System Dynamics for Strategic Resource Planning at Watford Hospital Esther Moors Goncalo Esteves 13/11/2013

System Dynamics for Strategic Resource Planning at Watford Hospital People David Gaunt Esther Moors Ruth Connolly Kim Warren Gonçalo Esteves Douglas McKelvie

System Dynamics for Strategic Resource Planning at Watford Hospital Motivations To have science behind “gut feeling” and experience of A&E professionals to ensure the intended results in the long term David Gaunt Esther Moors Ruth Connolly August 2013

System Dynamics for Strategic Resource Planning at Watford Hospital Vision The vision of future work is that the modelling methodologies should be integrated into the everyday activities of the clinicians and staff that deal with changes to the emergency medical pathway, after this is achieved… simulating changes before implementing them should become a part of the Trust management processes.

System Dynamics for Strategic Resource Planning at Watford Hospital Project Requirements – what to achieve? 1. A simulation environment to test policies, processes and decisions regarding the planning, deployment and maintenance of resources in emergency medical pathways at Watford Hospital. 2. A simulation toolkit enabling the sponsors to simulate decision making in emergency medical care. 3. A training environment for the internal use on A&E specific to the System Dynamics simulation tool, with supporting elective materials. 4. Use case for the Master Thesis of Goncalo Esteves.

System Dynamics for Strategic Resource Planning at Watford Hospital Project Requirements – questions to be answered with the SD model: 1.What is the impact of increasing A&E flow direct to Medical Wards? 2.What is the impact of increasing the flow of patients from A&E to Ambulatory Care? 3.What happens if we have if we have more frail elderly patients going to ambulatory care, as opposed to being admitted? 4.When to change medical staffing arrangements? 5.Which are the most valuable staff arrangements to do? 6.What type of bed allocation is more effective? 7.What can cause the patient flow to stop? 8.What is the best use of beds over time? 9.What is the effect of having a GP in the initial assessment? 10. What is or what would be a single pathway of patients in the A&E?

System Dynamics for Strategic Resource Planning at Watford Hospital Project Requirements – questions to be answered with the SD model: 1 – What is the impact of increasing A&EtoMedW Bed numbers ( less beds available, more beds, less duration in stay, better care…) 2 – what is the impact of increasing the flow of patients from A&E to Ambulatory Care Bed numbers ( less beds, more beds, less duration, better care)

System Dynamics for Strategic Resource Planning at Watford Hospital Project Planning Phase I – A&E Modelling ( Physical Flows of Patients) September- November 2013 Phase II – A&E Modelling Strategic Resource Planning November- December 2013 Phase III – A&E Simulation use for Training and Decision Making December- January 2014

System Dynamics for Strategic Resource Planning at Watford A&E Current State Phase I – A&E Modelling ( Physical Flows of Patients)

System Dynamics for Strategic Resource Planning at Watford A&E Current State

System Dynamics for Strategic Resource Planning at Watford A&E Future Steps Model Validation Phase I -Data reality checks -Model limitations Modelling Resource Planning -Beds -Medical Staff -Facilities Personal -Other Physical assets

System Dynamics for Strategic Resource Planning at Watford A&E Future Steps Model Validation Phase I -Data reality checks -Model limitations Modelling Resource Planning -Beds -Medical Staff -Facilities Personal -Other Physical assets

System Dynamics for Strategic Resource Planning at Watford A&E Future Steps Modelling Available to Available – a function that includes critical factors in the achievement of A&E Goals Influence of: 1.Number of bed changes 2.Age of patients 3.Number of patients 4.Day of week 5.Consultants

System Dynamics for Strategic Resource Planning at Watford A&E Future Steps Modelling Available to Available – a function that includes critical factors in the achievement of A&E Goals

System Dynamics for Strategic Resource Planning at Watford Hospital Future Steps Training A&E Decision Makers – to ensure

System Dynamics for Strategic Resource Planning at Watford Hospital Lessons Learned so far: Access to data has many steps Model validation to be done in terms of parts and not the whole Keep modelling simple A4 – A3 page Impact of factors outside our direct control – eg changes in staffing

System Dynamics for Strategic Resource Planning at Watford Hospital Achievements: Common Framework for A&E ( Phase I) Complexity decrease in model Single source of data and QA process Continuous support of the SD modelling approach by Watford Specific questions (requirements) definition

System Dynamics for Strategic Resource Planning at Watford Hospital Q/A

System Dynamics for Strategic Resource Planning at Watford Hospital Thank you