Virtual Festival of Evidence | Dr. Mark Mackay


Setting metrics and making service provision more effective and efficient: challenges and guidance


Dr. Mark Mackay | Fliders University


Mark Mackay: We’ve created a simulation model. It’s a multi method model that draws upon a number of modelling approaches. It’s designed to measure the patient journey through the emergency department, if patients are discharged, or when they are admitted and then continue through the hospital. It’s been built so we can better understand what happens to patients as they move through the hospital, but also to test new scenarios. So if we make a change, what might happen?

Interviewer: It is very visual – it’s coloured boxes with lots of little flickering people moving around. What’s the reaction you get when you show it to people in the hospitals?

Mark Mackay: Having the little bodies move around the screen is really important as an engagement tool for clinicians. Suddenly the light switches on, and they get it. The ‘aha’ moment is loud and clear.

Interviewer: You could see how this could be very relevant to the NHS and some of the challenges that it’s facing. You’ve done some work modelling what would happen if you introduced fees for people to go and see their GP. Tell us about that.

Mark Mackay: In Australia the Federal Government has a desire to introduce a copayment, which is a fee of about $7.50 for every time someone sees a GP. Currently 80 percent of people don’t pay anything and it’s what we call bulk build. We used our model of the hospital to say okay, some of these people decide to swap from going to their GP and go to the emergency department, what might happen at the hospital as a consequence of this change in policy?

It didn’t take a lot of shift of patients turning up at the hospital to see the time they spent in the emergency department double and the queue waiting for services in the emergency department to lengthen considerably. An additional four patients an hour, which is a small number given how many GPs consults occur each day, was all it took to see that happen.

Interviewer: You’ve also done some work tracking doctors and the time they spend doing different tasks around the hospital. What did that tell you about how efficiently or not their time was used?

Mark Mackay: That was a really good example of trying to convert anecdotes to evidence. We employ doctors and nurses to undertake care of patients and provide services in hospitals, but what they do from minute to minute we don’t understand, so we decided to get some measures of that. We did an observational study, and that showed for example that 10 percent of their time was spent on logistics. In this case logistics mean waiting for something to happen; something was missing from the room, some piece of equipment they needed. 10 percent is a lot of time. If you can fix those problems, which you don’t know exist until you do this sort of study, you can potentially improve the efficiency and effectiveness of the service.