Sheffield Teaching Hospitals NHS Trust have purchased WITNESS software to model the Trust´s in-patient waiting lists. The simulation-based software has been used to analyse the impact of proposed Purchaser contract targets on the waiting time for patients needing general surgery, ophthalmology or urology operations. The findings revealed that the proposed contract targets would not have allowed the Trust to keep within the Government?s 18-month Patient Charter guarantee. Through the use of WITNESS, the hospital has been able to persuade Health Authorities to commission additional elective activity valued at approximately £150,000 and also to appreciate the inter-dependencies of the out-patient and in-patient queues.

CSUH is no different from any other NHS Trust in England in that it has to provide services to Health Authorities, which purchase these from annual budgets. The Health Authority uses these funds to purchase specific numbers of episodes from a range of the specialities. These targets are historical in nature, but are modified over time by demand assumptions. Many hospitals are unable to back up or prove the assumptions that they make about additional resource requirements. This has led to problems convincing Purchasers of the need for additional investment, whereas the ability to simulate the problem provides a more objective view of the available options.

CSUH approached Lanner Group after seeing WITNESS being used to simulate ambulance service route planning. It was looking for a method of simulating the procedures used in the hospital so that by posing "what if" questions the hospital could identify any lack of resources or requirements for new equipment.

Paul Harriman, Information Development Manager at Royal Hallamshire Hospital states, "In the past, decisions such as these have been made through intuition and experience alone. This is the first time that we have been able to simulate the hospital environment and provide ourselves and, in certain cases, the Health Authority, with valuable proof to back up our predictions, for issues such as waiting list length or facility layout changes."

Simulation was initially used by CSUH to produce a model of the X-ray department. This model outlined the differences between the present configuration and future possibilities for the department. The Executive Director of Corporate Strategy was shown the product and was very impressed with its use and potential.

Previously, the hospital had modelled procedures and efficiencies using Excel spreadsheets. This had always been helpful to give an idea of the various options available to managers, but there was no way of actually visualising or quantifying the options.

WITNESS not only allows CSUH to visualise and quantify the results, but also presents a tool that can be used on an ad-hoc basis to demonstrate the implications of different business decisions. When they invested in WITNESS, CSUH acquired a tool which proved to be very versatile.

There were initially three projects for which the hospital needed WITNESS:

• The hospital needed to model waiting lists and to identify whether contracting requirements were sufficient for each speciality, or whether there was a requirement for an increase in the activity levels to be purchased
• Assessing where additional resources and money could be used in the radiology department.
• To model the new theatre facility for layout and admissions options.

Contracting requirements Health Authorities have agreements with the Trust that waiting lists must be kept below eighteen months at all times, in line with national Patient Charter guarantees. The Trust has to ensure that the guarantee given to a Health Authority will not be breached.

The prediction of the movement of in-patient queues is extremely difficult. Each queue is fed from an out-patient queue, which in turn is fed by a referral system from General Practice. Even in a single Consultants queue, there are in excess of twenty variables and modelling these is almost impossible. Multiplying this by the number of Consultants and the number of Purchasers compounds the problem. Before using WITNESS, they had believed that the agreement would be breached at some time in the future but, because of this complexity, were unable to prove their theories. This made it difficult to persuade the Health Authorities to increase their purchasing targets.

With WITNESS, through a combination of workload and waiting list pattern analysis over the previous eighteen-month period and simulating different contract targets for the three specialities under scrutiny, a final contract model was produced. The model allowed a number of these complexities to be better understood, in addition to providing quantitative information. The Trust soon realised and importantly, could now prove, that the eighteen-month waiting time would indeed be breached by the end of the financial year. This finding, along with the WITNESS model, was presented to the relevant Health Authorities so that they could understand the implications of their proposals. After a short negotiation period, the Health Authorities provided the additional funding needed in order to maintain the waiting list positions. WITNESS paid for itself many times over within the first month.

Radiology department

At the start of 1998, the Royal Hallamshire Hospital (part of CSUH) ran three radiology departments. In an audit of facilities, the three departments were analysed to see if efficiencies could be made through re-equipping the departments or laying out the departments more cost effectively. The options included purchasing new state-of-the-art digital imaging equipment in order to speed up processes, to rationalise the number of departments, or a combination of both.

The hospital used WITNESS simulation software to model what was needed. The software looked at the possibilities of furnishing rooms with flexible equipment so that they could be used to perform the majority of tasks without having to move the patient between rooms. With this method it was proved that by reducing the number of rooms from twenty-four to fourteen, in conjunction with new equipment it would be possible to halve the patient waiting time and reduce the capital costs of the equipment base. It would also be possible, using WITNESS, to model the staffing impact of the proposed facility.

Theatres

Plans have been made in the hospital for a new theatre facility at the site. The plans include alterations to the way that patients are admitted, in order to cut down the amount of time spent at the hospital and therefore reduce bed occupancy figures. At present, patients typically arrive the evening before their operation and stay overnight. For about 80% of the operations performed in the hospital theatres however, it is thought possible for patients to be admitted to the hospital two hours before the operation.

The Trust currently uses WITNESS to assess whether by changing the procedures for admitting the more routine theatre patients, it would significantly reduce the patient waiting times and free up the number of beds available. Using the day case unit as an example, the layout of the theatre facility could be changed to make the transfer of patients from the theatre back to the ward more efficient. The plan is to complete this project by the end of 1998.

Paul Harriman is delighted with the capabilities of WITNESS and the results that it has given the corporate planning department. "The key benefit of WITNESS for us is that we are now able to visualise the options available when planning new procedures and layouts of the hospital departments. Previously, we were unable to prove figures we identified with much degree of reliability. WITNESS has enabled us to test out scenarios in the hospital without committing to the purchase of expensive equipment or facilities."