Analysis about creating Adjustable Capacity for BWH:
Adjustable capacity can be done by expanding capacity at the peak period by effective use of slack time or by making a portion of capacity is being made variable through design.
Stretch existing capacity: People, Facilities and equipment can work longer to meet demand. This helps in concentrating on essentials tasks during emergency period.
Align capacity with demand fluctuations: Use part time employees, outsource, rent or share facilities etc.

Analysis of BWH Sharing Capacity:
A service delivery system often requires a large investment in equipment and facilities. During periods of under utilization, it may be possible to find other uses for this capacity. BWH can also evaluate making some of underutilized wards can converted to ICU as demand arises and converted back to regular wards as demand reduces.

Yield Management of BWH:
Based on case, a comprehensive yield management system incorporating all strategies relating to demand for and supply of services was not incorporated to. Its not clear that how far their existing Yield management system has the ability to segment patient requirements into different service classes and helps for an efficient yield management. They should have implemented Yield management software applications which can be customized do this for them, which will same the time and energy.

What strategies can be used to manage BWH capacity?
Need for adjusting service capacity to match demand. BWH can use part time employees when peaks of activities are persistent and predictable. BWH can also follow “Chase Demand” approach, which adjusting capacity to meet demand. They should consider elective & emergent/urgent flows as need arises rather following single patient inflow model.

Exhibit 1 ICU Access Management Plan, states that ICU bed manager knows the ICU bed availability. The ICU bed availability data can be made transparent for all the physicians to access. They should be able to reserve the ICU bed, which should trigger and approval request for the ICU bed manager. After approval, it should trigger a work flow to CARE team shift the patient.

Flow Efficiency – Should also implement a reliable process for early prediction of day and time of discharge, reliable processes for communication of discharge data and time to all stakeholders.

Segmenting the demand for BWH:
The ICU demand can be segmented with reliable metrics of MICU, SICU and TSICU. The ICU can be organized into three areas, MICU, SICU, TSICU and General ICU Walk-in to use equipments only. The can be located in separate physical areas with room numbers to identify and can serves a different set of patients. We can also look at,

Alter the service process: Based on the above segmenting of demand and through coordination, process changes, communication, automation, etc., increase the capacity for admitting patients, and increase the synchronization between capacity and waiting patients.
Alter the arrival process: The above segmenting will also helps and influence the patterns by which patients present for service, improving the alignment between capacity and demand.
Alter the queuing process: All the general ICU needs can be done in the ICU walk in before admitting them to special ICU cares.

Smoothing Demand: We can try smoothing the demand through segmenting demand and by communicate customers to use service at other times and set priorities.

On Exhibit2, the case states that, transferring patients from ED to MICU can be done only during week days 7.00AM to 4.00PM. But this can be extended to other floors and other department. The time can also be extended to 12 hours.

Can Inventory Demand applied for BWH?
From inventory demand stand point, we can’t apply inventory demand management for an ICU, because, most of the time it’s unpredictable. Inventor demand can be applied only if we can establish a reservation process, establish formal queuing system and spread demand and reduce long waits.

But we can implement a forecasting system to generate metrics based on number of surgeries per doctor per day that can be performed, hours of operations in a day, average stay of a patient and days of the week for operations