Overcoming the barriers: a qualitative study of simulation adoption in the NHS

Brailsford, Sally C.; Bolt, Timothy; Bucci, G.; Chaussalet, Thierry J.; Connell, N.A.D.; Harper, Paul Robert; Klein, Jonathan H.; Pitt, Martin; Taylor, Melinda E.

doi:10.1057/jors.2011.130

Cited by 50 publications

(34 citation statements)

References 13 publications

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“…But even before the Act, these two communities did not work well together, as other studies have shown. 52 A former NHS analyst thought that separating analytics from commissioning was 'absolutely' wrong for the fast-paced, highly changeable environment of commissioning.…”

Section: Gap Between Analysts and Commissionersmentioning

confidence: 99%

Knowledge exchange in health-care commissioning: case studies of the use of commercial, not-for-profit and public sector agencies, 2011–14

Wye

Brangan

Cameron

et al. 2015

Health Services and Delivery Research

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BackgroundEnglish health-care commissioners from the NHS need information to commission effectively. In the light of new legislation in 2012, new ‘external’ organisations were created such as commissioning support units (CSUs), public health departments moved into local authorities and ‘external’ provider organisations such as commercial and not-for-profit agencies and freelance consultants were encouraged. The aim of this research from 2011 to 2014 was to study knowledge exchange between these external providers and health-care commissioners to learn about knowledge acquisition and transformation, the role of external providers and the benefits of contracts between external providers and health-care commissioners.MethodsUsing a case study design, we collected data from eight cases, where commercial and not-for-profit organisations were contracted. We conducted 92 interviews with external providers (n = 36), their clients (n = 47) and others (n = 9), observed 25 training events and meetings and collected various documentation including meeting minutes, reports and websites. Using constant comparison, data were analysed thematically using a coding framework and summaries of cases.ResultsIn juggling competing agendas, commissioners pragmatically accessed and used information to build a cohesive, persuasive case to plot a course of action, convince others and justify decisions. Local data often trumped national or research-based information. Conversations and stories were fast, flexible and suited to the continually changing commissioning environment. Academic research evidence was occasionally explicitly sought, but usually came predigested via National Institute of Health and Care Excellence guidance, software tools and general practitioner clinical knowledge. Negative research evidence did not trigger discussions of disinvestment opportunities. Every commissioning organisation studied had its own unique blend of three types of commissioning models: clinical commissioning, integrated health and social care and commercial provider. Different types of information were privileged in each model. Commissioners regularly accessed information through five main conduits: (1) interpersonal relationships; (2) people placement (embedded staff); (3) governance (e.g. Department of Health directives); (4) ‘copy, adapt and paste’ (e.g. best practice elsewhere); and (5) product deployment (e.g. software tools). Interpersonal relationships appeared most crucial in influencing commissioning decisions. In transforming knowledge, commissioners undertook repeated, iterative processes ofcontextualisationusing a local lens andengagementto refine the knowledge and ensure that the ‘right people’ were on board. Knowledge became transformed, reshaped and repackaged in the act of acquisition and through these processes as commissioners manoeuvred knowledge through the system. External providers were contracted for their skills and expertise in project management, forecast modelling, event management, pathway development and software tool development. Trust and usability influenced clients’ views on the usefulness of external providers, for example the motivations of Public Health and CSUs were more trusted, but the usefulness of their output was variable. Among the commercial and not-for-profit agencies in this study, one was not very successful, as the NHS clients thought that the external provider added little of extra value. With another, the benefits were largely still notional and with a third views were largely positive, with some concerns about expense. Analysts often benefited more than those making commissioning decisions.ConclusionsExternal providers who maximised their use of the different conduits and produced something of value beyond what was locally available appeared more successful. The long-standing schism between analysts and commissioners blunted the impact of some contracts on commissioners’ decision-making. To capitalise on the expertise of external providers, wherever possible, contracts should include explicit skills development and knowledge transfer components.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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Section: Gap Between Analysts and Commissionersmentioning

confidence: 99%

Knowledge exchange in health-care commissioning: case studies of the use of commercial, not-for-profit and public sector agencies, 2011–14

Wye

Brangan

Cameron

et al. 2015

Health Services and Delivery Research

View full text Add to dashboard Cite

show abstract

“…It has also been used within the NHS, as part of a public private partnership arrangement between the software developer (SIMUL8 Corporation) and the NHS Institute for Innovation and Improvement. 62 …”

Section: Model Implementationmentioning

confidence: 99%

Economic modelling of diagnostic and treatment pathways in National Institute for Health and Care Excellence clinical guidelines: the Modelling Algorithm Pathways in Guidelines (MAPGuide) project

Lord

Willis²,

Eatock³

et al. 2013

Health Technology Assessment

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“…Many studies applied OR models for hospital operations but they often proved to be challenging to implement and unsustainable [13,14]. Brailsford et al [13] evaluated the adoption of the simulation tool similar to the one used in this study.…”

Section: Patient Schedulingmentioning

confidence: 99%

“…Brailsford et al [13] evaluated the adoption of the simulation tool similar to the one used in this study. They concluded that difficulties in adoption came from lack of capacity (lack of time, internal expertise and budget), lack of management support (due to not seeing a timely return on investment) and data issues (lack of useful data and data that hospital staff found hard to read from the software).…”

Section: Patient Schedulingmentioning

confidence: 99%

Modeling the critical care pathway for cardiothoracic surgery

Bahou

Fenwick

Anderson

et al. 2017

Health Care Manag Sci

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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.

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Overcoming the barriers: a qualitative study of simulation adoption in the NHS

Cited by 50 publications

References 13 publications

Knowledge exchange in health-care commissioning: case studies of the use of commercial, not-for-profit and public sector agencies, 2011–14

Knowledge exchange in health-care commissioning: case studies of the use of commercial, not-for-profit and public sector agencies, 2011–14

Economic modelling of diagnostic and treatment pathways in National Institute for Health and Care Excellence clinical guidelines: the Modelling Algorithm Pathways in Guidelines (MAPGuide) project

Modeling the critical care pathway for cardiothoracic surgery

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