White paper #1 - Why modelling is key to designing health services and what it costs you if you don’t
Thanks for the picture to Owen Beard on Unsplash
How much is it worth to model a health system and what does it cost if you don’t?
Three long-term projects reached significant milestones in 2022 for Datchet Consulting. The first is to find numbers that value the modelling of healthcare services before they are introduced.
Motivation
I came into healthcare research from industrial R&D. When I took a package in 2001 and emerged in an academic career, I believed there was a chance to deliver better care at significantly lower cost. This year, things reached a helpful waypoint.
What is modelling worth?
The new and early evidence is that each £ spent in modelling options before committing is likely to return £30-1,000, much more in exceptional cases. The numbers are still very crude – as is our approach – but the emerging picture is consistently positive about modelling being good value.
We are close to the point where it could be deemed negligent to procure any healthcare service, building, or even equipment, without rigorous simulation modelling or an equivalent diagnostic evaluation during the design process.
Where do the gains come from?
Our preliminary findings show that rigorous design of patient pathways (including hiring extra staff) has cut the cost of such routine processes as having scans or moving patients from the emergency room onto wards. In other cases, a detailed analysis of usage enabled existing facilities to cope with rising demand instead of building, or buying capital equipment, and hiring the extra staff. In other examples, competing strategies could be compared (e.g.: should you put all your big operations through one suite of theatres and your minor operations through another)?
These are not minor decisions – they tie up expensive staff most hours of most days. Moreover, getting them right means easier access for patients with faster attention and better care.
Modelling a service focuses on streamlining the steps staff and patients take and aligns this choreography with what is available (physically and as information) to everyone at every stage.
Models don’t just work for good days but specifically help to explore poorer days: everything from disasters (where the payback for modelling is enormous) to typical days (when knock-on effects from modest waits and random delays drag efficiency down disproportionately).
The journey
2001 Prof Young becomes Professor of Healthcare Systems in a Computer Science Department at Brunel University (London)
2004 Publishes Using industrial processes to improve patient care in the BMJ with a team from Southampton: Sally Brailsford, Con Connell, (Emeritus Prof) Ruth Davies, Paul Harper and Jonathan Klein. Its strategic agenda scopes how industrial thinking can improve care.
2007 Leads RIGHT, a 2½ EPSRC project with 4 universities: Brunel, Cambridge, Southampton and Ulster. Showed that health lags well behind aerospace and manufacturing in service design.
2014 Leads the Cumberland Initiative, a multi-university, industrial, clinical, management collaboration. SEGRO provided a building for modelling trials from 2014-2017.
2015 Starts to research if it is possible to put a number to what modelling is worth in health with Sada Soorapanth. Jointly published a paper on the financial pay-back of modelling. Evaluating the financial impact of modeling and simulation in healthcare: Proposed framework with a case study (preprint here if you lack access to IEEExplore)
2017 Brunel University London granted Prof Young a sabbatical to collect data and case studies. The combination of visits and collaborations produced methodological development and case studies, published with Sada Soorapanth (additional authors cited separately below)
Assessing the value of modelling and simulation in health care: An example based on increasing access to stroke treatment on-line (2018, JORS hard copy, 2019). It showed how to use health economics to evaluate modelling as a health intervention.
Systems, design and value-for-money in the NHS: mission impossible? with Alec Morton in 2018. This short paper outlines a simple graphical tool for service design using a health economics approach that accounts for financial and health gains and losses for cutting services or introducing new ones.
The costs and value of modelling-based design in healthcare delivery: five case studies from the US was published on line (print version 2020) with Jim Wilkerson, Lance Millburg, Todd Roberts and David Morgareidge. This provided the first evidence of before-and-after evaluation we are aware of and won the OR Society’s Griffiths Medal in 2021.
2022 Towards a framework for evaluating the costs and benefits of simulation modelling in healthcare with Professors Soorapanth and Eldabi. 18 case studies with information on costs and calculations for financial and even health benefit.
If you would like Datchet Consulting’s support in health service design, framework development or simulation modelling, please contact terry@datchet.consulting.