What is capacity in healthcare? Dr Vincent Connolly


Discussions concerning capacity in emergency healthcare often focus on the number of beds, cubicles or spaces that are available to place patients in. While it is important to understand the physical capacity requirements what is much more important is to consider the staff capacity to deliver care for patients.

Patients are placed in beds or cubicles then endure long waits at a time of maximum anxiety and stress. When organisations are under chronic strain the response is often to admit patients to outlier wards or open more beds. Often this is done without addressing the underlying capacity issue with the consequence of patients suffering even longer waits. This results in a spiral of deteriorating hospital performance, worsening patient experience and most importantly worse patient outcomes. Patients managed as outliers appear to have a longer in-patient stay, are more likely to be readmitted than those managed in the most appropriate ward.

What are the capacity issues that need to be addressed to resolve the situation, preventing the spiral of deteriorating performance and outcomes? Capacity should be viewed as the capacity to care which comes from interactions with healthcare professionals. Healthcare staffing capacity can be considered in two forms

1. Decision makers, typically senior doctors, nurses and members of the MDT

2. Action takers, staff who implement the agreed case management plan

Inadequate capacity of either of these two groups of staff will lead to longer waits for patients, increased length of stay, high occupancy levels and crowded emergency departments.

The question is have you calculated how many staff are needed to provide great patient care?

Dr Vincent Connolly -Consultant Physician, The James Cook University Hospital Middlesbrough & Medical Director, Emergency Care Improvement Programme (ECIP) @vincentconnolly
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