A health manager’s thoughts on scenario modelling

By Esther Moors

What I know currently about scenario modelling would fit neatly on the back of a postage stamp. Perhaps that’s why I’m so keen to find out more. As a health manager with a keen interest in service improvement, finding good quality information about the evidence base for change is akin to finding the pot of gold at the end of the rainbow.

Sifting through the huge amount of data that is readily available within the NHS in order to reach a sensible conclusion seems a never ending quest. Just when you think you’ve found the ‘right’ data to answer your queries, an alternative explanation or conflicting piece of data will invariably be proffered.

Will scenario modelling merely prolong the data quest further, or might it just prove to be the ‘pot of gold’ we’ve been searching for? At this stage I do not know, but seeing a clinician at our Trust using Simul8 to map out flows through our Emergency Department has certainly sparked my interest. Conversations with Professor Young from Brunel University have also left me wanting to find out more.

Working in an acute hospital, our services are continually changing in order to respond to our patients’ needs in the most caring, effective and efficient way. But how much confidence do we have that the changes that we prioritise are the ones that will have greatest effect and that they will have the impact that we originally anticipated?
One area in which scenario modelling has real potential is patient flow and length of stay. Managing ‘peaks’ in activity is a challenge that all hospitals routinely confront. However, these ‘peaks’ arise not only from an increase in demand, but from a variety of factors for which a few subtle changes together create a profound effect.

There are three simple questions that need answering in order to manage patient flow effectively at all times:
What is happening right now?
What might I expect tomorrow as a result?
What difference will our planned changes make?

If a model could direct us more quickly to the bottle-necks, show the impact of changes in patient flows and identify our tolerance for change in the number of arrivals, admissions and discharges then I’m certainly interested. If it can draw out, from uncertainty, the patterns that we know are there but that are not always visible, then it will inform our everyday thinking.

Decisions as to appropriate service development often start with a ‘gut reaction’ that a particular change is needed. Improved empirical evidence to support or refute these decisions can only ever be beneficial. However, one of the key challenges in promoting scenario modelling within healthcare will be reconciling the difference in knowledge and language between academic and operational professionals. To be truly successful, any model will need to be easily explained and readily accessible to someone like me. It could then be a powerful tool indeed!

Esther Moors is Head of Service Planning, West Hertfordshire Hospitals NHS Trust

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