The west of Scotland heart and lung center based at the Golden Jubilee National Hospital houses all adult cardiothoracic surgery for the region. Increased demand for scheduled patients and fluctuations in emergency referrals resulted in increasing waiting times and patient cancellations. The main issue was limited resources, which was aggravated by the stochastic nature of the length of stay (LOS) and arrival of patients. Discrete event simulation (DES) was used to assess if an enhanced schedule was sufficient, or more radical changes, such as capacity or other resource reallocations should be considered in order to solve the problem. Patients were divided into six types depending on their condition and LOS at the different stages of the process. The simulation model portrayed each patient type's pathway with sufficient detail. Patient LOS figures were analyzed and distributions were formed from historical data, which were then used in the simulation. The model proved successful as it showed figures that were close to actual observations. Acquiring results and knowing exactly when and what caused a cancellation was another strong point of the model. The results demonstrated that the bottleneck in the system was related to the use of High Dependency Unit (HDU) beds, which were the recovery beds used by most patients. Enhancing the schedule by leveling out the daily arrival of patients to HDUs reduced patient cancellations by 20%. However, coupling this technique with minor capacity reallocations resulted in more than 60% drop in cancellations.
Purpose -The purpose of this paper is to explore the leadership implications of a mutual health service in National Health Service (NHS) Scotland. Design/methodology/approach -Analysis of extant government policy and suggestions of leadership considerations for practice. Findings -Moving towards a mutual health system will require new ways of thinking about health care and existing leadership practices in NHS Scotland. The leadership implications at the strategic, operational and tactical levels of delivery in NHS Scotland will need to be thought through. At present, it is not clear how this will be done, either from the available health-related literature or from policy. "Mutuality" will require a complex and multi-layered effort to embed it within the culture of the organisation, which will require inspirational leadership and sustained management from the government, the NHS and the wider public to make the change happen. Research limitations/implications -This paper suggests that more leadership research is still required to understand fully -and implement -a mutual health service in Scotland. A theoretical framework and/or empirical reference points have yet to be developed. Practical implications -This paper highlights the practical implications in operationalising government policy. Originality/value -Little -if any -has been written about the leadership implications of a mutual and public health service.
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