Comment

02.08.15

Model hospitals

Source: NHE Jul/Aug 15

Professor Terry Young of Brunel University London, associate dean for health partnerships at the Department of Computer Science, is one of the driving forces behind the Cumberland Initiative and the push to increase NHS efficiency and innovation through systems thinking and computer modelling. The Initiative is now truly getting off the ground, Professor Young explains.

The second interim recommendation in Lord Carter’s recent review of hospital efficiency (see page 30) is to “develop a ‘model NHS hospital’ to help providers aspire to best practice across all areas of productivity”. As with good ideas – and this one is excellent – it may mean many things to many people.

Perhaps the most refreshing element of the report is its down-to-earth focus on efficiency: people’s time is the major cost in providing care, and so it makes sense to get the processes that they must follow sorted out. The report recognises how difficult efficiency is to assess, and proposes a measure to drive the quest for the best way to perform every hospital process. Hence the call for a ‘model hospital’.

Performance league tables have shown that the best routinely achieve much more, or take less time about it, or spend less in doing so, than the poorest performers, and calls to standardise practice make sense in that context. Of course, it is not as simple as that, and we recognise that the needs of served communities may make one hospital or practice, or community service, look much better or worse than its neighbours, irrespective of the quality or efficiency of care. We also know enough to be aware of hidden effects that may skew our view. And so a transparent model of a hospital would be a good way to make comparisons and assess, for instance, whether the excellence of one group’s orthopaedic offerings are subsidising, say, its stroke service.

So the existence of a model hospital would focus the discussion on the quality and efficiency of the processes themselves, provide a means of comparing processes even where patient groups or clinical areas differ, and set the business of continuous improvement on a more evidence-based footing.

Critically, it would allow staff to discuss the cost and benefit of different strategies to standardise performance: is it worth making all the staff in one hospital perform angiograms in one particular way, for instance, and if so, which way? Are there greater gains with less stress elsewhere? Finally, models allow different communities to comment on the options and to watch changes play out beyond their own fields of expertise.

Cumberland Initiative-04

But what would such a model look like? On 30 and 31 July 2010, a group of academics and companies met at Cumberland Lodge on the Great Park at Windsor to seek something radical in healthcare delivery. With a nod to the venue, we called ourselves the Cumberland Initiative and started meeting regularly. Not long afterwards, we set ourselves twin goals:

• To transform the quality and cost of NHS care delivery through systems thinking.
• To secure significant economic stimulus through new products, systems and services.

Computer models and simulation methods (including serious-gaming and walk-through exercises) are key tools for systems thinkers, so after five years, it is heartening to discover a major review setting out a challenge in so familiar a context.

On 6 July 2015, the vice-chancellor of Brunel University, Professor Julia Buckingham, opened the Cumberland Institute: the living laboratory in which the network of Cumberland Initiative affiliates can run simulations and models at scale with large numbers of users and even patients.

Cumberland Initiative-01

Our aim is not to set up a single all-embracing computer model that tracks everyone in the health system everywhere, minute by minute. A form of that already exists: it’s called reality, and it is too complicated for us to make predictions about even when we have great insight and many years of expert experience. Rather, we aim to socialise modelling as a way of understanding and improving process in the NHS.

Cumberland Initiative-08

On 6 July, we brought the three key elements to achieving such a vision together under one roof. First, there were the people. Nothing will happen without people and in this case it is critical that clinicians and clinical managers lead the search for models of performance. The Cumberland brings two other communities together with the clinical: academics and companies. We may not like the terminology, but we are going to have to follow the Mayo in recognising the importance of ‘industrial engineering’ if we are to emerge with safer, more efficient processes that offer a better experience to patients.

guests - clinicians, academics and computer companies, playing a timed simulation game on meeting AandE targets.  (1)

The other two components were laid out in the large laboratory area – or CumberLab – computer models (in this case a game to run a hospital using a silicon engine to assess the decisions and track performance) and the physical space to accommodate 100 experts in the same room. Part of the room was mocked up to look like a part of an A&E department, but it could have been used to track services across a region such as Manchester.

Cumberland Initiative-14

People, models and a neutral, safe, space to explore how we deliver better care. It’s not the model, not yet. But it is a great start.

Cumberland Initiative-11

Comments

There are no comments. Why not be the first?

Add your comment

 

national health executive tv

more videos >

latest healthcare news

NHS Providers: Urgent action plan needed to mitigate winter pressures

28/02/2020NHS Providers: Urgent action plan needed to mitigate winter pressures

This latest weekly winter reporting data published by NHS England and NHS Improvement, which has seen NHS performance improve slightly. Dire... more >
Number of nurses increases by 8,570 in the past year

27/02/2020Number of nurses increases by 8,570 in the past year

The Government has announced nursing numbers in the NHS have gone up by 8,570 nurses over the past year, as they work towards their ambitious goa... more >
NHS Digital annual report shows increase in adult social care workforce

27/02/2020NHS Digital annual report shows increase in adult social care workforce

An additional 1,000 adult social services roles were filled in local authorities across England, according to the latest NHS Digital annual repor... more >

the scalpel's daily blog

Too much emphasis on leadership development… and not enough

24/02/2020Too much emphasis on leadership development… and not enough

Words by Dean Royles and Kevan Taylor, who continue their regular contribution to NHE’s blog content. Kevan and Dean work in organisations and systems providing strategic support, advice and development. Every time the NHS goes through one of its many, many structural reorganisations, there is a renewed emphasis on the importance of leadership development. This is a good thing. We know the importance and value of good leadership a... more >
read more blog posts from 'the scalpel' >

interviews

Mike Farrar, Swim England - Last Word

07/12/2019Mike Farrar, Swim England - Last Word

Mike Farrar Chairperson of Swim England Would you talk us through your previous roles within the NHS? I’ve held a number of ... more >
Matt Hancock says GP recruitment is on the rise to support ‘bedrock of the NHS’

24/10/2019Matt Hancock says GP recruitment is on the rise to support ‘bedrock of the NHS’

Today, speaking at the Royal College of General Practitioners (RCGP) annual conference, Matt Hancock highlighted what he believes to be the three... more >
NHS dreams come true for Teesside domestic

17/09/2019NHS dreams come true for Teesside domestic

Over 20 years ago, a Teesside hospital cleaner put down her mop and took steps towards her midwifery dreams. Lisa Payne has been delivering ... more >
How can winter pressures be dealt with? Introduce a National Social Care Service, RCP president suggests

24/10/2018How can winter pressures be dealt with? Introduce a National Social Care Service, RCP president suggests

A dedicated national social care service could be a potential solution to surging demand burdening acute health providers over the winter months,... more >

last word

Haseeb Ahmad: ‘We all have a role to play in getting innovations quicker’

Haseeb Ahmad: ‘We all have a role to play in getting innovations quicker’

Haseeb Ahmad, president of the Association of the British Pharmaceutical Industry (ABPI), sits down with National Health Executive as part of our Last Word Q&A series. Would you talk us th... more > more last word articles >

editor's comment

25/09/2017A hotbed of innovation

This edition of NHE comes hot on the heels of this year’s NHS Expo which, once again, proved to be a huge success at Manchester Central. A number of announcements were made during the event, with the health secretary naming the second wave of NHS digital pioneers, or ‘fast followers’, which follow the initial global digital e... read more >

health service focus

Royal Voluntary Service: The power of NHS volunteers

25/02/2020Royal Voluntary Service: The power of NHS volunteers

Sam Ward, Deputy CEO and Director of Services... more >
APCC: Cracking down on illegal sales of medicines with communication

25/02/2020APCC: Cracking down on illegal sales of medicines with communication

Hardyal Dhindsa, Association of Police and Cr... more >