OR and the challenge to improve the NHS: modelling for insight and improvement in in-patient flows

Abstract

This paper considers efforts to improve in-patient flows, a particularly urgent issue in the National Health Service (NHS). The context is described and related to reasons why OR has been making relatively little contribution. The paper argues that large complex models may often be unnecessary and even get in the way of providing clear insight and guidance for problem owners. The importance of understanding the generic working of systems to lead to improvement, and the limitations of simply describing them, is stressed. It is demonstrated that some very simple models can be of significant practical value in understanding and managing complex systems, changing mindsets and driving collection and use of operationally valuable data. Recommendations for more effective engagement with the NHS are offered.

Keywords:

• health service
• hospitals
• forecasting
• simulation
• process of OR

Acknowledgements

We thank the Information, Performance and Bed Managers at the two hospitals whose data are cited, for access and additional insights into interpreting the data and understanding processes, and the anonymous reviewers for their guidance on structuring this paper. Most DH documents are available from their website (http://www.dh.gov.uk); MA documents are available through the legacy repository (http://www.wise.nhs.uk); The NHS Institute for Innovation and Improvement is at http://www.institute.nhs.uk. This paper represents the views of the authors, rather than necessarily being the views of PA Consulting or the DH.