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Transforming the management of healthcare with Operational Research

Research at the University of Southampton has led to effective use of operational research (OR) in healthcare settings to provide valuable information to managers, clinicians and service users, and thus to inform and facilitate decision-making that leads to improved outcomes.

Context

There is limited evidence of healthcare settings implementing the results of modelling approaches using operational research (OR). This is seen by proponents of OR as a missed opportunity to deliver healthcare that is both effective and resource-efficient.

Hampshire map

Southampton researchers have studied the under-use of OR modelling within the NHS and found that the reasons for the lack of implementation of results range from a lack of engagement on the part of potential clients, to the overwhelming complexity of healthcare contexts.

Four interventions delivered by Southampton researchers have demonstrated how OR can inform decisions, leading to improved outcomes, and changes in organisational culture in favour of a more evidence-based, rational approach to decision-making.

 

Improving sexual health services in Hampshire

In 2016, a Data Science research team developed a tool for Solent NHS Trust to support the reduction of the number of sexual health clinics in Hampshire without compromising service delivery – in particular, accessibility of clinics which were either very overrun with long waiting times or poorly attended.

The tool allowed the Trust not only to identify alternative locations for sexual health clinics, but also to enhance a subsequent patient engagement exercise with clear data and different options. It enabled the service to co-design solutions and make transitions easy and non-contentious.

Following the relocation of the clinics, the experience of patients and staff was much improved, with staff “well utilised”, allowing the clinics to be better resourced. Reductions in waiting times and complaints were also reported. 

Evaluation of overnight working of consultants in a hospital Emergency Department

In the mid-2010s, the prospect of providing high-quality 24/7 healthcare in hospital emergency departments was a prominent political issue, leading to scepticism over how data were interpreted to relate provision policies to positive outcomes.

University Hospital Southampton NHS Foundation Trust commissioned the University of Southampton to undertake a study to explore the benefits or disadvantages of a round-the-clock working pattern for Emergency Department (ED) consultants.

The study by Tom Monks and Marion Penn showed that, although junior staff feel more confident with a consultant on hand, there was no convincing evidence of overall outcome benefits to consultant overnight working in the ED. It was clear, however, that 24/7 working would be deeply unpopular and could affect recruitment and retention of consultants.

Driven by the research, the Trust decided not to pursue 24/7 working for emergency department consultants. The money saved was subsequently invested in other areas of improvement activity. 

Improving operational performance in endoscopy units

In 2015 Dr Richard Guerrero-Ludueña undertook a project for the NHS Wessex Cancer Alliance that aimed to address the issues of workforce shortfalls and limited resources in order to sustain effective and safe patient care – in particular the need to improve early cancer diagnosis.

Using discrete event simulation to model the endoscopy units at a number of sites, the analysis concluded that endoscopy capacity in Wessex was operating at an average of 70 per cent utilisation. This enabled the team to make recommendations as to how to increase capacity using existing resources, saving substantial costs. 

Redesign of a rehabilitation ward

Dr Marion Penn undertook a 2017 study for NHS Southampton City Clinical Commissioning Group, which was planning to build a new older people’s rehabilitation ward that combined the functions of two existing wards.

She developed a model of the system that enabled a wide range of demand, capacity and flow scenarios to be examined and assessed.

After extensive discussion with front-line clinicians and operational managers, the most efficient and effective ward configuration was devised. This informed the application to the Department of Health to proceed with the plan now in progress, which constitutes a significant capital investment of more than £15m. 

Wider benefits on awareness of OR and organisational culture change

The above projects have improved recognition of the value of OR as a means of generating evidence on which to plan healthcare provision. The demonstrable success of the projects is having a material effect on organisational culture, resulting in active demand for further studies.

Key Publications

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