Exploring alternative routes to realising the benefits of simulation in healthcare

Discrete event simulation should offer numerous benefits in designing healthcare systems but the reality is often problematic. Healthcare modelling faces particular challenges: genuine, fundamental variations in practice and an opposition to any suggestion of standardisation from some professional groups. This paper compares the experiences of developing a new simulation in an Accident and Emergency (A&E) Department, a subsequent adaptation for modelling an outpatient clinic and applications of a generic A&E simulation. These studies provide examples of three distinct approaches to realising the potential benefits of simulation: the bespoke, the reuse and the generic route. Reuse has many advantages: it is relatively efficient in exploiting previous modelling experience, delivering timely results while providing scope for adaptations to local practice. Explicitly demonstrating this willingness to adapt to local conditions and engaging with stakeholders is particularly important in healthcare simulation

Location of services and the impact on healthcare quality: insights from a simulation of a musculoskeletal physiotherapy service

Many healthcare systems are being redesigned to deliver local care with more services within the community. Relocation may enhance access but other aspects of healthcare quality should also be considered, notably waiting times and equity of care. This study examined a musculoskeletal physiotherapy service using a discrete-event simulation with simple heuristics to model patient behaviour. This combination provided an effective mechanism for incorporating the individuality of the patients in the flows along the patient pathways, subject to the varying availabilities of key resources. In particular, it captured the feedback that is critical in system performance, especially where waiting times are important. The model recognised the heterogeneity of patient attitudes and demonstrated how the behaviour of a relatively small proportion can affect the experience of all patients. The study suggested that, with careful operational management, more care could be delivered locally while exploiting many of the benefits of a centralised service

Learning from discrete-event simulation: Exploring the high involvement hypothesis

Discussion of learning from discrete-event simulation often takes the form of a hypothesis stating that involving clients in model building provides much of the learning necessary to aid their decisions. Whilst practitioners of simulation may intuitively agree with this hypothesis they are simultaneously motivated to reduce the model building effort through model reuse. As simulation projects are typically limited by time, model reuse offers an alternative learning route for clients as the time saved can be used to conduct more experimentation. We detail a laboratory experiment to test the high involvement hypothesis empirically, identify mechanisms that explain how involvement in model building or model reuse affect learning and explore the factors that inhibit learning from models. Measurement of learning focuses on the management of resource utilisation in a case study of a hospital emergency department and through the choice of scenarios during experimentation. Participants who reused a model benefitted from the increased experimentation time available when learning about resource utilisation. However, participants who were involved in model building simulated a greater variety of scenarios including more validation type scenarios early on. These results suggest that there may be a learning trade-off between model reuse and model building when simulation projects have a fixed budget of time. Further work evaluating client learning in practice should track the origin and choice of variables used in experimentation; studies should also record the methods modellers find most effective in communicating the impact of resource utilisation on queuing

Innovating Pedagogy 2017: Exploring new forms of teaching, learning and assessment, to guide educators and policy makers. Open University Innovation Report 6

This series of reports explores new forms of teaching, learning and assessment for an interactive world, to guide teachers and policy makers in productive innovation. This sixth report proposes ten innovations that are already in currency but have not yet had a profound influence on education. To produce it, a group of academics at the Institute of Educational Technology in The Open University collaborated with researchers from the Learning In a NetworKed Society (LINKS) Israeli Center of Research Excellence (I-CORE). Themes: • Big-data inquiry: thinking with data • Learners making science • Navigating post-truth societies • Immersive learning • Learning with internal values • Student-led analytics • Intergroup empathy • Humanistic knowledge-building communities • Open Textbooks • Spaced Learnin

Here’s something we prepared earlier: development, use and reuse of a configurable, inter-disciplinary approach for tackling overcrowding in NHS hospitals

Overcrowding affects hospital emergency departments (ED) worldwide. Most OR studies addressing overcrowding develop bespoke models to explore potential improvements but ignore the organisational context in which they would be implemented, and few influence practice. There is interest in whether reusable models, for ED crowding and in healthcare generally, could have more impact. We developed a configurable approach for tackling ED overcrowding. A reusable queuing model for exploring drivers of ED performance was augmented by a qualitative approach for exploring the implementation context and a generic framework for assessing the likely compatibility of interventions with a given organisation. At the hospital where the approach was developed it directly informed strategy. We describe reuse of the approach at three hospitals. One project was completed and well-received by hospital management, two were terminated partway when data problems surfaced. The primary contribution of this work is its novelty in considering, alongside quantitative modelling, evidence-based interventions to overcrowding and qualitative assessment of a hospital’s aptitude and capability to adopt different interventions. A secondary contribution is to further the debate on model reuse, particularly by introducing more complex, modelling-centred approaches that acknowledge how models must relate to tangible interventions with reasonable prospects of being adopted locally

Governing autonomous vehicles: emerging responses for safety, liability, privacy, cybersecurity, and industry risks

The benefits of autonomous vehicles (AVs) are widely acknowledged, but there are concerns about the extent of these benefits and AV risks and unintended consequences. In this article, we first examine AVs and different categories of the technological risks associated with them. We then explore strategies that can be adopted to address these risks, and explore emerging responses by governments for addressing AV risks. Our analyses reveal that, thus far, governments have in most instances avoided stringent measures in order to promote AV developments and the majority of responses are non-binding and focus on creating councils or working groups to better explore AV implications. The US has been active in introducing legislations to address issues related to privacy and cybersecurity. The UK and Germany, in particular, have enacted laws to address liability issues, other countries mostly acknowledge these issues, but have yet to implement specific strategies. To address privacy and cybersecurity risks strategies ranging from introduction or amendment of non-AV specific legislation to creating working groups have been adopted. Much less attention has been paid to issues such as environmental and employment risks, although a few governments have begun programmes to retrain workers who might be negatively affected.Comment: Transport Reviews, 201

Health and Care Infrastructure Research and Innovation Centre final report 2014

Improving healthcare, while containing costs, demands sophisticated understanding of three core elements in healthcare systems: infrastructure, technology and services. Their tripartite relationship is extremely complex, not least because the pace of change for each is different. That creates considerable challenges in planning for future needs and makes the management of innovation and change difficult. [Continues.

Strategic asset management for improved healthcare infrastructure planning in English NHS Trusts

The management of physical healthcare assets is vital for efficient delivery of healthcare services along with improving quality and productivity, amidst significant structural and funding re-organisation within the NHS. Capital allocations are under pressure and advanced strategic planning of healthcare infrastructure is required to maintain services. In doing so, the complexity of multiple interacting systems and mixed stakeholder expectations and competencies need to be addressed. The relationship between stakeholder public consultation and estates strategy development in theory and practice is poorly understood and further theoretical development is required to advance our knowledge in Strategic Asset Management (SAM). This thesis adopts an interpretivist paradigm, and an abductive approach with a case study design methodology. Data were collected from six case studies comprising 91 participants (focus groups and workshops); 6 unstructured interviews; 907 questionnaires; and observations resulting in over 30 hours of transcribed data, along with web-based document analyse (desk studies) within 149 NHS Trusts. The data were further analysed using thematic analyses. Findings reveal how localised conditions within individual healthcare Trusts influence the ways in which national initiatives are interpreted and incorporated; these impact existing ways of developing an estates strategy and in some cases, have implications on the usability of associated healthcare infrastructure spaces. This had clear implications on existing SAM practice, which were diverse, driven by individual project team competencies and associated project management practice. In practice, more focus was given to technical competencies (knowledge of SAM datasets and tools) and behavioural competencies were downplayed. Thus, the integrative Strategic Asset Management (iSAM) framework developed in this research, established a unique baseline to develop SAM plans from a complex interaction of care, estates and transport, providing a valuable resource for healthcare planning teams. Stakeholder consultation should be selective (representative sample) and the content of consultation should be appropriate at various SAM stages. Trusts should clearly indicate how their plans have been influenced, given the feedback from stakeholder consultation. Thus, moving it from a tick box exercise, to one that adds value in the decision making process. Empirical findings revealed that although literature promoted tools and methods to facilitate SAM, in practice, these were hardly used and most teams within English healthcare Trusts were not aware of best practice tools and solutions. Structuration theory was further used as a heuristic device to theoretically triangulate the empirical findings and contribute to a nuanced understanding of SAM within healthcare Trusts. In doing so, a middle range theory for integrative SAM (iSAM) was developed. It revealed that a dynamic system of individual action and organisational structure both constrained and enabled SAM. It was evident that the process of SAM is an open, emergent process of sense making rather than a pre-determined and closed process following prescriptive rules. This thesis has advanced knowledge in SAM and has raised the importance of front end project management within English healthcare Trusts. The new integrative and interdisciplinary iSAM framework facilitates the development of estates strategy and stakeholder consultation decision-making within healthcare Trusts