Healthcare modelling for improvement
I was initially reluctant to get involved in this area of work, mainly because my wife is a doctor and I didn't want have to talk much about work when at home. However, I became involved because of a research fellowship funded by the UK's Advanced Institute of Management Research in which I looked at performance measurement in public services. As a result of this I became interested in the effects of the then Labour government's waiting time target regime on NHS hospitals. This led to the EPRSC-funded DGHPSim project.
DGHPSim: District General Hospital Performance Simulation
DGHPSim is a suite of models that simulate individual patients as they enter and move through a hospital. It covers outpatients, inpatients and patients needing emergency care. DGHPSim models support smart thinking about reducing waiting times whilst avoiding side effects. The models were built by Murat Gunal.
The NHS constitution guarantees that patients will wait no longer than 18 weeks from GP referral to treatment (the 18-week RTT standard). DGHPSIm models can be used to select policies to meet this standard.
The models can be used to estimate waiting times at the stages through which patients pass as they experience hospital care. Using them, policy makers, managers and clinicians can see where bottlenecks exist and cause unnecessary waiting. It is tempting to try new service configurations in the hospital to find ways to remove these problems. But these experiments may go wrong and may make things worse. Instead, the options can be simulated in DGHPSim and the best ones chosen for implementation. Examples include:
1. What would be the effect of increasing the proportion of elective surgery completed as day-cases?
2. What if we devote more beds to elective rather emergency care?
3. What would happen to waiting times if GP referrals increase?
A DGHPSim experiment shows the effect on waiting times of such changes but also shows side effects. For example, if we increase the proportion of beds used for elective care, are we at risk of not meeting emergency demand?
Using lean methods in healthcare
I've also supervised a PhD student, Luciano Brandao de Souza, who researched aspects of Lean in healthcare. initially looking at the link to simulation methods. A paper, Brandao de Souza L and Pidd M. (2011) 'Exploring the barriers to lean healthcare implementation'. Public Money & Management, 31, 1, 59-68, explores some of the issues.
The Cumberland Initiative
The CI is a group of senior academics, consultants, medical practitioners and others with proven track records, committed to improving healthcare.
This group, of which I was part, emerged during 2010 believes that transforming the quality of care through radically better processes and systems will save money through step changes in provision that also produce much better outcomes. The savings should dwarf those available through better selection of drugs or technology alone and the impact should readily exceed 10% of the total NHS budget.
