Capacity Constraints Require the Health System to do More with Less

June 30, 2024

Health, quite obviously, is an area of increasing demand. This demand, as Paul McBeth highlights, is insatiable.

Our growing and ageing population makes this a certainty for the next few decades at least. When demand for essential health services outstrips our ability to meet that demand, we have a capacity issue.

This is nothing new. The health system always operates within constraints that limit its ability to meet demand. We all experience capacity constraints. When we can’t remove them, we learn to operate as best we can within them.

When a health system is overly constrained it can lead to reduced quality of care and reduced access to care, which leads to more pressure on the heath system. Not the sort of pressure you can easily solve with budget increases either.

No matter how many people we hire or how many hospitals we build, we won’t catch up with demand for healthcare while it continues to grow. We’re starting from too far back. Even with larger budgets we are constrained by workforce supply in both health and construction.

In some areas, such as residential aged care, the number of available healthcare facilities is now declining.  In other areas, such as primary care, the proportion of GPs is declining.

Despite this, demand for essential health services that they provide keeps growing and it won’t stop anytime soon.

Doing more with less

To maintain quality of care and access to care, many hospital departments are being asked to do more with less. Less people, less time, less money, less equipment, less space, less back-office support.

Hospital services will valiantly keep trying to add more front-line staff and clinic space wherever they can, but it’s not easy. We can’t even be certain they’ll keep up with attrition in some departments, which heaps pressure on remaining staff.

We do know, however, that technology can help the existing workforce free up time and help our hospitals free up space.

I applaud healthcare teams and individuals around the country who are pushing ahead with new models of care, using technology to improve the efficiency of front-line workers and free up space at hospitals and clinics around Aotearoa.

How the health system can use remote patient monitoring (RPM) to manage increased demand without adding staff

One of the secrets to doing more with less is to stop doing things that waste your time. This has the effect of increasing available productive time. At Spritely we have spoken at length about how much potentially productive health workforce time is wasted sitting in the car travelling to visit patients in clinics and in their homes.

If we take a remote first approach, many of those visits would be done remotely with no worse outcome for patients and considerably less time wasted for clinicians. With more productive time available to them, clinicians can choose to see more patients, see less patients for longer or just work less overtime.

If a clinical team shrinks due to illness, attrition, or extended leave then they can choose to increase the number of patients being seen remotely. This saves extra time for remaining team members and ensures quality of patient care isn’t compromised.

RPM doesn’t just save time; it also increases the amount of clinical oversight that a patient gets. This can lead to earlier interventions and hospital avoidance, freeing up space for other patients in ED and on the ward. Clinic space, which is at a premium, can then be prioritised for patients that aren’t suitable for RPM.

RPM also minimises the cost of DNA’s. The convenience of video consults reduces the number of missed appointments, and if someone doesn’t attend their video consult, time hasn’t been wasted travelling to see them, clinic space hasn’t been left empty and it’s easy to reschedule the patient.

These savings on time and space when multiplied across the whole health system could be huge. Over the next decade we must achieve considerable productivity gains to alleviate capacity issues. Other countries have recognised this and are well advanced with their planning and implementation of virtual wards.

How RPM can fund itself and return cash into the health system

RPM doesn’t just free up time and space it saves money. Actual cash can be put back into the system and allocated to other front-line services or essential medications.

By taking a remote first approach Health NZ can reduce costs associated with travel. The cost of flying staff in planes and reimbursing mileage for community-based nurses is unnecessarily high. Underspend on pre-allocated travel costs should be redistributed to high demand areas on the front line.

RPM can also create underspend on approved FTE. When a nurse goes on extended leave, or someone resigns and moves to Australia, replacing them can take time. Pressure on the remaining team members increases while money that was pre-allocated for that FTE goes unspent by the team.

Utilising just some of the unspent money to implement an RPM platform will enable the team to see more patients despite having less staff. This is how we do more with less.

Talk to us at Spritely about the models of care we’ve helped pioneer for patients in renal, early supported discharge and cardiology.

The Spritely platform:

- Returns cash to Health NZ | Te Whatu Ora

- Saves time for cardiology staff

- Increases clinical oversight/patient safety

- Helps to avoid hospital admissions

- Creates underspend on pre-allocated funding for travel and staff

- Minimises cost of DNAs

- Reduces pressure on clinic space

- Improves quality of life for patients