A healthy outlook

Success or failure in a business setting often depends on understanding how all kinds of factors develop and interact - not just at any given moment but over months, years or even decades. As demonstrated by a recent review of doctor training in the UK, system dynamics can prove a powerful and cost-effective resource when tackling such issues.

An empty hospital room with four beds and some chairs inside, with large windows looking out onto some greenery outside.

The Problem

It can take more than 15 years and over half a million pounds in government funding to train a single specialist doctor in the UK, who can then expect their lifetime salary to exceed £2m. So when you train a specialist doctor, you want to make sure it’s exactly what you want to do, and is the right thing to do.

Undersupply and Oversupply are constant and unwelcome threats. The corollaries of training too few doctors – including negative impacts on the general health and wellbeing of the population – are hard to quantify but unmistakeably significant. The principal consequence of training too many doctors – millions of pounds in unwarranted investment – is painfully simple to calculate.

In 2011, the Department of Health requested the help of the OR community in addressing these risks. The answer it sought were in system dynamics – a cutting-edge approach to understanding and refining the behaviour of complex systems over time. It resulted in a new method of workforce planning and substantial savings for the NHS.

The Solution

Poor workforce planning can put patients’ lives at risk and be wasteful; understaffing can leave employees stressed, while overstaffing can endanger livelihoods if jobs aren’t available. To solve this, a scenario-based model was created that would permit much more informed long-term decision-making called the ‘Robust Workforce Planning Framework’ – nothing like it has ever been seen in healthcare before. The RWPF incorporates everything from near-inevitabilities to apparent imponderables. The objective was to combine accepted facts, reasonable assumptions, controllable parameters and intrinsic uncertainties.

Stakeholder engagement was central to the RWPF, as it’s imperative to arrive at a shared view of future challenges when formulating policies. Known as ‘horizon scanning’, this involves capturing and synthesising a broad array of expert opinions concerning the potential factors that should be taken into account. Horizon scanning is about learning from the past, i.e. what we know, and surveying the future, i.e. what we want to know – and led in the model’s second phase, scenario generation.

It’s not possible to predict long-term accurately, so scenarios are crucial. The aim is to envisage futures that are challenging but consistent, so we have to establish contexts and produce a range of plausible futures – including a ‘business as usual’ baseline. The first stages of developing the model revolved around mapping out relevant processes – these maps were then shared with stakeholders to keep that stakeholder buy-in to the modelling. One of the models used contained 15 separate influence diagrams, almost 1000 distinct variables and more than 900,000 items of data – and yet simulation of this took place within 10 seconds.

The Value

The work was quickly utilised, with the findings informing a major review by the Health and Education National Strategic Exchange (HENSE), investigation medical and dental school intakes. HENSE called it a “sophisticated model” that could best inform its deliberations and those of future review groups looking at the same issue.

Underpinned by the RWPF, HENSE recommending a 2% reductions in medical school intakes from 2013, which could equate to considerable savings. Further reviews were recommended every three years – the system is finally capable of anticipating and responding to circumstance.

The framework has since been used in more than 20 reviews of health and social care professions. Its underlying structure remains the same; a testament to its simplicity and ease of use. Part of the appeal is that it can continue to be developed in the future, depending on how the industry changes.