----- Original Message -----
From: "Dunn Matthew Dr.
Subject: Re: A & E reforms
> To clarify my view: as an experiment we brought in a team of process
> engineers from Warwick University (under one of their professors, but with
> most of the actual work done by a senior research fellow). We worked
closely
> with them. This was funded from various sources and took a lot of work
from
> various people. Conclusions BTW were that we needed more doctors and more
> beds. But one thing I got out of it was that the modelling is not
something
> one individual can do in their spare time. We did need someone with an
> appropriate PhD to understand the maths of it.
Oh c'mon Matt, really, isn't that being a bit defeatist? I suspect many of
the people on this List have reached third level education and beyond, some
with strong maths and stats backgrounds, but you're saying we can't deal
with patient flow modelling. I think Danny is right; these "information
analysts", "service planners", "access managers" and "programme
facilitators" are making out their jobs are more complex than they really
are, in order to justify their existence! And when I said I couldn't figure
streaming, I meant I tried some models but they all came out with no
advantage for streaming, I didn't mean I couldn't work it out at all.
I'm pleased though that they came to the conclusions that more doctors and
beds are needed. It peeves me however that so much time and money is
squandered just to reach the same conclusion we could have all predicted
from the outset.
> We're still hammering out the details and bear in mind that these are
> preliminary unpublished data and as such should be take with a pinch of
> salt; but it looks as though the mathematical model will show that by
trick
> or treating we should be able to improve our 4 hour percentage from 90% to
> 93%. A few refinements are needed that may reduce this.
So a minimal improvement in four-hour targets; this doesn't surprise me as
the benefits of trick and treat (and I don't deny there are benefits to
minors patients) occur much earlier than four-hours, e.g. average waiting
times for minors are likely to drop from, say, 90 minutes to 30 minutes, and
so this will have little impact on a four-hour target. By the same token if
you simply look at the four-hour target you will also miss the fact that
waits for majors might creep up from, say, 90 minutes to 120 minutes, as a
result of trick and treat.
OK, I admit modelling is a lot more complex than that, but that's the sort
of results you get. There's no such thing as a free lunch in this business;
if we divert resources to minors, majors will suffer, although this may not
be detected on four-hour targets alone, but should be detectable with more
detailed monitoring. But the last thing I want to see is more boffins
studying this problem; just think how many nurses you could employ instead
of those extra 12,000 "patient pathway" managers on 40-60K each.
Adrian Fogarty
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