With an ageing population and increasing care costs, it’s essential to find new ways to organise and use healthcare resources. This proved especially important recently, as the Covid-19 pandemic has pushed hospitals across the world to breaking point.
The problem of capacity
Professor Christos Vasilakis established the Centre for Healthcare Innovation and Improvement (CHI2) to address this problem. CHI2 aims to help the NHS improve service and quality of care, save money and improve decision making.
One of the major problems the NHS faces is that there are not always enough staff, beds, ambulances and equipment to meet demand. If patients can’t access these resources, their likelihood of recovery is worse.
In recent years, Christos and CHI2 members have collaborated with local healthcare bodies on several projects to help increase capacity in the NHS, improving patient outcomes.
This work laid the foundation for local NHS trusts’ quick response to the Covid-19 outbreak. Early on in the pandemic, Christos and colleagues carried out a study and developed a simulation tool to help hospitals reduce coronavirus deaths that were related to capacity.
A quick response to Covid-19
Managing healthcare demand and capacity is especially difficult in the context of a pandemic. A large number of admissions over a short period can overwhelm intensive care resources.
As part of a collaboration with the NHS Bristol, North Somerset and South Gloucestershire, the Bristol Royal Infirmary and the Bristol, North Somerset and South Gloucestershire Clinical Commissioning Group, CHI2 set out to discover whether there was any way to prevent deaths related to capacity problems in intensive care.
Building on their existing work with local NHS trusts, Christos and colleagues used a simulation tool to identify key factors that would reduce deaths, such as shortening lengths of stay. CHI2 shared this tool for free with healthcare providers across the country.
Priorities for better care
In 2014 Christos and colleagues developed a ‘researcher in residence’ programme with Bath’s Royal United Hospital. Through this, they were able to better identify and address the hospital's problems and priorities. They identified several key areas of study, most of which related to the problem of resource allocation.
One such priority was stroke care. Christos and colleagues carried out a study on the acute stroke service and were able to suggest several process improvements. This research led to both strategic and operational changes that improved care delivery.
Following a 2019 hospital inspection, the Care Quality Commission reported an improvement in stroke care that was above the national average.
Transforming maternity services
Bath and North East Somerset, Wiltshire and Swindon (BWS) Local Maternity System also commissioned CHI2 to help with their Maternity Transformation Programme. This programme proposed a redesign of regional maternity care by closing some maternity centres and re-allocating staff and resources to others. CHI2 analysed the impact of the proposed changes and developed a tool to identify the optimal locations for maternity services. BWS accepted CHI2’s recommendations and built them into the business case for change. Following a public consultation, this business case was approved and the new service provision is being rolled out.
A new type of modelling
The success of CHI2 is due in part to its multidisciplinary nature and focus on collaboration. The Centre has built a network of over 200 members from 40 organisations across the West of England. It has raised over £1.2 million from research contracts with local organisations.
CHI2 combines its operational research and management science expertise with the technical knowledge of clinicians and healthcare managers. This has allowed researchers to develop unusually complex modelling tools, which link all the wards, clinics, surgeries and community health services into one network. With these tools they can map how patients travel through the healthcare system, getting a better understanding of where and why there may be long waiting times or bottlenecks.
Improving understanding of operational research
The collaborative nature of CHI2’s work extends beyond the South West of England. One of the Centre’s goals is to raise awareness of how management science and a systematic approach can improve quality in all healthcare systems.
CHI2, along with the West of England Academic Health Science Network, set out to achieve this by developing an accredited Massive Open Online Course (MOOC) called Quality improvement in healthcare: Making the case for change.
A MOOC is a free online course to help people learn new skills in an accessible way. CHI2‘s MOOC consists of short lectures, interviews and articles to help improve healthcare professionals’ knowledge and confidence in using quality improvement methods.
The course has had over 22,000 participants from 100 countries. 96% of participants who gave feedback felt that they had learned new knowledge or skills.
Christos plans to continue running the MOOC, in the hope of bringing the benefits of operational research to as many healthcare professionals as possible