly reduced the waiting time for consumers in two EDs.
What are the implications for practitioners? No single improvement will reduce access block in the ED for mental health consumers. Reductions in waiting times require a concerted, multifocal approach across all components of the acute mental health journey.
References Forero R, McCarthy S, Hillman K. Access block and emergency department overcrowding. Crit Care 2011; 15 216
| Access block and emergency department overcrowding.CrossRef |
 Cameron PA, Campbell DA. Access block: problems and progress. Med J Aust 2003; 3 99–100.
 Forero R, Young L, Phung H, Hillman K, Mohsin M, Bauman A, Ieraci S, McCarthy S, Hugelmeyer D. Access block in NSW hospitals, 1999–2001: does the definition matter? Med J Aust 2004; 180 67–70.
 Lowthian JA, Curtis AJ, Cameron PA, Stoelwinder JU, Cooke MW, McNeil JJ. Systematic review of trends in emergency department attendances: an Australian perspective. Emerg Med J 2011; 28 373–7.
| Systematic review of trends in emergency department attendances: an Australian perspective.CrossRef |
 Booz Allen Hamilton. Key drivers of demand in the emergency department. Sydney: NSW Department of Health; 2007.
 Kalucy R, Thomas L, King D. Changing demand for mental health services in the emergency department of a public hospital. Aust N Z J Psychiatry 2005; 39 74–80.
| Changing demand for mental health services in the emergency department of a public hospital.CrossRef |
 Larkin G, Claassen C, Emond J, Pelletier A, Camargo C. Trends in U.S. emergency department visits for mental health conditions, 1992 to 2001. Psychiatric Services 2005; 56 671–7.
| Trends in U.S. emergency department visits for mental health conditions, 1992 to 2001.CrossRef |
 Toloo S, FitzGerald G, Aitken P, Ting J, Tippett V, Chu K. Emergency health services: demand and service delivery models. Monograph 1: literature review and activity trends. Brisbane: Queensland University of Technology; 2011.
 American College of Emergency Physicians. Definition of boarded patient. 2011. Available at: https://www.acep.org/content.aspx?id=75791 [verified 21 July 2016].
 Heslop L, Elsom S, Parker N. Improving continuity of care across psychiatric and emergency services: combining patient data within a participatory action research framework. J Adv Nurs 2000; 31 135–43.
| 1:STN:280:DC%2BD3c%2FpvVKjtA%3D%3D&md5=9cd417dda578fbd245db3c5b9dd9cd1fCAS |
 Richardson D, Mountain D. Myths versus facts in emergency department overcrowding and hospital access block. Med J Aust 2009; 190 369–74.
 Carey MR, Sheth H, Braithwaite RS. A prospective study of reasons for prolonged hospitalizations on a general medicine teaching service. J Gen Intern Med 2005; 20 108–15.
| A prospective study of reasons for prolonged hospitalizations on a general medicine teaching service.CrossRef |
 Selker HP, Beshansky JR, Pauker SG, Kassirer JP. The epidemiology of delays in a teaching hospital. Med Care 1989; 27 112–29.
| The epidemiology of delays in a teaching hospital.CrossRef | 1:STN:280:DyaL1M7kt1Kluw%3D%3D&md5=d3798f58de7a2efc53f5611274c9bf46CAS |
 Hubbard G, Huby G, Wyke S, Themessl-Huber M. Research review on tackling delayed discharge. 2004. Available at: http://www.scotland.gov.uk/Resource/Doc/26350/0012813.pdf [verified 21 May 2011].
 Lim S, Doshi V, Castasus B, Lim J, Mamun K. Factors causing delay in discharge of elderly patients in acute care hospital. Ann Acad Med Singapore 2006; 35 27–32.
| 1:STN:280:DC%2BD28%2Fot1yisQ%3D%3D&md5=a8838d757a1f33b0e012ade52f22f591CAS |
 Moss JE, Flower CL, Houghton LM, Moss DL, Nielsen DA, Taylor DM. A multidisciplinary care coordination team improves emergency department discharge planning practice. Med J Aust 2002; 177 435–9.
 Zeitz K, Hester P. Use of a capacity audit tool in a mental health setting. Aust Health Rev 2016; 40 82–5.
| Use of a capacity audit tool in a mental health setting.CrossRef |
 Novak L. Mental Health Minister Jack Snelling has set new targets to more quickly treat mental health patients. The Advertiser December 4, 2014. Available at: http://www.adelaidenow.com.au/news/south-australia/mental-health-minister-jack-snelling-has-set-new-targets-to-more-quickly-treat-mental-health-patients/news-story/46d5cd3feb5b6ad1d85d0163699137fd [verified January 2017].
 Eisenbach R, Watson K, Pillai R. Transformational leadership in the context of organizational change. J Organ Change Manage 1999; 12 80–9.
| Transformational leadership in the context of organizational change.CrossRef |
 Staib A, Sullivan C, Griffin B, Bell A, Scott I. Report on the 4-h rule and National Emergency Access Target (NEAT) in Australia: time to review. Aust Health Rev 2016; 40 319–23.
| Report on the 4-h rule and National Emergency Access Target (NEAT) in Australia: time to review.CrossRef |
 Maumill L, Zic M, Esson AA, Geelhoed GC, Borland MM, Johnson C, Aylward P, Martin AC. The National Emergency Access Target (NEAT): can quality go with time timeliness? Med J Aust 2013; 198 153–7.
| The National Emergency Access Target (NEAT): can quality go with time timeliness?CrossRef |