Eric Wolstenholme

A patient flow perspective of U.K. health services: exploring the case for new “intermediate care” initiatives

This article applies system dynamics to the development of national policy guidelines for the U.K. health service. A model of total patient flow through the U.K. National Health Service is developed and used to test alternative major new structural initiatives for relieving pressure on health services and to complement health initiatives in “joint working” at the interface between health care sectors. The policies tested include the use of “intermediate care” facilities aimed at preventing patients needing hospital treatment or continuing and community care. Intermediate care, together with reductions in the overall length of stay of all patients in community care made possible by its use, is demonstrated here to have a much more profound effect on total patient wait times than more obvious wait time solutions, such as increasing acute hospital bed capacity. The results provide a clear demonstration that adjustments to “flow” (throughput) variables in a system provide significantly more leverage than adjustments to “stock” (capacity) variables. Copyright

Influencing and Interpreting Health and Social Care Policy in the UK

Over the past three years the authors have used System Dynamics modelling to improve service delivery for patient pathways in a wide range of health and social care settings. At the national level models have used to support the moderation of legislation by influencing national agencies and the upper house of parliament. At a local level models have been used to help health communities interpret legislation in a meaningful and shared way to achieve a more balanced and sustainable consensus for change. Here modelling was the means to review investment decisions from a “whole systems” and multiple agency perspective. Many such communities are now working towards consolidating the modelling process into regular planning activities. This paper describes the background issues facing health and social care in the UK and then describes work carried out around the national issue of delayed discharge from hospitals and the local issues of commissioning services across whole health communities. Apart from describing the issues, model and example results, emphasis is placed on data and the role of models in designing data requirements for management of patient pathways. Particular reference is also made at the end to the process of application of system dynamics in health and social care services.

Dynamic cost benefit analysis for mental health reform

Purpose – This paper aims to describe the application of system dynamics to enhance traditional cost benefit analysis (CBA) in planning a significant expansion of therapy capacity for mental health treatment in the UK. The aim of the initiative is to benefit the health of individuals, reduce costs to society and the exchequer and increase employment.Design/methodology/approach – The paper describes a conventional CBA and comments on its merits and limitations. The development and use of a system dynamics model of the situation is then described, together with how this complements and supports the conventional analysis and its outcome.Findings – By focussing analysis on the dynamics of people flows over time, simulation is shown to assist understanding of the issue and its potential benefits. The numbers of patients expected to benefit is shown to depend on the treatment capacity, on the sources of people presenting, the number and type of treatment channels and their parameters, the success of treatment, ...