1. K Silvester 190310 The maths behind a Hospital’s heart failure The maths behind a hospital’s heart failure. Kate Silvester BSc MBA FRCOphth Programme Lead for the Flow, Cost, Quality programme The Health Foundation, With thanks to Richard Steyn MS FRCSEd(C-Th) FIMCRCSEd MRCGP Thoracic surgeon Heart Of England NHS Foundation Trust

2. K Silvester 190310 The maths behind a Hospital’s heart failure Objectives Run the NHS Back to reality! –What is going on in a hospital? –Learning in the real world Deming Cycle Lessons Re-run the NHS A role for modelling?

3. K Silvester 190310 The maths behind a Hospital’s heart failure Run the NHS 12345 Computer Model Demonstration Go to www.steyn.org.uk/models/patflow.pptwww.steyn.org.uk/models You can’t use these models for real life data

4. K Silvester 190310 The maths behind a Hospital’s heart failure Flow, Cost Quality At the conference real data for the –Timeliness –Cost –Quality of care (death rate) will be presented

5. K Silvester 190310 The maths behind a Hospital’s heart failure The Deming Cycle Plan Check DoAct

6. K Silvester 190310 The maths behind a Hospital’s heart failure The NHS Plan Do

7. K Silvester 190310 The maths behind a Hospital’s heart failure 1 st Lesson ‘A system is only as good as its feedback’ –No feedback –Slow feedback –Faulty feedback Data distortion Interpretation –comparative v continuous statistics Check!

8. K Silvester 190310 The maths behind a Hospital’s heart failure Comparative Methods What is the statistical significance of this? And what value does this add? What is the hypothesis? The SHA performance management meeting MONTHLY

9. K Silvester 190310 The maths behind a Hospital’s heart failure Emergency & Elective Admissions - 8000 9000 10000 11000 12000 13000 14000 15000 16000 17000 05/04/200912/04/200919/04/200926/04/200903/05/200910/05/200917/05/200924/05/200931/05/200907/06/200914/06/200921/06/200928/06/200905/07/200912/07/200919/07/200926/07/200902/08/200909/08/200916/08/200923/08/200930/08/200906/09/200913/09/200920/09/200927/09/200904/10/200911/10/200918/10/200925/10/200901/11/200908/11/200915/11/200922/11/200929/11/200906/12/200913/12/200920/12/200927/12/200903/01/201010/01/201017/01/201024/01/201031/01/201007/02/201014/02/201021/02/201028/02/201007/03/201014/03/201021/03/201028/03/2010 Emergency Elective (Voluntary Data Item) Continuous methods Is this statistically significant?!!!! Sept 09 Real life Results: SHA Sitrep report

10. K Silvester 190310 The maths behind a Hospital’s heart failure 2 nd Lesson ‘Assumptions are the things we don’t know we are making’ –Changing the mindset Act differently!

11. K Silvester 190310 The maths behind a Hospital’s heart failure Mental Model Queues = Bottlenecks = more capacity & reduce demand = demand management Heart failure Irregular pulse Oedema Reduce variation –Steady the pulse Drain the backlog –Get the patient to pee

12. K Silvester 190310 The maths behind a Hospital’s heart failure Av. Demand > Av. Capacity For model go to www.steyn.org.uk/models/demand analysis.xlswww.steyn.org.uk/models/ You can’t use these models for real life data

13. K Silvester 190310 The maths behind a Hospital’s heart failure Variation Mismatch For model go to www.steyn.org.uk/models/demand analysis.xlswww.steyn.org.uk/models/ You can’t use these models for real life data

14. K Silvester 190310 The maths behind a Hospital’s heart failure If av. Demand = av. Capacity, variation mismatch = queue time Demand Capacity Queue Can’t pass unused capacity forward to next week

15. K Silvester 190310 The maths behind a Hospital’s heart failure Hospital emergency admissions & discharges Daily variation mismatch

16. K Silvester 190310 The maths behind a Hospital’s heart failure 3 rd Lesson The Flaw of Averages –NHS Plans are based on Averages Plan capacity to meet variation in demand

17. K Silvester 190310 The maths behind a Hospital’s heart failure Planning the right capacity For model go to www.steyn.org.uk/models/demand analysis.xlswww.steyn.org.uk/models/ You can’t use these models for real life data

18. K Silvester 190310 The maths behind a Hospital’s heart failure Erlang 20408010060% utilisation Service Failure: Waiting or Defaults

19. K Silvester 190310 The maths behind a Hospital’s heart failure All emergency admissions April 07 to July 09

20. K Silvester 190310 The maths behind a Hospital’s heart failure What have we achieved? March 2010 Check Act A&E performance Daily

21. K Silvester 190310 The maths behind a Hospital’s heart failure Daily A&E performance Sept 07 to 28/02/10: The canary in the healthcare system Community Referral hub Closing down of 40 community beds Opening of new Hsp ward 29/11/09 X-mas and New Year Change to the acute medical Take system Mon to Fri Pull system At discharge Hub A&E ‘crashes’ again Why? Lots of outliers Elective activity is trying to pick up Other contributing factors? What is happening elsewhere? What happened here? X-mas and New Year

22. K Silvester 190310 The maths behind a Hospital’s heart failure The System: GPHsp Intermediate care Community Hsp Care Homes Home Death Flow through A&E is a very sensitive indicator of flow through the whole system

23. K Silvester 190310 The maths behind a Hospital’s heart failure Re-Run the NHS 12345 Computer Model Demonstration Go to www.steyn.org.uk/models/patflow.pptwww.steyn.org.uk/models You can’t use these models for real life data

24. K Silvester 190310 The maths behind a Hospital’s heart failure Summary Plan Check DoAct Access to continuous data (Statistical Process Control) Verification of ‘The Model’ Teaching principles The Flaw of Averages Little changes quickly Simple to use models Paper + pens = Gantt charts