Building Modelling Capability within Aneurin Bevan

Building Modelling Capability withinAneurin Bevan University Health Board

The ABCi Silver Modelling Fellows Programme

2018

Copyright c© 2017 Dr. Doris A. Behrens, Dr. John Boulton, Dr. Tracey England,John Frankish, Dr. Daniel Gartner and Dr. Izabela Spernaes

Acknowledgements: The authors thank Dr. Daniel Chalk, Dr. Soheil Davari,Dr. Penny Holborn, Dr. Jennifer Morgan and Dr. Julie Vile for developing earlierversions of the course material and for their valuable contributions and discussionsduring the development of this programme. Special thanks go to Prof. Paul Harper,Prof. Sue Bale and Dr. Vincent Knight for their continuous support to the ABCiModelling Unit.

PUBLISHED BY THE ANEURIN BEVAN UNIVERSITY HEALTH BOARD AND CARDIFFUNIVERSITY

HTTP://WWW.WALES.NHS.UK/SITESPLUS/866/HOME AND HTTP://CARDIFF.AC.UK

Second edition, November 30, 2017

Contents

1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

1.1 Data Analytics in Healthcare 5

1.2 The National Importance of Operational Research in Healthcare 5

1.3 Analytics and Operational Research at the Aneurin Bevan UniversityHealth Board 5

1.4 Outline of this Course Programme Document 6

2 Programme Structure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

2.1 Teaching and Coaching of ABCi Silver Modelling Fellows 72.1.1 Prerequisites, Teaching and Coaching . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72.1.2 Additional Requirements for the Coaching of ABCi Modelling Fellows . . . . . . . 9

2.2 Aligning the Programme with a Healthcare OM Framework 112.2.1 An Example on the Strategic Decision Level . . . . . . . . . . . . . . . . . . . . . . . . . . 112.2.2 An Example on the Tactical Decision Level . . . . . . . . . . . . . . . . . . . . . . . . . . . 112.2.3 Examples on the Operational Decision Level . . . . . . . . . . . . . . . . . . . . . . . . . . 12

2.3 Programme Objectives 12

3 Programme Evaluation Strategy . . . . . . . . . . . . . . . . . . . . . . . . . 13

3.1 Overview 13

3.2 Evaluation of the programme 13

3.3 Silver & Gold 14

4 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

4.1 Summary 154.2 Pathways to Impact in the NHS 15

5 Course Specifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

5.1 Geographical Analytics 175.2 Forecasting 185.3 Systems Thinking in Healthcare 195.4 Essential Statistics II (Inferential Statistics) 205.5 Visual Basic for Applications (VBA) 215.6 Healthcare Operations Management Courses 225.7 Queueing and Simulation in Healthcare 235.8 Rostering 245.9 Scheduling in Healthcare 25

Bibliography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

Books 27Articles 27

Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

1. Introduction

1.1 Data Analytics in HealthcareAccording to the Wall Street Journal, healthcare providers are pushing data an-alytics to new heights, sponsoring competitions to find algorithms which identifypatients who are likely to be readmitted to hospitals [Tib16]. While timely andeffective Operations Management (OM) methods have been used in the publicsector for decades [PRB94], the history of using data analytics and OM methodsin healthcare primarily gained attention in or after the year 2000 and has grownexponentially since then [CDB10].

1.2 The National Importance of Operational Research in HealthcareThere has been recognition of the role that mathematical modelling and Opera-tional Research (OR) have to play in decision making across the U.K.’s NationalHealth Service (NHS) over the last 20 years: The inauguration of the NationalInstitute for Health and Care Excellence (NICE) can be seen as an example ofresponding to pressures of tight public sector fiscal settlements and for usinginnovative approaches. The goal is to ensure excellence by applying OR methodssuch as Simulation with the ultimate objective to improve outcomes for patientsand streamlining services.

1.3 Analytics and Operational Research at the Aneurin Bevan Uni-versity Health BoardPreviously, Analytics and Operational Research in the NHS has been the domain ofspecialists often operating from university centres or analysis units in a supporting

6 Chapter 1. Introduction

role. The experience of four years of the Aneurin Bevan Continuous improvementunit (ABCi) strongly suggests that if the service is to get the best from theseapproaches further effort has to be made to prepare, teach and support the NHSworkforce to understand and using data analysis and operations management (OM)approaches to support decision making in the service. Responding to this need,ABCi is evolving its existing suite of courses: It develops, runs and evaluates aconcise course programme for teaching healthcare analytics and OM excellenceto a small but high potential cohort of service staff in the Aneurin Bevan UniversityHealth Board (ABUHB).

A core objective of ABCi is to develop systems thinking capability, data analyticsand a healthcare operations management network within ABUHB. This can beconsidered as the foundation for improving services in the interests of deliveringsafe, person-centred, timely, effective, efficient and equitable healthcare. The focusfor systems thinking development in NHS Wales is the ‘1000 Lives’ led ‘ImprovingQuality Together’ (IQT) programme with its current Bronze, Silver, Gold structure.This document lays out our proposal for evolving Excel and Simul8 based coursesinto a three level Bronze, Silver & Gold structure to align it with IQT.

1.4 Outline of this Course Programme DocumentThe remainder of this programme document is structured as follows: In the nextsection we provide a description of the course programme, its link to a (healthcare)operations framework and its alignment with the existing ABCi’s Quality Improve-ment programme. Section 3 provides an overview about the programme evaluationstrategies followed by concluding remarks.

2. Programme Structure

2.1 Teaching and Coaching of ABCi Silver Modelling FellowsOur course programme can be described as a sequence of taught courses andthe Silver Project as follows:

• Taught courses– Geographical Analytics– Forecasting– Systems Thinking– Statistics– Visual Basic for Applications– Queueing and Simulation in Healthcare– Rostering– Scheduling in Healthcare

• Silver ProjectAs a prerequisite, participants in the programme are expected to pass the ABCi

Bronze level courses before proceeding to silver level. Alternatively, the applicant’saptitude for the silver modelling fellows programme can be demonstrated in theirapplication.

The programme has a duration of 12 months in total and the cohort is limited to6–8 participants who will develop capability to undertake tasks in Excel or Simul8.Students, henceforth denoted as ABCi Modelling Fellows, will have the opportunityto work on case studies and develop solutions for problems in the service area thefellows work in.

2.1.1 Prerequisites, Teaching and CoachingAfter successful completion of the taught part, the programme continues with thesilver project in which the participants tackle a real-world problem in the service.

8 Chapter 2. Programme Structure

The problem has to be chosen by the participant and is aligned with the taughtprogramme using the Resource Planning & Control Matrix (see Table 2.3).

Table 2.1: Teaching and Coaching in the Silver ModuleMonth Activity Duration

1 Classroom based teaching 1: 1 day• Introduction to the programme• Overview of projects that have been selected• Geographical Analytics

1 Classroom based teaching 2: 1 day• Forecasting

1 Tutorial Session 1 1/2 day

2 Classroom based teaching 3: 1 day• Systems Thinking

2 Classroom based teaching 4: 1 day• Queueing and Simulation in Healthcare

2 Tutorial Session 2 1/2 day

3 Classroom based teaching 5: 1 day• Statistics

3 Classroom based teaching 6: 1 day• Rostering

3 Classroom based teaching 7: 1 day• Scheduling

4 Classroom based teaching 8: 1 day• Visual Basic for Applications

4 Tutorial Session 3, Project Introduction 1 day

5–11 Weekly mandated coaching sessions

12 Celebration event: 1/2 day• Presentation of project work

The course will be front loaded with classroom teaching, see Table 2.1. Thesessions are followed by 5 months of project work with a minimum mandatedmonthly 2 hour coaching sessions with their mentor. Participants are expectedto be supported in work time to undertake and complete their project. Projectswill need to be agreed with sponsors/managers to ensure appropriate scope andcontent of the project and fit with service objectives. The participants will needformal agreement from their workplace supervisor and senior manager / execmember to be released from their day to day jobs for the mentioned amount oftime.

2.1 Teaching and Coaching of ABCi Silver Modelling Fellows 9

2.1.2 Additional Requirements for the Coaching of ABCi Modelling FellowsParticipants will need to be released from their daily duties:

1. in the classroom teaching phase for 1 day a week every fortnight to attendteaching sessions and 1/2 day a week after teaching session to completetheir coursework. In total 10 days over initial 3 month period (including 1/2day session for assessment and discussion about their project)

2. in project phase - that will take approx. 5 months participants are expectedto work on the project 1 day per week - including mentoring sessions andfinal report.

Participants will be expected to demonstrate that they have sufficient expertiseto take part in Silver training, completing an application form by a given deadlineto demonstrate competencies and to identify a suitable silver project. Applicationforms will be assessed to determine if the project is feasible and suitable for Silvertraining and that candidates meet essential competency standards before beingaccepted on the course. ABCi Modelling Fellows will need to have a workplacesupervisor to support and sign off the agreed project.

The ABCi Modelling Fellows will formally present their project work at the endof the programme at a celebration event in the form of a poster and a presentation.With the support of ABCi, there is also an opportunity to submit an abstract to andpresent the work at national and international workshops and conferences. Also,if the project demonstrates impact, there are ways to prepare a manuscript for amedical, health policy, health economics or operational research journal. All underthe guidance of ABCi.

The preliminary dates are shown in Table 2.2. The classroom based teachingwill take place in Seminar Room 4, St. Cadoc’s hospital, ABUHB Headquarters.


Table 2.2: Application Deadline, Teaching and Coaching in the Silver ProgrammeDate Activity

December 4th, 2017 Application form submission deadline

January 17th, 2018 Classroom based teaching 1:• Introduction to the programme• Overview of projects that have been selected• Geographical Analytics

January 30th, 2018 Classroom based teaching 2:• Forecasting

February 2nd, 2018 Tutorial Session 1

February 7th, 2018 Classroom based teaching 3:• Systems Thinking

February 20th, 2018 Classroom based teaching 4:• Queueing and Simulation in Healthcare

February 28th, 2018 Tutorial Session 2

March 7th, 2018 Classroom based teaching 5:• Statistics

March 16th, 2018 Classroom based teaching 6:• Rostering

March 23rd, 2018 Classroom based teaching 7:• Scheduling

April 4th, 2018 Classroom based teaching 8:• Visual Basic for Applications

April 16th, 2018 Tutorial Session 3, Project Introduction

TBA with the Weekly mandated coaching sessionssupervisor

December 13th, 2018 Celebration event:• Presentation of project work

2.2 Aligning the Programme with a Healthcare OM Framework 11

2.2 Aligning the Programme with a Healthcare Operations Manage-ment FrameworkAccording to Ozcan [Ozc05], healthcare (service) management can be defined asthe process of informed decision making using state-of-the-art decision-makingtechniques. To use those techniques successfully managers need to be able todescribe the distinctive characteristics of healthcare services in a way that allowsthem to describe the area of decision making in order to deploy the right tools andtechniques that will help them to solve problems.

Hans et al. [HHH11], break down decisions in healthcare operations manage-ment into three levels; Strategic, Tactical and Operational which can be seen tooperate across four domains: clinical management, resource management, mate-rials management and financial management (Table 2.3). This framework allowsus to consider where potential problems or questions lie and help us to identifyappropriate methods for analysing and modelling systems to support decisionmaking. Our aim is to link these decision levels to the content of our courses byteaching timely and effective methods relevant to the issues of the organisation.

Medical Resource capacity Materials Financialplanning planning planning planning

StrategicResearch, develop- Case mix planning, Supply chain and Investment plans,

ment of medical capacity dimensioning warehouse design insurance strategyprotocols

TacticalSelection of medical Block planning, Supplier selection, Determining and

protocols staffing, rostering tendering allocating budgets,annual plans

OperationalDiagnosis and Patient scheduling, Purchasing, DRG billingplanning of an workforce determining order

individual patient planning sizes

Table 2.3: Resource planning and control decisions broken down by decisionlevels, see Hans et al. [HHH11]

In what follows, we provide two examples using Hans et al.’s [HHH11] frame-work.

2.2.1 An Example on the Strategic Decision LevelStrategic decision level examples include the staffing of full time equivalents (FTE)for specific services in the NHS. Using methods that will be provided in the SilverLevel Course “Staffing”, the total number of minutes of care required is calculatedwhich forms the demand pattern. Then, the number of FTE is determined to coverthe demand.

2.2.2 An Example on the Tactical Decision LevelOn the tactical decision level, personnel scheduling decisions can be consideredas one of the major tasks and challenges in a service which will be covered in the“Scheduling in Healthcare” course of the Silver Module. Given a valid upper boundof staff required, staff are assigned to days-on and days-off.


2.2.3 Examples on the Operational Decision LevelOn the operational decision level, patient scheduling decisions (see Gartner andPadman [GP17]) can be considered as one of the major tasks and challenges in aservice. For example, day-to-day scheduling of patients to beds by consideringgender, room requirement and specialty constraints is a challenge. Anotherexample is the optimal sequencing of patients within operating theatre sessions tomaximize patient-oriented outcomes.

2.3 Programme ObjectivesThe overall goal of the Silver modelling fellows programme is to improve thecapability of ABUHB staff in using appropriate operational management andmathematical modelling tools and techniques to plan, manage and improve theoperation of healthcare services and facilities to deliver effective and efficient careto our patients. Furthermore, the modelling fellows will develop a joint languageand shared agenda for analytics-driven process innovation.

3. Programme Evaluation Strategy

3.1 OverviewThe course programme has been developed with clear learning objectives for eachmodule. It will be delivered in ways that intend to maximise learning through theuse of practical, project based instruction.

3.2 Evaluation of the programmeMany programmes do not go beyond evaluation of the learning event. Thisprogramme has been designed in such a way that we believe that we will be ableto demonstrate evidence of behavioural change, and improved outcome. If we areto achieve this, deeper evaluation of the course and its participants is essential.Consequently, all components of the courses will be assessed using Kirkpatrick’sfour level model for evaluating training programmes, shown in Figure 3.1. This fourlevel model has been used widely throughout education.

14 Chapter 3. Programme Evaluation Strategy

Figure 3.1: Kirkpatrick’s Model for Learning Evaluation

All teaching across Bronze, Silver and Gold will be evaluated for Reaction andLearning (Kirkpatrick Levels 1 & 2) using evaluation surveys, debriefs, peer andmentor feedback, along with self assessments throughout the period of the course.

Evaluation at Level 3 will be undertaken using self-assessment surveys at theend of the course and 6/ 12 months after completion to understand behaviourchange. In addition, a survey of management satisfaction with skills implementa-tion in the workplace will be undertaken.

Results will be available within ABCi and will be used to inform content design,structure and teaching methodology for further cohorts, in addition to demonstrat-ing impact to the Health Board.

3.3 Silver & GoldSilver projects will allow consideration of Level 4 evaluation in terms of measurableoutcomes associated with the delivery of individual projects and potential returnon investment in terms of course impact in delivering project objectives. Outcomemeasures may usefully be considered as strategic, tactical and operational mea-sures. Similarly work related to Gold training can alo be considered at Level 4 interms of the delivery of measurable outcomes and potential return on investmentas a component of underlying service cost.

4. Conclusion

4.1 SummaryIn this document, we have described a concise course programme which dove-tails the current Mathematical Modelling with the Quality Improvement teachingactivities within the Aneurin Bevan Continuous Improvement Unit (ABCi). We haveframed our programme into the notion of Bronze, Silver and Gold which is predom-inantly used in the area of Quality Improvement. In addition, we have aligned theprogramme with the existing Healthcare Operations Management literature, seeHans et al. [HHH11] and Hulshof et al. [Hul+12].

4.2 Pathways to Impact in the NHSOur course programme designed for the NHS will continue building capabilityin the NHS workforce in terms of enabling those that attend the course to in-crease/improve their healthcare analytics skills. In doing so, NHS staff can tackleand structure the complex nature of problems that arise in the NHS in various do-mains and dimensions. As a consequence, reconfiguring and optimising servicesto improve the effectiveness and efficiency of patient and corporate services willbe the ultimate impact of our course programme.

5. Course Specifications

In this section, we will provide an overview of our course specifications.

5.1 Geographical AnalyticsBackgroundThis one day training course is intended for NHS employees with a solid un-derstanding of Microsoft Excel (2013 or a later version) who want to analysehealthcare data on the basis of UK postcodes and distances between loci ofinterest (e.g. patient place of residency and the location of service provision). Thepractical aspect of this course uses the functionality of Microsoft Excel, ArcGISand Google Fusion to aid the course participants’ ability to analyse and visuallydisplay real-life data on a map.

Aims and learning objectivesAt the end of this module, participants should be able to:

• Demonstrate a greater understanding of the procedures necessary to pre-pare the data for geographical analyses including the derivation of shortesttravel distance and time data.

• Demonstrate competency in building and visualising a geographical modelin Excel that analyses the expected impact of possible service closuresor mergers (e.g. like a non-replacement of a retiring GP or a merger ofpractices) on the basis of “what-if” scenarios.

• Understand how a geographical model could be built to assess the bestplace to locate services amongst a number of alternative options.

• Apply their new skills efficiently to analyse and produce assessments withtheir own data.

18 Chapter 5. Course Specifications

SyllabusThe module will be a taught course with practical examples included in eachsession so that everyone has the opportunity to practise the skills learned. Thetopics include:

• Preparing and correcting erroneous postcode data for analysis• Deriving shortest distance and travel time matrices• Choosing informative performance indicators• Interpreting histograms of “what-if” scenario analyses• Running t-tests to assure for significance of the differences between scenar-

ios• Visualise the results of the geographical analyses using Google Fusion

Course MaterialsA course booklet will be provided that includes the course notes and a step bystep guide for the worked exercises. A sample data set will be provided for theanalysis and modelling.

AssessmentFormal assessment of a piece of coursework in which the participants will beasked to present their approaches and findings to the rest of the group.

Further NotesParticipants require Microsoft Excel (2013 or a later version) and enrolling forthis module they must have either successfully completed the Bronze courses2 and 4 (Basic Data Analytics in Excel and Essential Statistics for HealthcareApplications in Excel), or must already have the skills taught within it, particularlythe functions offered by the Function Wizard. Participants should also wish toapply the techniques learned to their everyday role within the Health Board.

5.2 ForecastingBackgroundThis one day training course is intended for NHS users with a basic understandingof Microsoft Excel (2013 or a later version) who want to undertake forecastingmethods applicable to healthcare data. The practical aspect of this course usesthe functionality of Microsoft Excel to aid the users’ ability to analyse and forecastreal-life data.


• Demonstrate a greater understanding in the statistical techniques requiredto analyse their data before applying the necessary forecasting techniques.

• Demonstrate competency in a range of forecasting techniques that can beapplied to healthcare data.

• Apply their new skills efficiently to analyse and produce forecasts with theirown data.

5.3 Systems Thinking in Healthcare 19


• Preliminary numerical summary statistics (mean, standard deviation)• Useful graphical summary statistics (time, seasonal and scatter plots)• Understanding trend and seasonality (through decomposition plots)• Moving averages• Exponential smoothing forecast methods• Regression models• Accuracy of the chosen model (Mean absolute error, mean square error,

mean absolute percentage error)• Communicating the results

Course MaterialsA course booklet will be provided that includes the course notes and a step bystep guide for the worked exercises. A sample data set will be provided for theanalysis and forecasting.

AssessmentFormal assessment of a piece of coursework in which the participants will beasked to present their approach and findings to the rest of the group.

Further NotesParticipants require Microsoft Excel 2013 or a later version and when enrolling forthis module they must have either successfully completed the Excel Skills course,or must already have the skills taught within it, particularly the functions offeredby the Function Wizard. Participants should also wish to apply the techniqueslearned to their everyday role within the Health Board.

5.3 Systems Thinking in HealthcareBackgroundThis full day training course is intended for NHS employees and decision makers inthe healthcare sector and in social care who have to deal with complex problemsthat involve many factors, many actors and many areas of responsibility. Thepresented methods are particularly useful for handling problems in healthcaremanagement and operations that recur after being “fixed” or problems that havebeen made worse by past attempts to fix them. The practical aspect of this courseseeks to provide the course participants with the ability to analyse, understand,visually represent the underlying structure of the problems they are involved in.


• Be able of apply the principles of Systems Thinking to problems in healthcaremanagement and operations.


• Demonstrate competency in detecting and analysing the most common“types of system behaviour” that occur in the health and social care system.

• Apply their new skills to real-world problems to identify how to create sus-tainable change for improvement. The example we will work through is therepresentation of managing the waiting list( dynamic)s of outpatient clinics,which will not only take into account the immediate effect of our interventionsbut also their future effects.

SyllabusThe module will be a taught course with multiple practical examples included(partially implemented in Excel 2013) so that everyone has the opportunity topractise the skills learned. The topics include:

• Principles of System Thinking• Introduction to causal mapping, influence diagrams and simple stock-and-

flow diagrams• Archetypes of Systems Thinking, i.e. frequently occurring patterns of system

behaviour like “Fixes that Backfire”, the “Tragedy of Commons” or “DriftingGoals”

• Jointly analyse Excel implementations of examples for systems observed inclinical practice that profit from stepping into the shoes of a systems thinker.

Course MaterialsA course booklet will be provided that includes the course notes, conceptualexercises that will be jointly worked through in class and a step by step guide forthe worked Excel exercises.


Further NotesParticipants require Microsoft Excel 2013 or a later version.

5.4 Essential Statistics II (Inferential Statistics)BackgroundThis one day training course is intended for NHS employees with a basic under-standing of descriptive Statistics in Microsoft Excel who want to deepen theirknowledge with respect to statistical tests (p values) and causal forecasting /regression. The quantitative methods covered include skills particularly useful forevaluating medical trials. The practical aspect of this course uses the functionalityof Microsoft Excel to aid the course participants’ ability to analyse and visuallydisplay real-life data.


• Identify cause-effect relationships within data (taking correlation for causality).

5.5 Visual Basic for Applications (VBA) 21

• Demonstrate competency in analysing outcomes of questionnaires, simula-tion runs and data grouped by attributes like ages, sex, place of residency,etc and identify whether “differences” are due to chance or of systematicnature.

• Apply their new skills efficiently to analyse and produce assessments withtheir own data.


• Regression analysis (incl. multiple regression)• Hypothesis testing• Significance level (p-values)• Two independent samples t-test• Analysis of averages (t-test, ANOVA)• Chi-square goodness of fit



Further NotesParticipants require Microsoft Excel 2013 or a later version and when enrolling forthis module, they must have either successfully completed the Bronze courseson “Basic Data Analytics in Excel” and “Descriptive Statistics for Healthcare Appli-cations in Excel”), or must already have the skills taught within it, particularly thefunctions offered by the Function Wizard. Participants should also wish to applythe techniques learned to their everyday role within the health board.

5.5 Visual Basic for Applications (VBA)

BackgroundThis one day training course is intended for NHS employees who are advancedusers of Microsoft Excel and want to deepen their knowledge with respect to basicprogramming skills. No prior programming experience is required. The practicalaspect of this course uses the functionality of Microsoft Excel to aid the courseparticipants’ ability to program features and functions to develop the accessibilityand usability of their data.


Aims and learning objectives

At the end of this module, participants should be competent in the fundamentalsof VBA, including recording macros, working with the Visual Basic Editor andwriting their own code, format worksheets, create user-interactive macros, workwith multiple worksheets, and perform calculations. In order to ensure minimaldowntime while building and rolling out the program, the course also includesadvice on debugging code and handling errors.

Syllabus

The module will be a hands on course with practical examples included so thateveryone has the opportunity to practise the skills learned. The topics include:

• Why use VBA?• Displaying the Developer Tab in the Ribbon.• Recording and running macros.• Absolute cell selection.• Working with the Visual Basic Editor.• Writing Visual Basic code using variables.• Using logical comparisons. The IF. . . ELSE. . . ENDIF loop. The FOR. . . NEXT

loop.• Debugging and Error Handling, Prevention, Good Habits and Runtime Errors.

Course Materials

A course booklet will be provided that includes the course notes and a step bystep guide for the worked exercises. There is a plentiful supply of hands-ondemonstration work together with formal exercises at the end of each topic.

Assessment

Formal assessment of a piece of coursework in which the participants will beasked to present their approaches and findings to the rest of the group.

Further Notes

Participants require Microsoft Excel 2013. Students enrolling for this modulemust have either successfully completed the Bronze courses on “Basic DataAnalytics in Excel” or must already have the skills taught within it, particularly thefunctions offered by the Function Wizard. Participants should also wish to applythe techniques learned to their everyday role within the health board.

5.6 Healthcare Operations Management Courses

Our Healthcare Operations Management courses include Staffing, Scheduling aswell as Queueing and Simulation in Healthcare.

5.7 Queueing and Simulation in Healthcare 23

5.7 Queueing and Simulation in Healthcare

BackgroundThis one day training course is intended for NHS employees with a basic under-standing of Statistics (including distributions e.g. Gaussian) and a knowledge ofMicrosoft Excel.

According to Ozcan [Ozc05], a healthcare manager must consider five typicalmeasures when evaluating existing or proposed service systems. Those measuresare:

1. Average number of patients waiting (in queue or in the system)2. Average time the patients wait (in queue or in the system)3. Capacity utilization4. Costs of a given level of capacity5. Probability that an arriving patient will have to wait for serviceAs a consequence, the quantitative methods covered in this course include

skills particularly useful for evaluating service systems and in particular queuesin healthcare. The practical aspect of this course uses the functionality of Mi-crosoft Excel and Discrete Even Simulation software – Simul8 to aid the courseparticipants’ ability to analyse and visually display real-life queueing situations.


• Describe queuing systems and their use in healthcare services.• Recognize queuing concepts and their relationship to capacity planning.• Design a pathway model in Simul8, validate the model and collect results.• Identify potential bottlenecks in the system.• Test various ‘what-if’ scenarios.


• Queuing System Characteristics• Servers• Arrival Patterns• Service Patterns• Specific Queue Characteristics• Measures of Queuing System Performance• Infinite Source-Models• Model Formulations• Theory of constraints




Further NotesParticipants require Microsoft Excel 2013 or a later version. Access to a Simul8teaching licence will be made available on the day.

5.8 RosteringBackgroundThis one day training course is intended for NHS employees with an understandingof Microsoft Excel (2013 or a later version) who want to deepen their knowledgewith respect to healthcare operations methods. The quantitative methods coveredinclude skills particularly useful for managers who are responsible for staffingdecisions. The practical aspect of this course uses the functionality of MicrosoftExcel to aid the course participants’ ability to analyse and visually display real-lifeplanning scenarios.

Aims and learning objectives• Describe workload management systems: the relationship between staffing

and scheduling with respect to human resource capacity planning.• Evaluate patient acuity systems and their relation to staffing and scheduling.• Describe the various scheduling options and relationship to human resource

operations.• Develop levels of utilization and coverage factor for core level staffing in

healthcare facilities.

SyllabusThe module will be a taught course with practical examples so that skills that arelearned can be applied, dierctly using Microsoft Excel. The topics are:

• Workload Management Overview• The Establishment of Work Standards and Their Influence on Staffing Levels• Patient Acuity Systems• Internal Work Standards• Utilization of Full Time Equivalents (FTEs)• FTEs for Nurse Staffing• Coverage Factor• Reallocation-Daily Adjustments• External Work Standards• Productivity & Workload Management


5.9 Scheduling in Healthcare 25


Further NotesParticipants require Microsoft Excel 2013 or a later version.

5.9 Scheduling in HealthcareBackgroundThis one day training course is intended for NHS employees with an understandingof Microsoft Excel (2013 or a later version) who want to deepen their knowledgewith respect to healthcare operations management methods. The quantitativemethods covered include skills particularly useful for managers who are responsi-ble for personnel and patient scheduling decisions. The practical aspect of thiscourse uses the functionality of Microsoft Excel, Excel Solver and the E-HOSPITALplatform available at https://github.com/drdanielgartner to aid the course partici-pants’ ability to analyse and visually display real-life planning scenarios.


• Categorize patient scheduling problems• Apply priority rules in patient scheduling• Solve a patient scheduling problem using mathematical programming• Categorize personnel scheduling problems• Formulate a shift scheduling problem as a mathematical model• Describe shift scheduling problems and a method for solution

SyllabusThe module will be a taught course with practical examples so that skills that arelearned can be applied, directly using Microsoft Excel. The topics include:Part 1: Job shop scheduling Learn and apply priority rules using Microsoft Ex-

celPart 2: Patient scheduling Classify and solve problems where patients are as-

signed to resources such as time, staff or roomsPart 3: Demand modeling Determine staff requirements per time periodPart 4: Shift scheduling Select which shifts have to be worked in order to cover

demand




Further NotesParticipants require Microsoft Excel 2013 or a later version. ABCi ModellingFellows enrolling for this module must have either successfully completed theBronze courses 2 and 4 (Basic Data Analytics in Excel and Essential Statisticsfor Healthcare Applications in Excel), or must already have the skills taught withinit, particularly the functions offered by the Function Wizard. Participants shouldalso wish to apply the techniques learned to their everyday role within the HealthBoard.

Bibliography

Books[GP17] D. Gartner and R. Padman. Handbook of Research on Healthcare

Administration and Management. Edited by Nilmini Wickramasinghe.IGI Global, 2017. Chapter Mathematical Programming and Heuristicsfor Patient Scheduling in Hospitals: A Survey, pages 627–645 (cited onpage 12).

[HHH11] E.W. Hans, M. van Houdenhoven, and P.J.H. Hulshof. A framework forhealth care planning and control. Edited by Randolph Hall. Volume 168.Springer International Series in Operations Research & ManagementScience. New York: Springer, 2011. Chapter 12, pages 303–320 (citedon pages 11, 15).

[Ozc05] Y.A. Ozcan. Quantitative methods in health care management: tech-niques and applications. Volume 4. John Wiley & Sons, 2005 (cited onpages 11, 23).

[PRB94] S.M. Pollock, M.H. Rothkopf, and A. Barnett. Operations research inthe public sector: An introduction and a brief history. Elsevier, 1994(cited on page 5).

Articles[CDB10] B. Cardoen, E. Demeulemeester, and J. Beliën. “Operating room plan-

ning and scheduling: A literature review”. In: European Journal of Oper-ational Research 201.3 (2010), pages 921–932 (cited on page 5).


[Hul+12] P.J.H. Hulshof et al. “Taxonomic classification of planning decisionsin health care: A review of the state of the art in OR/MS”. In: HealthSystems 1.2 (2012), pages 129–175 (cited on page 15).

[Tib16] Shara Tibken. “Numbers, Numbers and More Numbers”. In: The WallStreet Journal (2016). last accessed on 20 September 2016, http://www.wsj.com/articles/SB10001424052702304692804577285821129341442(cited on page 5).

Index

A

ABCi. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6ABUHB . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

I

IQT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

O

Operational Research (OR) . . . . . . . . . 5

Documents

Building Modelling Capability within Aneurin Bevan