Scenario Generator Training Video for CCGs

Using Simulation for Strategic

Planning and Commissioning:

Scenario Generator Claire Cordeaux: Executive Director, Healthcare

SIMUL8 Corporation | SIMUL8.com | [email protected]

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Agenda

• Who are we? – our experience

• What is simulation and why use

it?

• Scenario Generator

• Case studies

• Getting Started


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• Established 1994

• Business simulation software

worldwide

– Powerful

– Flexible

– Visual and interactive

– Fast to learn

• Specialists in health and social care

• Combine healthcare knowledge and

software development to create sector-

wide tools

SIMUL8 Corporation


1 800 547 6024 | +44 141 552 6888

Our healthcare users

http://www.leememorial.org/index.asp

http://images.google.co.uk/imgres?imgurl=http://www.theoconocon.com/ChildrensHosp%2520Logo.jpg&imgrefurl=http://www.theoconocon.com/directions.html&usg=__Ihhoqf9RVZcbrNwBpyXyTR_hX1I=&h=262&w=600&sz=24&hl=en&start=8&tbnid=obDPWR3uOCtKLM:&tbnh=59&tbnw=135&prev=/images%3Fq%3DChildrens%2BHospital%2BWisconsin%2Blogo%26gbv%3D2%26hl%3Den

http://www.scenario-generator.com/case_studies/east_riding.htm

http://www.scenario-generator.com/case_studies/NHS_Grampian.htm

http://www.geisinger.org/index.html


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What is simulation?

Models a flow of individual patients

Small scale operations

Service operations

Whole system

Passing of time

Arrivals

Duration of treatment

Time between treatments

Waiting times and bottle necks

Experimentation

What if?....

No risk to patients through pilots

Results

Costs

Resource utilisation

Waiting times

High level flow and operational questions,

individual patient variability, graphical visualisation


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The benefits of simulation

Risk- Free Uses data intelligently

Increases confidence in decision

making

Test and compares potential solutions

More accurate than

a spreadsheet

Models variability

Simulates the passing of

time

Visual-Engages

Stakeholders

Click to edit Master title style


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Click to edit Master title style Planning for Healthcare

How much can I

spend?

How much resource

have I got?

What is my demand likely to

be?

How long is it

reasonable for patients

to wait?

What are my

expected outcomes?

Financial Winners and Losers


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• Simulation tool for strategic planning in health

and social services

• Framework for understanding whole systems

• Default data for immediate scenario testing

• Easy to use for those new to simulation

• Developed with NHS Institute UK

• 80% of NHS England, Scotland Health Boards

Canada, Italy, US, Australia

Scenario Generator


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How the model works

Activity from demographic projections and age-related factors influencing demand

Simulating patient journeys through a set of services depending on need

Whole system, user-configured to represent “what if?” questions


1 800 547 6024 | +44 141 552 6888

Scenario Generator

Pathways

Scenarios

Whole system model

Simulation results

Service points, flows

& waits

Mental Health

Social Care

Service models

Referral patterns Capacity Duration

Population Demography Prevalence

Prevalence/ Influencing

factors

Demographic weighting

Population

Constrained resources

Urgent

Planned

Maternity


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Results

• Simulation runs of up to 50 years

• Activity by service

• Costs

• Constraints (queuing)

• Resource utilisation

• Comparison of scenarios


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Benefits

• Understand whole health and social care

system flows

• Simulate impact of population change

• Segment populations/disease groups to

model expected use of service

• Test service redesign initiatives in a virtual

system to see impacts, risk free


1 800 547 6024 | +44 141 552 6888

Example projects

Planning for

• Care and condition pathways

• Care of older people (health and social

care)

• End of life care services

• “Virtual Wards” – community services as

alternative to hospitals (Scotland)



1 800 547 6024 | +44 141 552 6888

Click to edit Master title style ADOPTING BEST PRACTICE

East Riding PCT modelled the impact of BNP blood test on heart failure

Saved £100k per year, national impact, £15m

Now in NICE guidance


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County Durham – Stroke Care

Treat new patients with preventative drugs - cost an extra £415,615

Treating all new patients with

Warfarin saves £352,414.

In five years, savings of over £1m


1 800 547 6024 | +44 141 552 6888

• NHS and County Council working together

• Whole system health and social care

model

• Driven by demographics

• Testing impacts across health and social

care

Gloucestershire Case Study


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Gloucestershire adaptation

Pathways Scenarios

Whole system model

Simulation results

Mental Health

Social Care

Referral patterns Capacity Duration

Population Prevalence

Prevalence/ Influencing

factors

Population

Constrained resources

Urgent

Planned

Maternity

Older People

Learning

Disabilities Physical

Disabilities

Social Care Post

Discharge

Reablement


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Integration


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NHS Grampian – Planning

Capacity for Scanners • What impact does demographic change

and new clinical practice have on the potential demand for CT and MRI

scanners over the next 5 and 10 years?

• “Clinicians say we must have a new scanner – that’s a £1m decision – and we

are in deficit – can we manage without one?”


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Developing a model

Key steps required

to answer

questions


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Scenario Results

•Scenario 1

•Natural population growth

Scenario 2

7% (CT) and 11% (MRI)

Annual Increase

Scenario 3

New Clinical Practice +

Annual Increase


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Results: MRI Scans

Demand begins to exceed

capacity.

Queues build within the

model.

Additional capacity is

required to meet demand.

Additional capacity not

required until Year 8 –

scanners operational

7days.


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The Virtual Ward Scenario –

what? The questions

“If we implement the virtual ward, what is the

impact on:

• Inpatient bed capacity?

• Community hospital bed capacity?

• Reablement?

• Social care?”


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Building the pathway: Urgent

care

Urgent care admissions over 75

Assessment alternative to admission for 50% of medical inpatients

Links to social care pathway


1 800 547 6024 | +44 141 552 6888 10/04/2014 © Ken Laurie

Year Actual no. of Acute Medical Admissions

Results from Simulation

Variance –

Actual Number Variance in % terms

2008 9013 8960.2 52.8 -0.59%

2009 9244 9197.52 46.48 -0.51%

2010 9426 9385.78 40.22 -0.43%


1 800 547 6024 | +44 141 552 6888 10/04/2014 © Ken Laurie

2008 2009 2010 2011 2012 2013 2014 2015

Base 8,956 9,150 9,354 9,769 10,035 10,325 10,591 10,561

0

2,000

4,000

6,000

8,000

10,000

12,000

Anticipated mean number of >65yrs emergency medical admissions per annum - NHS Fife

Base


1 800 547 6024 | +44 141 552 6888 10/04/2014 © Ken Laurie

Q1/08

Q2/08

Q3/08

Q4/08

Q1/09

Q2/09

Q3/09

Q4/09

Q1/10

Q2/10

Q3/10

Q4/10

Q1/11

Q2/11

Q3/11

Q4/11

Q1/12

Q2/12

Q3/12

Q4/12

Q1/13

Q2/13

Q3/13

Q4/13

Q1/14

Q2/14

Q3/14

Q4/14

Q1/15

Q2/15

Q3/15

Q4/15

50% 269 270 273 270 275 276 277 280 281 283 285 283 293 297 294 295 301 302 305 285 286 291 287 287 295 300 297 298 297 299 297 299

60% 269 271 273 270 275 276 277 279 281 283 285 283 292 297 295 295 301 302 305 282 282 286 283 283 290 295 293 294 295 294 294 293

70% 269 270 273 270 275 276 277 280 281 283 285 283 293 297 294 295 301 302 305 278 278 280 280 279 286 289 291 288 288 290 289 289

250.0

260.0

270.0

280.0

290.0

300.0

310.0

320.0

330.0

Anticipated number of beds required for >65yrs medical emergency admissions following introduction of ICASS

working 5 days


1 800 547 6024 | +44 141 552 6888 10/04/2014 © Ken Laurie

Q1/08

Q2/08

Q3/08

Q4/08

Q1/09

Q2/09

Q3/09

Q4/09

Q1/10

Q2/10

Q3/10

Q4/10

Q1/11

Q2/11

Q3/11

Q4/11

Q1/12

Q2/12

Q3/12

Q4/12

Q1/13

Q2/13

Q3/13

Q4/13

Q1/14

Q2/14

Q3/14

Q4/14

Q1/15

Q2/15

Q3/15

Q4/15

50% 269 271 273 270 275 276 277 279 281 283 285 283 292 297 295 295 301 302 305 280 280 281 281 280 287 291 281 289 292 289 290 292

60% 269 271 273 270 275 276 277 279 281 283 285 283 292 297 295 295 301 302 305 275 274 275 275 275 281 286 275 284 286 285 285 285

70% 269 271 273 270 275 276 277 279 281 283 285 283 292 297 295 295 301 302 305 270 269 270 269 269 276 280 269 279 280 278 279 279

250.0

260.0

270.0

280.0

290.0

300.0

310.0

320.0

330.0

Medical beds required ICASS working 7 days


1 800 547 6024 | +44 141 552 6888 10/04/2014 © Ken Laurie

Q1/08

Q2/08

Q3/08

Q4/08

Q1/09

Q2/09

Q3/09

Q4/09

Q1/10

Q2/10

Q3/10

Q4/10

Q1/11

Q2/11

Q3/11

Q4/11

Q1/12

Q2/12

Q3/12

Q4/12

Q1/13

Q2/13

Q3/13

Q4/13

Q1/14

Q2/14

Q3/14

Q4/14

Q1/15

Q2/15

Q3/15

Q4/15

Base 272 269 269 271 276 278 276 276 276 280 282 286 290 292 300 295 300 303 305 304 308 312 310 310 319 318 325 318 322 318 319 317

250.0

260.0

270.0

280.0

290.0

300.0

310.0

320.0

330.0

340.0

350.0

Anticipated number of Beds required each quarter per annum for Emergency Medical >65yrs Admissions – NHS Fife


1 800 547 6024 | +44 141 552 6888

Results and learning

• Understand capacity, demand and

queues:

– When queues start if finite resource for virtual

ward

– Impact on medical inpatient beds

– Cost implications

• Need to start simple


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Simulating Stable Prostate

Cancer

Start with the questions…

• How many patients require GP and

Outpatient treatments a year?

• Could this be delivered more efficiently?

• What is the impact on costs?

• Could breaches in waiting times be

avoided?


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High level pathway

LUTS Urology referral Treatment

Wait

Targets 2 week wait to referral 62 day wait to treatment


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Building the pathway: Diagnosis


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Building the pathway: Treatment


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Populating the pathway

Population: 400,000

Age-banded prevalence

1.35%

Annual demand

3566


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Capacity constraints

• Outpatient clinic capacity– 80

appointments a week covering:

– First and Follow Up Outpatients

– Treatments


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Validating result of current state

• Data required

– Incidence data

– New prostate cancer diagnosis

– First and follow up urology outpatient

appointment and procedures

– Waiting times

– Surgery

• Local analyst and clinician sign off as

“reasonable representation”


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What if? PSA Diagnostic

Scenario We introduced a second PSA test in primary

care?

Scenario:

• Current state – after first positive PSA all

patients referred to secondary care

• Future state – what if two thirds (instead of

one third) of patients have second PSA

test in primary care?


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What if PSA?: before


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What if PSA?: after


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What if? GP treatment scenario

Treatment ? GPs carried out the 6 month PSA/QA with

LHRHa?

Scenario:

• Current state – patients have 3 monthly

LHRHa with GP and 6 month PSA/QA at

outpatients

• Future state – what if 50% of patients had

6 month PSA/QA test in primary care?


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What if GP LES for treatment?:

before QA and PSA performed in outpatients every 6 months


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QA and PSA performed by GP with 6 months LHRHa instead of in outpatients

What if GP LES for treatment?:

after


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User feedback

We will be able to demonstrate to

the PCT and GPs how a simple

change to the pathway by adding in

a second PSA test in primary care

will prevent the majority of our

prostate cancer 62 day treatment

breaches – a real issue in this

pathway where diagnostics require

a wait between them(TRUS and MRI)


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Using Scenario Generator

Step 1: What is your simulation

question?

Example: What if more community services

are available to support people with an

urgent care need?


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Step 2: Choose your pathways

• All pathways?

• Only one pathway?

• Example: urgent care pathway


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Step 3: Consider steps in

pathway – add some…

• Flow

• Cost

• Duration

• Resource

• Add Community Service Step and multiple

visits


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Step 4: Generate Demand • Choose your population (note most recent

version includes CCG and local authority

populations)

• Check disease prevalence data


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Step 5: Run Scenario

• Run the scenario

• Run multiple times to get a range of

answers


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Step 6: Check and validate

results

• Volume of activity in different services

• Number of admissions, ED visits

• Is this a good enough reflection of the

actual system?


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Step 7: Test scenario and

compare results

• 10% of primary care referred to

community?

• Community nurse cost £50 a visit/call

• Impact on admissions?

• Impact on finance?

• Cost of service?


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Step 9: Test capacity

• Add Community Nurses – 50 calls per

week each

• Utilisation


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Step 10: Simulate with older

people only

• Create new pathway

• Assign population to the pathway

• Run and test results



1 800 547 6024 | +44 141 552 6888


[email protected]

Executive Director, Healthcare, SIMUL8 Corporation

07812033439

QUESTIONS??

mailto:[email protected]

Scenario Generator Training Video for CCGs

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