OR and the challenge to improve the NHS: modelling for insight and improvement in in-patient flows

Abstract

This paper considers efforts to improve in-patient flows, a particularly urgent issue in the National Health Service (NHS). The context is described and related to reasons why OR has been making relatively little contribution. The paper argues that large complex models may often be unnecessary and even get in the way of providing clear insight and guidance for problem owners. The importance of understanding the generic working of systems to lead to improvement, and the limitations of simply describing them, is stressed. It is demonstrated that some very simple models can be of significant practical value in understanding and managing complex systems, changing mindsets and driving collection and use of operationally valuable data. Recommendations for more effective engagement with the NHS are offered.

Discrete event simulation for performance modelling in health care: a review of the literature

“…Fone et al (2003) also reports that the quality of the papers seems to have improved over the survey period. However, such a judgement must be tentative, as very few papers provide enough detail of model implementation, which is important given the views of Proudlove et al (2007).…”

“…On a related issue, Proudlove et al (2007) suggests that, in health-care modelling, a combination of simplicity and supportive presentation is more important than aiming at a complex and detailed representation when trying to support people to develop their thinking. They illustrate the argument with two examples in which simple Excelbased bed simulation models were built for clients and conclude that providing simple tools can help local system owners make sense of their systems.…”

SimLean: Utilising simulation in the implementation of lean in healthcare

“…see NHSI, 2010b). Although they do not specifically discuss DES and lean, Proudlove et al (2007) demonstrate how the use of simple models can be effective in giving generic insights into improving patient flow.…”

Assessing the Queuing Process Using Data Envelopment Analysis: an Application in Health Centres

“…In numerous developing nations, such as Pakistan, almost all health organizations lack a set Appointment System, resulting in long waiting. The former works have emphasized on evaluating and improving patient flow and scheduling (Bhattacharjee and Ray, 2014) in different departments of the hospital including inpatients (Proudlove et al, 2007), outpatients (Cayirli and Veral, 2003), emergency (Gul and Guneri, 2015) and surgical/operations (May et al, 2011). However, there are only a limited number of studies which particularly assessed the flow of walk-in patients in health centres (Fetter and Thompson 1966;Rising et al, 1973;Ashton et al, 2005;Cayirli and Gunes 2014).…”