industry & reform
industry & reform
Model thoughts
More time should be spent teaching healthcare professionals and students how to design an efficient health system, experts say.
Terry Young interviewed by Dallas Bastian
Can you design a better health system around you? Professor Terry Young, from London’ s Brunel University, unpacked this question in a seminar at Flinders University’ s College of Medicine and Public Health.
Flinders professor Mark Mackay said not enough time is spent teaching healthcare professionals and students about designing an efficient system for moving patients through hospitals.
“ While it’ s clear that our future health professionals and our current health professionals have a focus on building and practising their clinical skills, they are key decision-makers in the system. Consequently, it’ s important that these decision-makers and those involved in health management have the opportunity to learn about tools that may help improve the flow of patients through the health system. At the same time, better system design needs a multidisciplinary approach.”
Mackay said Australian healthcare providers, particularly hospitals, have much to gain from the Cumberland Initiative, a movement to encourage simulation and modelling of healthcare scenarios to improve quality of care.
The Australian version of the collaboration, formed in 2014 and headed by Mackay, is made up of clinicians and non-clinicians who are interested in using design thinking, systems thinking and operations research methods to improve the health sector.
Last year, Mackay and Young co-authored a piece published in The Conversation that held the health sector can learn from other industries that turn to operations research( modelling) to fix everyday challenges.
“ Take checkout lines, for example,” they wrote.“ Rather than customers having to choose which queue to join – and face uncertain wait times – some retailers are now introducing single queues designed to provide the quickest service time to all customers based on a first come, first served basis.”
While they said the health system is yet to routinely embrace this style of modelling, other countries have seen success using the approach.
“ The National Health Service in Wales has created a modelling unit that’ s embedded in hospitals to help redesign services in a more connected way. This has improved rostering of the workforce, led to better decisions on where to locate services, and optimised operating room schedules to avoid unnecessary patient cancellations,” they wrote.
The authors suggested clinicians, health managers, and systems modellers and designers work together and acknowledge that while hospital staff do great work, the sector can do better by giving them better tools to help tackle the challenges they face.
Nursing Review spoke with Young about these issues.
NR: Could you tell us about the Cumberland Initiative? TY: The Cumberland Initiative was started really because academics had been modelling healthcare for 40, 50 years. So people have been trying to use computers to predict what’ s happening in healthcare for a long time. But there’ s very little evidence of impact. In fact, the evidence is of non-impact.
So we got together and realised that it’ s not just a case of academics doing more modelling. It requires academics to work with clinicians. Clinicians can’ t solve these problems on their own. They’ ve been trying to solve them certainly since the‘ 80s. They’ ve been really focused on trying to streamline care.
So we tried to create a neutral group of people that could talk safely to one another and could begin to promote the idea that we are better off modelling things before we implement them, in order to test whether our ideas will work. And we’ ve been building support and ideas for the last seven or so years.
What else do you think we are getting wrong in terms of trying to improve the health system and quality of care? I think the first thing you have to say about most healthcare systems is that they do a phenomenally good job. The best that can be done in a healthcare system is almost miraculous. And I think that when we are looking at some of the areas where people are being challenged, it’ s against the backdrop of enormously high expectations. And it’ s been set by the best part of 70 years of steadily improving health and amazing abilities to diagnose and treat what is going on. I’ m not an expert on the Australian system, I’ m only just getting to grips with some of the elements of it, but I think the challenges are in being able – reproducibly and at scale – to deliver the best of what we know.
So, how do we ensure that day in, day out people are always able to get the best care? The best care is exceptionally good, so how do we make that possible? So often, if you begin to open up the journeys that patients make, the system cannot respond in the way that they expect it to. So you end up with queues. Short-term queues are perhaps building up on ramps in hospitals, for instance. Long-term queues are building up as people wait for a sleep study or an interventional diagnostic of some sort.
And that’ s characteristic, really, of care all over the world. We know what to do, but what we’ re struggling to do is deliver that at scale and at high quality all the time. And that’ s the next big challenge with healthcare: to be able to do the best that we know how to do every time, and for everybody at an affordable level.
What do you hope people think after reading this interview? I hope people think:“ Modelling is something I want to know more about. This is something I want to put down on my list of options when I am trying to improve the system or when I am trying to diagnose what is wrong with the system in which I am operating.” n
8 | nursingreview. com. au