Patient pathways - basic building blocks methodology: guidance

6. Using Simulation to Support Improvement

The tools developed to support the generation of Basic Building Blocks analysis, such as the occupancy template can also be used for simulation modelling. Once the area for further investigation has been identified in the Basic Building Block the same tools can be used to test the impact of proposed test of change and service redesign.

The occupancy template can be used to measure the potential reduction in ED occupancy, if patients suitable for ambulatory care were directed to this new unit from triage. The template can also be used to ascertain the daily and hourly occupancy of this new unit, and hence provide information on the number of cubicles / chairs /staffing resource required.

This process has been tested out at a busy Emergency Department where the Basic Building Blocks identified an issue with over occupancy from 11 a.m - 8 p.m.

Further analysis of length of stay and flow group presentations suggested an alternative pathways would be useful. The analysis tools were utilised to simulate this change and measure the impact statistically before any changes were made to actual patient flow. An Ambulatory Care Unit appeared to be a solution. By presenting the analytical modelling within the business case operational and managerial engagement and ownership can be generated and service redesign and transformation developed at pace based on modelling scenarios. It is important to follow this modelling up along the way of the test of change and continue to monitor impact on flow as often practical issues can change the dynamics. This must be a joint initiative of data and operational input.