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Modelling and Simulation


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Modelling and Simulation
 



What is it and how can it help me?

Modelling and simulation tools give you a range of options for testing and experimenting with potential improvements.  They provide a safe environment to see what their potential impact may actually be.  This helps to reduce wasted resources and helps identify potentially unforeseen impacts.

When does it work best?

Below are list of different types of tools and when they may be appropriate.

Health system simulation tools
You can use simulation tools to develop a virtual health system which allows new systems of care to be tested in a simulated context. You can use this to evaluate the potential impact of changes in population, demand and the burden of disease.

Care pathway analysis tools
Care pathway analysis software allows health systems to map out the patient's healthcare journey as a process map. You can then modify it to show the potential impact of new ways of working, or the effects of new technology and practice.

Benchmarking tools
Benchmarking software tools allow you to compare the current performance of a health system with the performance of similar health systems.  When combined with simulation, you can also test the impact of changing performance to that of another health system or group of health systems.

Forecasting tools
Forecasting software allows operational and strategic service planners to predict short and long term changes in healthcare demand. This means that they can put service changes in place to meet any variations in demand. Many systems provide a single point forecast and a reliable picture of how demand will change over hours and days. If used in conjunction with simulations to model a range of future scenarios, this provides a powerful decision support tool for the health service planner who is forecasting over longer timescales.

How to use it

Forecasting software works in two ways. Firstly, IT systems mathematically model trends in historical data and show the impact of these trends continuing. Secondly, some systems incorporate data from other sources e.g. weather forecasts and flu watching (where there are known links to healthcare demand) using changes in these to predict a variation in demand for healthcare.

By predicting short term and significant variations in healthcare, hospitals can balance their emergency and elective workloads more effectively. In 2001, it took an average of nine months for the NHS to work through the backlog of elective work created by a three week period of cancellations during the winter of 2000. The cost of not putting in additional bed capacity during three weeks in January and February 2000 has been calculated in excess of £750 million.

By accurately predicting peaks in emergency care workload and rapidly responding to these, forecasting software can help avoid cancelling elective workload during the winter months.

Examples

Examples of health simulation tools:
There are a number of off the shelf simulation packages, many of which have been used by parts of the NHS to test future service changes, model the impact of disease outbreaks or to forecast the impact of population growth.

The NHS Institute and SIMUL8 Corporation have jointly developed a healthcare specific simulation software tool called Scenario Generator.  It is a software tool specifically designed to allow simulation of the whole health and social care systems.  It comes pre-configured with population and prevelence data, and with a number of generic pathways of care.  users can modify all the defaults, change existing pathways or createe new ones and develop any number of what-if scenarios.  the behaviour of each scenario can then be explored by simulating healthcare activity for one to 10 years or more.  Detailed results for each part of the model are provided of activity, flow, capacity, queues and cost.

The simulation software tool SIMUL8 was used by the NHS Ayrshire and Arran Health Board to model the relative benefits of different options for reconfiguration of unscheduled care services.  This process highlighted some major potential problems with the existing configuration's ability to cope with clinical shortages, changes in working times and the requirements of new technology.  The simulation came into its own during public consultation when the sponsors of change were able to demonstrate the impact of different models of care live to public audiences. 

Simulation is helpful in both diagnosing the problems to be resolved through reconfiguration and in aiding the decision on the best option for reconfiguration.

Examples of care pathway analysis tools:

Map of Medicine is available through the NHS Connecting for Health programme and is free to the NHS.

The Map of Medicine package is designed for the practitioner. It identifies the most appropriate route for the patient from diagnosis to treatment. Comparing local pathways of care with those in Map of Medicine can help you identify potential inefficiency, duplication or constraints in the local pathway.

Examples of benchmarking tools:

NHS Comparators provides comparative data to enable commissioners and providers to investigate aspects of local activity, costs and outcomes. This includes activity and costed data through the payment by results (PbR) tariff from the Secondary Uses Service (SUS), together with quality and outcomes framework (QOF) information, GP practice demographic population profile data and now prescribing data.

NHS Better Care, Better Value indicators use benchmarking techniques to identify potential areas for improvement in efficiency via 15 high level indicators.  The indicators are primarily aimed at commissioners (PCTs) and acute hospital providers (AHTs).

The NHS has recently developed its own web based benchmarking software known as SHAPE, (Strategic Health Assets and Performance Evaluation). The software allows providers and commissioners to compare costs and activity by condition, to look at length of stay, day surgery and outpatient rates. They can then identify future service and asset requirements, based on the top quartile performance.  The system also links to a geographical information system, allowing you to compare performance with the demographic trends of the local population and to test whether different service configurations could improve performance.

Examples of forecasting tools:

Some hospitals have used forecasting software for an overview of their operations by measuring the following across the organisation or health system:

  • Patient flow – a precise measure of pressure in the system. If the flow of patients in is not matched by the flow of patients out, this increases pressure on the system
  • Length of stay – one of the main causes of pressure in a hospital
  • Inpatient occupancy – the number of patients that are currently in the hospital and the number forecast
  • Real time status – shows the current operational status of the hospital so managers have an understanding of the pressures that the hospital is subject to.

What next?

In January 2008, the NHS Institute completed a desk top study into the available software to model pathways and where they may add value. The NHS Institute makes no recommendation regarding the purchase of any system currently on offer, but rather sets out in the table below how each type of software can make a positive contribution to modelling to improve provision of patient pathways.

Use the table below to assess which tools or techniques may be suited to the improvement initiative that you are working on. 
   

 

Type of software

 

Example

Patient outcomes

Service improvement and redesign

Demand capacity and activity modeling

Pathway performance monitoring

Planned versus unplanned care

Process mapping

Microsoft Visio

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Forecasting and demand modeling

Forecaster

 

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Balanced scorecard systems

QPR

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Six SIGMA and Lean software

SigmaFlow

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System dynamics software

WSP Simulator Isee/Ithink

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Scenario planning software

Scenario Generator

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Benchmarking

Shape

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Key

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No relevant functionality

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Some helpful functions or helpful but not user friendly

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Helpful and user friendly


Additional resources

Better Care Better Value indicators - www.productivity.nhs.uk

NHS Comparators - http://www.ic.nhs.uk/nhscomparators

Background

Simulation has its origins in the early development of aircraft testing and flight simulation and the expansion of role play. By the mid 1980s, role play exercises were being supported by computer models as part of strategic planning and training in the military, aeronautical and oil industries.

Simulation software is now a routine planning tool in most industries and many parts of the public sector e.g. aeronautics, logistics, criminal justice, education, housing, private healthcare and pharmaceuticals.