SIMT: A holistic framework for embedding simulation into the health care systems.

Simulation and Modelling (S&M) have been proven as very valuable tools in the health care sector. In recent years, the sector has experienced a rapid increase in applications. However, it appears that health care organisations have failed to sustain the use of these powerful techniques. In this research, an extensive literature review is carried out to identify the main challenges of the use of health care simulation and the underlying barriers of implementing S&M in the sector. In order to address these issues, it identifies the need to fully embed S&M into the sector through a systematic approach. However, the literature in this subject area has not provided such a holistic approach to the use of simulation.With the view to embed these techniques in health care decision making processes, this research develops a new framework, known as SIMulation Thinking (SIMT), to overcome the identified challenges and barriers. SIMT includes five key components: infrastructure, management, culture change, methodology and modelling. Whilst the SIMT framework presents the important elements that need to be considered to make S&M mainstream tools, this research also presents an implementation framework which transforms SIMT into a practical and applicable approach to embed S&M in health care organisations. The implementation framework includes two main stages: planning stage and action stage. Questionnaire and case study approach are conducted to validate the usefulness and importance of the SIMT components and the proposed implementation framework. The questionnaire is used to understand how the selected group of experts consider the SIMT components and the planning stage of the implementation framework as a valuable guideline. To validate the action stage of the implementation framework, this research uses the case study approach which introduces the proposed methodologies and modelling best practices into a local hospital. The feedback received from the hospital is used to evaluate the usefulness and practicable of the proposed approach

Variation in suspected cancer referral pathways in primary care: comparative analysis across the International Benchmarking Cancer Partnership

Background International variations in cancer outcomes persist and may be influenced by differences in the accessibility and organisation of cancer patient pathways. More evidence is needed to understand to what extent variations in the structure of primary care referral pathways for cancer investigation contribute to differences in the timeliness of diagnoses and cancer outcomes in different countries. Aim To explore the variation in primary care referral pathways for the management of suspected cancer across different countries. Design and setting Descriptive comparative analysis using mixed methods across the International Cancer Benchmarking Partnership (ICBP) countries. Method Schematics of primary care referral pathways were developed across 10 ICBP jurisdictions. The schematics were initially developed using the Aarhus statement (a resource providing greater insight and precision into early cancer diagnosis research) and were further supplemented with expert insights through consulting leading experts in primary care and cancer, existing ICBP data, a focused review of existing evidence on the management of suspected cancer, published primary care cancer guidelines, and evaluations of referral tools and initiatives in primary care. Results Referral pathway schematics for 10 ICBP jurisdictions were presented alongside a descriptive comparison of the organisation of primary care management of suspected cancer. Several key areas of variation across countries were identified: inflexibility of referral pathways, lack of a managed route for non- specific symptoms, primary care practitioner decision- making autonomy, direct access to investigations, and use of emergency routes. Conclusion Analysing the differences in referral processes can prompt further research to better understand the impact of variation on the timeliness of diagnoses and cancer outcomes. Studying these schematics in local contexts may help to identify opportunities to improve care and facilitate discussions on what may constitute best referral practice

Variation in colon cancer survival for patients living and receiving care in London, 2006-2013: does where you live matter?

BACKGROUND: Marked geographical disparities in survival from colon cancer have been consistently described in England. Similar patterns have been observed within London, almost mimicking a microcosm of the country's survival patterns. This evidence has suggested that the area of residence plays an important role in the survival from cancer. METHODS: We analysed the survival from colon cancer of patients diagnosed in 2006-2013, in a pre-pandemic period, living in London at their diagnosis and received care in a London hospital. We examined the patterns of patient pathways between the area of residence and the hospital of care using flow maps, and we investigated whether geographical variations in survival from colon cancer are associated with the hospital of care. To estimate survival, we applied a Bayesian excess hazard model which accounts for the hierarchical structure of the data. RESULTS: Geographical disparities in colon cancer survival disappeared once controlled for hospitals, and the disparities seemed to be augmented between hospitals. However, close examination of patient pathways revealed that the poorer survival observed in some hospitals was mostly associated with higher proportions of emergency diagnosis, while their performance was generally as expected for patients diagnosed through non-emergency routes. DISCUSSION: This study highlights the need to better coordinate primary and secondary care sectors in some areas of London to improve timely access to specialised clinicians and diagnostic tests. This challenge remains crucially relevant after the recent successive regroupings of Clinical Commissioning Groups (which grouped struggling areas together) and the observed exacerbation of disparities during the COVID-19 pandemic

Sustainability and renewal: findings from the Leading Sustainable Schools research project

"A research study highlighting the characteristics of sustainable schools and the leadership qualities required to develop sustainable schools." - Page 1