Scenario Generator Training Video for CCGs

Using Simulation for Strategic
Planning and Commissioning:
Scenario Generator
Claire Cordeaux: Executive Director, Healthcare

SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com
1 800 547 6024 | +44 141 552 6888
Agenda
• Who are we? – our experience
• What is simulation and why use
it?
• Scenario Generator
• Case studies
• Getting Started

1 800 547 6024 | +44 141 552 6888
• 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

1 800 547 6024 | +44 141 552 6888
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

1 800 547 6024 | +44 141 552 6888
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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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

1 800 547 6024 | +44 141 552 6888
• 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

1 800 547 6024 | +44 141 552 6888
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

1 800 547 6024 | +44 141 552 6888
Results
• Simulation runs of up to 50 years
• Activity by service
• Costs
• Constraints (queuing)
• Resource utilisation
• Comparison of scenarios

1 800 547 6024 | +44 141 552 6888
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 styleADOPTING 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

1 800 547 6024 | +44 141 552 6888
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

1 800 547 6024 | +44 141 552 6888
1 800 547 6024 | +44 141 552 6888
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

1 800 547 6024 | +44 141 552 6888
Integration

1 800 547 6024 | +44 141 552 6888
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?”

1 800 547 6024 | +44 141 552 6888
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

1 800 547 6024 | +44 141 552 6888
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.

1 800 547 6024 | +44 141 552 6888
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?”

1 800 547 6024 | +44 141 552 6888
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

1 800 547 6024 | +44 141 552 6888
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?

1 800 547 6024 | +44 141 552 6888
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

1 800 547 6024 | +44 141 552 6888
Capacity constraints
• Outpatient clinic capacity– 80
appointments a week covering:
– First and Follow Up Outpatients
– Treatments

1 800 547 6024 | +44 141 552 6888
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”

1 800 547 6024 | +44 141 552 6888
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

1 800 547 6024 | +44 141 552 6888
What if PSA?: after

1 800 547 6024 | +44 141 552 6888
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?

1 800 547 6024 | +44 141 552 6888
What if GP LES for treatment?:
before
QA and PSA
performed in
outpatients
every 6 months

1 800 547 6024 | +44 141 552 6888
QA and PSA
performed by GP
with 6 months
LHRHa instead of
in outpatients
What if GP LES for treatment?:
after

1 800 547 6024 | +44 141 552 6888
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)

1 800 547 6024 | +44 141 552 6888
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?

1 800 547 6024 | +44 141 552 6888
Step 2: Choose your pathways
• All pathways?
• Only one pathway?
• Example: urgent care pathway

1 800 547 6024 | +44 141 552 6888
Step 3: Consider steps in
pathway – add some…
• Flow
• Cost
• Duration
• Resource
• Add Community Service Step and multiple
visits

1 800 547 6024 | +44 141 552 6888
Step 4: Generate Demand
• Choose your population (note most recent
version includes CCG and local authority
populations)
• Check disease prevalence data

1 800 547 6024 | +44 141 552 6888
Step 5: Run Scenario
• Run the scenario
• Run multiple times to get a range of
answers

1 800 547 6024 | +44 141 552 6888
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?

1 800 547 6024 | +44 141 552 6888
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?

1 800 547 6024 | +44 141 552 6888
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

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Claire.c@SIMUL8.com
Executive Director, Healthcare, SIMUL8 Corporation
07812033439
QUESTIONS??

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