Summary: Results from the MASHnet Questionnaire presented at the MASHnet workshop "Modelling and Simulation for a Changing NHS" 12 December 2010

At the MASHnet workshop held in London on 12 November 2010, delegates were asked to complete an individual questionnaire about the most effective way to advance the successful application of modelling and simulation techniques within the NHS. 55 questionnaires were collected from delegates.

Seven categories of activity based on previous workshops were rated for importance and then ranked in order according to the most effective at promoting better application of these approaches in healthcare.

The ratings for each category are given below showing that all of the identified activities are rated as important.

The order of importance for each category based on the average responses is given below:

Summary: Copies of presentation slides from the MASHnet Workshop : Modelling and Simulation for a Changing NHS

Copies of the Presentation slides from the workshop are below:

David Bensley :

• Strategic challenges in a substantially transformed health landscape: Making a recognisable and valued impact :
• DavidBensley_MASHnet12Nov10

 Sally Brailsford :

• Modelling in turbulent times: why the NHS needs models more than ever :
• SallyBrailsford_MASHnet12Nov10

 Nick Gaunt :

• Simulating new models of care – lessons learnt from PCT use of Scenario Generator
• NickGaunt_MASHnet12Nov

Claire Cordeaux :

• Effective Modelling in the NHS – Some case studies and lessons learned. 
• ClaireCordeaux_MASHnet12Nov10

Jon Smith :

• The use of geographic modelling in healthcare planning
• JonSmith_MASHnet12Nov10

Martin Pitt :

• The TORCH project – Building capacity for modelling and simulation within the NHS
• MartinPitt_MASHnet12Nov10

Martin Utley :

• More for less: the modeller’s dream or a rude awakening?
• MartinUtley_MASHnet12Nov

Summary: A paper originally published in the British Journal of Healthcare Management examining the role of Operational Research in the Health services.

Resource Type: Articles

This paper, reproduced by kind permission of the British Journal of Healthcare Management, examines the role of operational research methods in the health services looking at the barriers and facilitators to implementation.

Click here to download pdf : The role of Operational Research in Health

Resource Type: Newsletters

September 2010

Issue 7.4 of Nosokinetics. Click here to download : Nosokinetics74

Resource Type: Newsletters

July 2010 Issue of Nosokinetcs

Click here to download: Nosokinetics73

Summary: Summary description of a project commissioned by the NHS Institute and overseen by MASHnet to develop a curriculum for teaching operational research techniques to health service commissioners.

Resource Type: Project Reports

The TORCH (Teaching Operational Research for Commissioning in Health) project was commissioned by the NHS Institute for Innovation and Improvement from March-May 2009 and co-ordinated by MASHnet. The project developed a currciulum for modelling and simulation for Healthcare commissioners particularly those in Primary Care Trusts engaged with World Class Commissioning and delivered according to the following aims.

• To scope the application of modelling and simulation techniques to strategic planning and commissioning within the English NHS
• To identify the educational requirements of key groups of staff within Primary Care Trusts and other relevant organisations to enable them to become competent in the application of those techniques.
• To develop an outline curriculum for which a suite of educational materials can subsequently be procured and presented

For more information about the TORCH project : TORCH Curriculum for Modelling for Commissioning

Summary: An account of the MASHnet One-day Conference held at Cardiff University with summaries and outputs of the presentations.

Resource Type: Event Reports

Modelling and Simulation in Healthcare – Shaping the Future

Held on Monday APRIL 3rd  @ Department of Mathematics, University of Cardiff

This full day workshop brought together a wide range of delegates from backgrounds in the health service, academic research and industry.

John Williams Presents at Cardiff

Delegates at the post workshop dinner

Presentations from the day are given below.

Summary: The full back catalogue of issues of Nosokinetics News - the newsletter of the Nosokinetics Group which is focussed on the use of modelling in health and social care.

Resource Type: Newsletters

NOSOKINETICS NEWS : Newsletter of the UK Nosokinetics Group in Health and Social Care Modelling

Nosokinetics [Nos’o’ki’net’ics] is the science/subject of measuring and modelling the process of care in health and social care systems. Nosokinetics brings together the Greek words for noso: disease and kinetics: movement.

Nosokinetics News is  distributed electronically to the Nosokinetics group and edited by Prof. Peter Millard who has agreed that MASHnet can include the newsletter on this site.

	Issue 7.2 : April 2010 Click image to preview front page, or use link to download pdf copy. Nosokinetics 7.2 (pdf)
	Issue 7.1 : February 2010 Click image to preview front page, or use link to download pdf copy. Nosokinetics 7.1 (pdf)
	Issue 6.4 : November 2009 Click image to preview front page, or use link to download pdf copy. Nosokinetics 6.4 (pdf)
	Issue 6.3 : September 2009Click Image to preview front page, or use link to download pdf copy. Nosokinetics 6.3 (pdf)
	Issue 6.2 : April 2009Click Image to preview front page, or use link to download pdf copy. Nosokinetics 6.2 (pdf)
	Issue 6.1 : February 2009 Click image to preview front page, or use link to download pdf copy. Nosokinetics 6.1 (pdf)
	Issue 5.6 : December 2008 Click image to preview front page, or use link to download pdf copy. Nosokinetics 5.6 (pdf)
	Issue 5.5 : October 2008 Click Image to preview front page, or use link to download pdf copy. Nosokinetics 5.5 (pdf)
	Issue 5.4 : August 2008Click image to preview front page, or use link to download pdf copy. Nosokinetics 5.4 (pdf)
	Issue 5.3 : June 2008 Click image to preview front page, or use link to download pdf copy. Nosokinetics 5.3 (pdf)
	Issue 5.2 : April 2008 Click image to preview front page, or use link to download pdf copy. Nosokinetics 5.2 (pdf)
	Issue 5.1 : February 2008 Click image to preview front page, or use link to download pdf copy. Nosokinetics 5.1 (pdf)
	Issue 4.6 : December 2007 Click image to preview front page, or use link to download pdf copy. Nosokinetics 4.6 (pdf)
	Issue 4.5 : October 2007Click image to preview front page, or use link to download pdf copy. Nosokinetics 4.5 (pdf)
	Issue 4.4 : August 2007 Click image to preview front page, or use link to download pdf copy. Nosokinetics 4.4 (pdf)
	Issue 4.3 : June 2007Click image to preview front page, or use link to download pdf copy. Nosokinetics 4.3 (pdf)
	Issue 4.2 : April 2007Click image to preview front page, or use link to download pdf copy. Nosokinetics 4.2 (pdf)
	Issue 4.1 : February 2007 Click image to preview front page, or use link to download pdf copy. Nosokinetics 4.1 (pdf)
	Issue 3.6 : December 2006Click image to preview front page, or use link to download pdf copy. Nosokinetics 3.6 (pdf)
	Issue 3.5 : October 2006Click image to preview front page, or use link to download pdf copy. Nosokinetics 3.5 (pdf)
	Issue 3.4 : August 2006Click image to preview front page, or use link to download pdf copy. Nosokinetics 3.4 (pdf)
	Issue 3.3 : June 2006Click Image to preview front page, or use link to download pdf copy. Nosokinetics 3.3 (pdf)
	Issue 3.2 : April 2006Click image to preview front page, or use link to download pdf copy. Nosokinetics 3.2 (pdf)
	Issue 3.1 : February 2006Click image to preview front page, or use link to download pdf copy. Nosokinetics 3.1 (pdf)
	Issue 2.6 : December 2005Click image to preview front page, or use link to download pdf copy. Nosokinetics 2.6 (pdf)
	Issue 2.5 : October 2005Click image to preview front page, or use link to download pdf copy. Nosokinetics 2.5 (pdf)
	Issue 2.4 : August 2005Click image to preview front page, or use link to download pdf copy. Nosokinetics 2.4 (pdf)
	Issue 2.3 : June 2005Click image to preview front page, or use link to download pdf copy. Nosokinetics 2.3 (pdf)
	Issue 2.2 : April 2005Click image to preview front page, or use link to download pdf copy. Nosokinetics 2.2 (pdf)
	Issue 2.1 : February 2005Click image to preview front page, or use link to download pdf copy. Nosokinetics 2.1 (pdf)
	Issue 1.6 : December 2004Click image to preview front page, or use link to download pdf copy. Nosokinetics 1.6 (pdf)
	Issue 1.5 : October 2004Click Image to preview front page, or use link to download pdf copy. Nosokinetics 1.5 (pdf)
	Issue 1.4 : August 2004Click Image to preview front page, or use link to download pdf copy. Nosokinetics 1.4 (pdf)
	Issue 1.3 : June 2004Click Image to preview front page, or use link to download pdf copy. Nosokinetics 1.3 (pdf)
	Issue 1.2 : April 2004Click Image to preview front page, or use link to download pdf copy. Nosokinetics 1.2 (pdf)
	Issue 1.1 : February 2004Click Image to preview front page, or use link to download pdf copy. Nosokinetics 1.1 (pdf)

Summary: A review of Simon Dodds' book which examines the use of simulation in the redesign of a vascular surgery.

Resource Type: Reviews - Books

By Simon Dodds, 2006. Kingsham Press, Chichester.

ISBN 1-904235-54-9
Price: £16.95. Soft back. 71 pages.

Review by Martin Pitt

Simon Dodds is a vascular surgeon with an unusual background. In addition to his medical training, he is qualified and experienced in computer science and has a working knowledge of process re-engineering.

This book charts Dodd’s award winning project of transforming the leg ulcer referral service at Good Hope Hospital in Sutton Coldfield. Rather than dwelling on the hard aspects of process re-design, however, the content majors on the softer sides of inducing radical change in a system emphasising the importance of team building and creating trust and commitment. In this the book draws on the work of management scientists such as Belbin and Bridges, looking at the necessary conditions for successful transformation. Only towards the end does Dodds tackle the application of his simulation modelling techniques in the redesign process and shows how this fits into the staged re-development of services.

The book is presented as a narrative, stepping through the key stages of process re-design applying the lessons of software engineering to process engineering. The ‘win-win-win’ of the title refers to the gains of re-design in terms of improvements in:

1. quality for patients
2. motivation for staff
3. performance for management.

This is very much a book for those who want to see examples of successful transformation and learn lessons of application. It succeeds because it is a practical approach, bedded in the experience of his own transformation of the leg ulcer service at Good Hope. Each stage of the story is underpinned by inset panels illustrating experiences from this innovative project. Dodds is clearly keen to spread the good word and the good work. The book has a positive, sometimes evangelical, style. But this does not grate, rather is refreshing in the context of an organisation – the NHS-where change of any sort evokes phrases such as ‘wading through treacle’ and ‘banging your head against a brick wall’.

Inevitably questions arise from a critical reading of the text. How, for example, is the advocated approach relevant when the ‘win-win’ benefits are not so obvious. The reality of many situations of service provision is that of trade-off, where typically gains in benefit are off-set by costs in resources. Here there are unavoidable judgements needed to deal with these trade-offs. Despite this, however, there is a clear potential that many ‘win-win’ possibilities do exist in healthcare and are yet to be engaged with for reasons of inertia.

It is also important to highlight the challenges that exist for departments which do not have the benefit of a champion such as Simon Dodds with his unusual mix of skills. It is the bridging of information from the problem holders to the system designers that is so often where the breakdowns occur – clearly an area where much more remains to be accomplished.

This is an engaging and challenging book on health service re-design which will be of interest to anyone concerned with the hard practical issues of instilling change and the role that modelling and simulation can play as an embedded part of this process. Dodds does not claim to provide all the answers in this slim volume and clearly has a great deal more to say on the issues that he introduces. We can only hope for further publications in the future.

Summary: Modelling Healthcare - making it work. A full review of the very successful MASHnet launch day event including outputs from the presentations and interactive sessions.

Resource Type: Event Reports

This event held at Warwick University Business School was a full house with over seventy participants active in the area of healthcare modelling – drawing from many areas of the health service, academic research and industry.

Keynote Presentations

Dr Geoff Royston is Head of Profession for OR. in the Dept. of Health and works in the Dept’s Strategy Directorate. Work includes developing methods for allocating health care resources to localities, improving communication of clinical risks, reducing waiting times, evaluating NHS modernisation programmes. Recently he has worked on “expert patients” and support for self-care. He was responsible for the concept of “NHS Direct” as a multi-channel service and led the first stages of its implementation. He has directed the programme of DoH work on health applications of digital TV and a satellite TV service “NHS Direct Interactive” which went “on air” in Dec 2004 now reaches 10 million in the UK.

PRESENTATION: Modelling and Simulation in Health – Potential, Achievement and Challenge Geoff Royston Presentation  

Commences with some background on recent major developments in UK health care and a short overview on modelling. It provides some illustrations of modelling and simulation in the UK health sector, including some from the work of OR analysts in the DH. The talk then highlights some key issues for the UK health sector in the early 21st century and the challenges and opportunities these present for members of MASHnet.

Professor Ruth Davies – Head of the Operational Research and Information Systems Group at Warwick Business School. Her expertise is in modelling health systems, using simulation to describe the interaction between the parts in order to evaluate current and potential future policies. Over the past few years she has run several substantial projects, funded by the Department of Health, in order to advise on policy. She has many active roles in this area and was co-editor of the February 2005 Special Issue of the Journal of the OR Society dedicated to “Meeting Health Challenges with OR”.

PRESENTATION: OR, Academics and the Health Service Ruth Davies Presentation  

Looks at the relationship between OR and the Health Service using a hospital and a disease based case study. Demonstrates that academic research needs to take a broad view, both developing and exploiting new techniques and also taking account of the objectives of a range of stakeholders. Whilst academics are also concerned with implementation and change, they and the “users” will benefit from closer links with practitioners and software developers. We anticipate that MASHnet will facilitate this.

Dr Mark Elder – CEO of SIMUL8 Corporation, a company he founded in 1994 because a radiology manager could not find simulation software that could answer his simple question: Should I build an additional radiology room, or hire an additional nurse? – Which would best reducing patient waiting times? Since then SIMUL8 Corp as driven forward the idea of simulation as a tool for gathering evidence for change, that works just as well for the service sector as it has for decades in manufacturing.

PRESENTATION: Developing Models of Health Mark Elder Presentation  

Mark’s talk uses a number of recent examples of healthcare simulation models to highlight some do’s and don’ts in simulation modelling. He shows us some of the numerical and non-numerical benefits of spending time on modelling.

Dr Simon Dodds – born and educated in Yorkshire, won an Open Scholarship to read Medicine at Cambridge in 1979. He chose a Part II in Computer Science and after completing his medical degree at St Bart’s Hospital in London he trained in surgery in London, Cambridge and Wessex. At Southampton he was awarded his MS degree in 1994 for research on computer modelling the haemodynamics of occlusive arterial disease and was appointed a consultant vascular surgeon at Good Hope Hospital in 1999. Since then he has combined his experience in medicine, research and computer science to improve vascular surgery services at Good Hope. In 2004 his team were awarded the NHS Innovation Award for Service Delivery for the Leg Ulcer Telemedicine Service. His current projects include the application of discrete event simulation (DES) to the design of improved healthcare processes for which he was awarded the HITEA 2005 Best use of IT in the Health Service for the successful implementation of the DES-designed One Stop Vascular Surgery Clinic.

PRESENTATION: Designing win-win-win solutions for improved healthcare performance – it is possible! Simon Dodds Presentation (pdf)

The current challenges in delivering high quality, cost effective healthcare are not lack of medical knowledge but ineffective delivery of existing knowledge. Applied OR in healthcare delivery has great potential to dramatically improve existing services. Over the last five years these principles were used to redesign the vascular surgery outpatient service at Good Hope Hospital. A discrete event simulation (DES) has been designed that predicted a possible increase of 40% in maximum clinic capacity using existing resources. Simulations were verified by successfully implementing the best model in practice – resulting in a win-win-win outcome for patients, staff and the hospital. The principles and methods of OR/OM require specific knowledge, skills and experience to apply safely. Active diffusion of innovation requires – support for further innovation, appropriate software tools, end-user training, and a programme of training successive waves of early adopters. The goal is the tipping point where the momentum generated is sufficient to complete the paradigm shift to a culture of evidence-based healthcare management.

Output From Interactive Sessions

Break-out sessions were held in the afternoon of the launch event in which groups of about eight people were each asked to complete a grid which outlined their responses to a each of the following four questions from the perspective of the three main sectors addressed by MASHnet (i.e. Health Services, Academic Research, and Industry)

1. Why is health care modelling and simulation important?
2. What are the main obstacles to its successful application?
3. What actions can be taken to overcome these obstacles?
4. What are the most important issues arising?

Grid Outputs – typed version (pdf)

Grid from the Pink Group

Grid from the Red Group

Grid from the Orange Group

Grid from the Yellow Group

Grid from the Green Group

Grid from the Dark Blue Group

Grid from the Light Blue Group

Grid from the Purple Group

Big Ideas

All participants at the MASHnet launch were asked to fill in a ‘Big Idea’ response form which asked for one idea which would improve the application of modelling and simulation in health care. These responses are listed below:

• Showing success of previous work using modelling to all academics, industry and health
• To look at the application of OR in operational running of health system
• Develop a repository of examples of successful applications
• Develop generic simulation software – joint project for all 3 branches of MASHnet
• You need to work ‘hands-on’ in the operational environment to appreciate actually what happens and who does what, else implementation of anything new is problematic as it will be potentially rejected by staff
• Academics need to ‘buddy-up’ with healthcare practitioners in order to increase awareness and more importantly implementation
• Do not approve any big projects that have not been validated by simulation
• “Go” to the Healthcare community rather than waiting for them to come (workshop, etc.)
• MASHnet representation at NHS conferences e.g. Harrogate and others
• Negotiate central R & D funding champions and National coordination so modelling can be applied across a large number of organisations in a uniform way
• MASHnet to become a more political driver to bring the 3 groups together – target modelling to be centre of health service change
• To look at the beginning – to work together with designers (key designers) to help them to find out the “key” questions in terms of how the healthcare building will operate
• Mashnet and healthcare conferences. Industry and academics working together with a health economy and actually doing some “hands-on” work. Not all healthcare organisations have the appropriate resources – people, time, etc. to be able to apply/use a mode “off the shelf”
• Workshops in regions of NHS
• Plan at least one training event for people to bring real problems and to work with acknowledged practitioner to experience first-hand to see MASH in action
• Every community (health service, academic and industry, etc.) needs to take responsibility for increasing implementation levels
• Developing intra-organisational pathway model
• Facilitating a feedback system so that all modelling work/outcomes get centrally registered
• Need to plan a programme grant application to a research council for a sustained (5-yr) research programme. One element could be a direct comparison of a RCT and DESM head to head
• On-line source of case studies of health service (real applications) projects that have been implemented. Particular emphasis should be on operational level (i.e. hospital). The Modernisation Agency has disseminated some material, e.g. toolkits, but more detailed real examples would be useful
• Find ways to integrate modelling as a key discipline of health-related research alongside the other key disciplines (e.g. statistics, economics, health psychology, etc.)
• Workshops for practitioners, clinicians, and healthcare managers. We need to get the modelling concept across more forcibly
• Hold “problem-drive” days where academics/health care professionals/ industrials meet – healthcare profs. Present current real-life major issues and others brain-storm ways of helping (i.e. put academics on the spot!)
• My mission statement – to de-mystify the building of models to solve real problems
• Publicise to Chief Executives of healthcare organisations in order to raise and support the profile of modelling and encourage ‘buy-in’
• Involve the independent sector of healthcare who might have an easier entry point than existing NHS to show effectiveness of modelling and therefore greater acceptance. Noting that IS is elective not 24×7
• The DoH to promote OR and modelling to NHS executives, managers
• Create a road show of big-hitting OR applications. Show the direct and practical implemental benefits … in 10 mins. Then show this to senior people in NHS
• Have articles about M&S in health service journals. Have presentations about M&S at professional (medic managers) conferences
• Collaborating closely between health care providers and system modelling builders (academics and software developers), clinicians and professionals and also users. Make model simple, valid and also flexible
• Composition of an “Idiots’ Guide” to modelling & simulation aimed at health management and practitioners so that they can get an easier grasp of the benefits
• Promote ‘soft OR’ techniques to highlight problem structuring types of models as well as ‘hard OR’ mathematical models
• Get the appropriate level of abstraction for the representation
• Develop a common language
• Archive of grey literature (much will soon be lost)
• Share modelling successes, particularly with the NHS
• Encourage health service (operations and management) involvement
• Data cleanup and review of ?
• Sharing successful models and learning from each other on a local basis
• Having info on the web: what was done, who did it, how can I contact them
• Whole system modelling that compares like with like to better understand the constraints & complexities of system change
• Find a better name than Mashnet for publicity to NHS; Publicise examples of good modelling and future support
• Incentivise the use of modelling and simulation in planning by sponsoring a Health Service Journal award
• An introduction agency between health service problems and potentially able research/modellers
• A presence at medical conferences/health service conferences and seminars, etc.
• I would like for managers and clinicians to take ownership of the data that is used in modelling and simulation so that they understand its strengths and weaknesses before its use
• To publicise/ inform/advertise/demos of MASHnet activities where NHS people are trained, e.g. to medical students or NHS management courses
• Joint NHS/ University posts in healthcare modelling
• Create a pod of examples where modelling and simulation have worked in health care (how it was implemented, advantages and disadvantages from it). Allow all 3 groups to see what has been done already and what can be applied elsewhere.
• The Government should place tighter controls on budget overspends for Trusts, which would force them to look at more efficient and effective ways of working. This would encourage the use of tools and techniques such as modelling and simulation, as the cause of most overspends is lack of planning
• Chief Executive commitment; Ask smart questions to engage operational staff to access modelling outputs and to implement changes
• Better publication of successful implementations (e.g. Good Hope Hospital)
• Get success stories distributed and create competition for excellence between Trusts
• Long-term strategic goals need to be identified, to develop long-term partnerships between industry, academia and health services – with a view to embedding sectors for knowledge sharing
• Training and skills development for staff who may be required to support their organisation in modelling. Development of standard modelling applications which could be tailored at local level
• Use of modelling & simulation to develop and communicate best practice, both Nationally and Internationally. Library of generic models which can be accessed and used by members
• Working together on (?low-risk) issues to improve each other’s knowledge of opportunities and red herrings
• Work together. Build up standard approaches. Advocate a common software language. Share information and good modelling applications