What happens when service delivery does not match demand?
When service delivery is not well-matched with patient demand, periods of oversupply and undersupply are created. Oversupply results in a waste of valuable resources. Although waiting lists can theoretically absorb excess demand, in practice, it is often challenging to mobilize this demand quickly enough to make use of this oversupply. Undersupply, where demand is greater than capacity, is more likely in this rising tide of demand and has three major impacts for a department.
Compromised patient care and access
First, undersupply affects patient access and results in longer waiting times. This reduces patient satisfaction, and potentially results in a lower standard of care.
Increased costs
Second, undercapacity incurs higher costs due to the need for unplanned additional capacity. If actual demand exceeds expected demand or planned capacity fails to deliver the required output, extra capacity must be sourced, often at a significantly higher cost. There is a cost hierarchy, stretching from baseline programmed activities (PAs) to additional activity paid under waiting list initiative payments, to the use of locums and temporary staff, with outsourcing being the most expensive option.
Workforce stress
Finally, employee satisfaction and work-life balance suffer when service delivery fluctuates between over and undersupply. It becomes harder to plan leave and periods of inconsistency in workload cause stress and anxiety.
Why does misalignment of delivery and demand occur?
Service delivery does not spontaneously align to patient demand. It is fair to say that, over time, rotas and resources will naturally adjust to meet demand, but since demand can change rapidly, services must respond proactively to prevent significant gaps appearing.
The NHS recognized this issue twenty years ago by making job planning a contractual obligation for consultants with the objective of organizing "resources effectively and efficiently for the benefit of organizations, patients, and doctors" (Guide to Consultant Job Planning, NHS Employers, 2017).
However, job planning has not achieved these expected benefits. The problem is that it is only one part of a larger cycle of activities that must be integrated and coordinated. Without a robust delivery-to-demand matching cycle, departments will face higher costs of unplanned capacity, increasing waiting lists and higher workforce stress or a combination of all three.
What causes misalignment?
Misalignment between delivery and demand can spring from several sources. At the planning stage, inaccurate demand estimates lead to mismatches in the total number of hours of capacity needed. If the type of patient demand is not accurately predicted, the capacity mix will be incorrect. Additionally, if demand and capacity planning does not consider the temporal nature of demand, capacity will be misaligned both in time and place.
Even if service planning accurately estimates the required programmed activities, this does not guarantee they will translate into contractual PAs as an outcome of job planning. Moreover, even with a good match between contractual PAs and patient demand, this may not result in the expected service delivery.
To prevent these potential causes of misalignment, a department needs to implement an integrated cycle of service planning, job planning, and service delivery monitoring. By establishing a robust delivery-to-demand matching cycle, a department can minimize the costs of unplanned extra capacity, enhance patient access, and improve the working lives of their workforce.