The intake capacity ceiling: why birth injury marketing stops working before it stops producing inquiries.

Two curves

Media spend is roughly linear: double the budget and, within the limits of the market, you buy about twice the inquiries. Review capacity is a step function: it is the number of screened inquiries your nurse reviewers and attorneys can take through records review and expert consultation in a month, and it changes only when you hire, outsource or change the criteria. Every acquisition plan has a point where the first curve crosses the second. Below it, spend buys cases. Above it, spend buys a queue.

Computing your ceiling

You need four numbers, all of which your own records contain.

1. Hours per screened inquiry. Average reviewer and attorney time from records request to a decision, including the inquiries declined after review. Firms that have never measured this are usually surprised by it.
2. Review hours available per month. Not headcount: hours actually available for review after litigation, depositions and everything else.
3. Expert consultation lead time. Where review depends on an outside expert, their availability caps throughput regardless of your own hours.
4. Screened rate. From the CRM, so that you can convert a capacity in screened inquiries into a capacity in raw inquiries.

Capacity in screened inquiries per month is available hours divided by hours per screened inquiry, bounded by expert lead time. Divide by the screened rate (and the contact rate) to find the inquiry volume that fills it, and multiply by cost per inquiry to find the spend that fills it. That spend is your ceiling. Spending more does not produce more signed cases; it produces a queue.

What a queue does to the numbers

When arrivals approach capacity, waiting time does not rise gradually; it rises sharply, a property of queues that holds whether the server is a call center or an attorney's inbox. In practice three things happen in sequence. Callbacks to screened families slow, and some families retain another firm. Reviewers triage, which means the written criteria tighten informally and the screened rate falls without anyone deciding it should. And the signed rate falls, because the cases that waited longest were often the ones that needed records from the most institutions. On the dashboard, all of this looks like the marketing got worse.

Deciding whether spend or staffing is the constraint

• Median time from screened to decision is rising while inquiry volume is flat or rising: staffing is the constraint.
• Contact rate is falling with volume: intake coverage is the constraint, which is cheaper to fix than review.
• Screened rate is falling but the search-term and creative mix has not changed: triage has begun, and the ceiling has been reached.
• All stage times are stable and signed cases rise with spend: you are below the ceiling, and scaling is justified.

What to do about it

Raise the ceiling before you raise the spend. The cheapest capacity is usually a sharper first conversation and written criteria, which reduce the hours spent per screened inquiry by sending fewer non-cases into review. The next is dedicated nurse review or a records service. The most expensive, and sometimes the right answer, is another attorney. In every case the decision should be made on the four numbers above, and the acquisition plan should state the ceiling it was built for. Ours do; it is written on the first page of the specification.