It wonderful news that the work of TCC-CASEMIX has been recognised. 18 months after being founded, we have achieved so much – despite the pandemic. Our biggest success was winning an Innovate UK SMART Grant – one of the most prestigeous grant awards in the UK and Europe – a recognition of our world-class research credentials. This grant enabled us to rapidly develop the technologies that make TCC-CASEMIX so unique in transforming surgical services delivery.
Indeed, the Medilink Midlands Business Awards for 2021 are a celebration and showcase for the best of the best in the Life Sciences sector for the East and West Midlands. The business will now be entered for the national award in October.
Spin-off business, from The Conclude Consultancy, TCC-CASEMIX has been appointed to lead ‘Project Meteor’, a transformation programme to drive 20% improvement in surgical productivity.
A year after winning the Innovate UK SMART Grant, one of the UK’s most prestigeous and competitive grant awards [3-5% success rate], TCC-CASEMIX brings to market a transformational new capability in the delivery of elective surgical care. The Northern Care Alliance (NCA), with Salford Royal NHS Foundation Trust, is a pioneer in digital health. At a time of desperately long surgical waiting lists, this capability could not be more timely.
Head of Research and Innovation at the NCA , Mrs Natalie Garratt says: “This is all the more remarkable because the transformation programme was conceived just as COVID-19 hit the NHS.The team had to be innovative and adaptable in ways that we would have never thought to be possible – but under the leadership of Dr Bacon, we have achieved something very special, that will impact patient care for years to come”.
The innovation behind TCC-CASEMIX is a transformation in digital health, using the power machine learning algorithms applied to a whole new dataset that has never previously existed. The discovery enables patients to be managed through waiting lists with a radical new process, that completely changes the way in which surgical services are planned and delivered.
The chart demonstrates all too clearly the productivity gains that are now possible. A 20% productivity improvement alone would deliver an additional 300,000 surgical procedures each year across the NHS.
It is a challenge that has been at the centre of a myriad of government enquiries, independent reviews, and commissions sponsored either by HM Treasury, Department of Health, Kings Fund or Government sponsored organisations, such as Getting It Right First Time (GIRFT). All have all failed to identify the root cause of this ‘open sore’ in our health system – one that causes extensive human suffering, stress, and anxiety. In the worst cases, patients become inoperable, because they have had to wait so long for their operation.
Dr Bacon says: “The key to our success lays in our ability to correlate all surgical risk factors with the correseponding impact on surgical procedure duration – measured at a highly granular level. It means that rather than a ‘one size – fits all’ strategy, we forecast procedure duration that is unique for every patient. Achieving predictability of procedure duration is central to achieving a transformation in productivity because it means more patients can be packed onto a theatre list, without fear of them being cancelled. “
The green zone in the chart above shows just how astonishing the predictability of surgery has been improved to a point where only 10% or less of all surgeries complete outside of the forecast. This compares to the whole of the NHS, where 54% of all procedures finish late (leading to cancelled operations) and 43% of them finish early (leading to theatres standing idle).
TCC-CASEMIX Mathematical Modeller, Jack Morewood says: “We are now able to identify what the latent capacity is for any surgical services provider, which means that it is now possible to identify surgical capacity across a whole region , and to direct patients accordingly. “
The innovation will have profound consequences. With the advent of the new Integrated Care Systems across the NHS, the ability to match demand and capacity should be a major tool in their armoury. It will avoid a peverse situation where theatres are standing idle simply because the latent capacity is so poorly managed.
At the Northern Care Alliance, the strategy is to utilise the latent capacity in day case surgery, and by this means bed constraint becomes much less of a problem. The patient’s will be cared for in their homes. This aligns very well with the NCA strategy to utilise community care resources in a whole new way. Again digital technologies play an important role. The plan is to expand the concept of the virtual ward, developed during COVID-19. TCC-CASEMIX will deliver real-time patient vitals data and other biometrics straight to mobile devices of the community care team.
As Mrs Garratt observes: “Being able to manage the additional productivity through day case surgery for carefully selected patients is the key to making this strategy work.”
On the 18th December 2019, just 3 months after the business was formally incorporated, TCC-CASEMIX Limited was notified that it had been selected as one of 15 innovative SME’s across the UK to participate in the Global Business Innovation Programme being run by UK R&I. The award is to participate in an innovation mission to South Korea in October 2020.
TCC-CASEMIX (TM) is already being seen as a compelling proposition, as it is the only company of the 15 selected, that has so far received a specific request to engage directly with a hospital and research team in the south of the country.
Dr Bacon comments: “Our extensive literature review identified that the planning of operating theatre sessions is as challenging in South Korea as it is here in the UK – so we share exactly the same needs: increasingly ageing populations making ever increasing demands on surgery, means that we have to learn to do far more with less. Forsurgery this means controlling the drivers that cause cancelled operations as much as those that cause theatres and their teams to be standing idle.”
TCC-CASEMIX Limited will be taking with them on this mission their highly innovative surgical procedure survey technology. This enables real-time data capture of procedure durations, critical to effective procedure planning. Earlier this month, the business also won an Innovation Support Grantpart funded by the European Development Fund (and supported by Medilink East Midlands) to develop the technologies required. This has enabled the business to work with two of the UK’s most innovative technology companies to develop the solution. At the same time Dr Bacon and his team have been designing some of the hardware for the technology using latest 3D modelling and printing technologies.
Within a matter of weeks of its incorporation TCC-CASEMIX Limited was offered the opportunity to be supported by the NatWest Entrepreneur Hub to receive coaching support, desk space and the opportunity to work alongside other innovative businesses in the Milton Keynes area. The programme commenced on the 1st October 2019.
Having now been on the programme for nearly two months, Dr Bacon comments: “This has been a highly formative experience and already some interesting relationships are starting to develop! More news about this as the building of the new business gets underway!“
On September 18th 2019, TCC-CASEMIX Limited was incorporated at Companies House. Dr Bacon designed and conceived the new Med Tech business to be an exemplar of transformational change in acute NHS hospitals, by driving substantial improvements in productivity, and revenue generation in surgical services delivery.
From deficit to sustainable productivity
The transformational change is designed to raise productivity by 20% and improve surgical revenues for a typical NHS trust by circa £7.5m per year, at a time when the majority of acute NHS trusts are running deficits.
February 2019: The NHS Improvement report [Opportunities to Reduce Waiting Lists] identified that nearly 300,000 patients each year had their urgent operations cancelled, directly because of poor planning. Currently, 54% of all surgical procedures over-run, resulting in cancelled operations. 43% of them under-run, leaving operating theatres standing idle. This also leads to a loss of revenues for all 156 acute trust of £1.25b annually. (ref: NHS Reference Cost datasets).
The government sponsored Getting it Right First Time reports provide the detailed evidence for poor planning. The General Surgery Report explains the situation in these terms: “surgeons have never typically collected surgical procedure duration data. ”
Without such data how can there ever be predictability of surgical services delivery? Well there can’t be is the simple answer. However it is more complex than that. This is because evidence collected by The Conclude Consultancy from surgical procedure duration data across European hospitals identifies that without systematic data collection at detailed procedure level, there will always be a high degree of procedure duration variability.
TCC-CASEMIX (TM) addresses this need with novel real-time data capture technologies designed for use in operating theatres.
Data captured from these technologies is then stored in a sophisticated database of surgical procedures. The database runs automated machine learning algorithms to produce a detailed statistical analysis of all procedure types. It is these analytics that are then processed in surgical simulations to optimise operating theatre sessions.
Now for the first time, it will be possible to optimise the case-mix for theatre sessions using a robust evidence-based dataset. As a technology founded on open standards and fully compliant with international standards of procedure coding, no other ‘current-state-of the -art’ commercial solution today can come anywhere close to what is being offered by the new business.
Over a few years now, The Conclude Consultancy (TCC) has been aggregating operating procedure data using their unique Patient Pathway Analysis to create hierarchies of patient types. The statistical analysis that is the foundation of Occupancy Analytics (TM) provides the basis for hierarchies of patient types based on the specifics of different operating procedures.
So what is the significance of this new approach?
It means that we are able to provide groupings of patient types related to procedure duration in the operating theatre, where each grouping is related to different time bands and Standard Deviations. Many surgeons would say that procedure durations are highly variable and consequently they need to allow for this in their planning of surgery lists. We in TCC argue that this type of planning using aggregated patient data will of course lead to large variances. However, using a time-band analysis significantly removes large variables and provides for much greater predictability.
This analysis is significant because it directly leads to:
Improved operating theatre utilisation.
Less patient waiting time due to overrunning procedures in surgery.
Much greater predicability of patient flow, leading to greater efficiency in the use of resources.
Significant capital an operational cost benefits.
The method enables the use of theatre capacity to be optimised and can directly impact the demand for space in hospitals. For example, should a hospital board be considering expansion of operating theatre capacity, our analysis challenges the often held binary thinking that greater demand should lead to the need for greater capacity.
If you would wish to find more about our innovative methods for hospital demand and capacity planning, please use our contact form.
The Conclude Consultancy Limited has recently completed the first phase of a clinical reorganisation project for the 1st Department of Medicine at the Szeged University Hospital in southern Hungary. This appointment is the first time that a UK health planning consultancy has been appointed to work in Hungary within its health system. TCC was appointed because of their unique methods for the analysis of health systems and health planning known as ‘Occupancy Analytics’ (TM). The appointment was awarded to TCC after extensive research by the the Hungarian Ministry of Health to identify internationally recognised health planning consultants who offered true innovation, rather than traditional methods of analysis, based on ‘this is the way we have always done it’ approaches. They required new ways of thinking and methods proven to deliver significant benefits.
Szeged University Hospital
The hospital is recognised as the leading institution of its kind in Hungary and has a very strong international reputation. It is currently collaborating in research with a number of UK universities such as University of Liverpool and Newcastle. Dr Bacon, founding director of TCC leads the specialised team who are working directly with the Executive leadership team and the 1st Department of Medicine.
Why the need for the reorganisation?
Hungary has some of the worst health indicators in Europe, yet it has some of the brightest minds working in the health system. Reports from The World Health Organisation and the European Commission have both identified significant latent capacity in the health system. Simply put, the need for the reorganisation is to achieve a much needed re-alignment between clinical needs of Hungary’s citizens and the effective and efficient delivery of clinical services. The 1st Department of Medicine was selected to be the candidate department for the reorganisation, and is the sponsor of the work.
A challenge for Europe not only Hungary
Hungarian healthcare needs are, to an extent, no different to the needs of other more developed health systems elsewhere in the European Union. For example, within the next 20 years around 35% of European populations will be over the age of 75. By this age well over half of this age group will have two or more morbidities. These pressing demands are causing significant strains in all acute care hospitals across Europe. TCC believes that in recent years these strains have become a significant concern to many health leaders because acute care facilities are ill-equipped to care for the rising numbers of patients presenting complex needs. Most notable in this respect is a primary focus on delivering healthcare through specialities, but with patients presenting comorbidity, the need is for ‘generalist specialists’ or multi-speciality services that consider the holistic needs of the patient.
TCC: Integrated Clinical Pathways
Harnessing multi-speciality skills requires carefully designed processes (Integrated Clinical Pathways) and specific skills such as co-ordination of specialist inputs and effective clinical information management along the patient care pathway. It also requires structured care plans that are designed for the specific needs of the patient, and provide the reference point for the management of the Integrated Clinical Pathway. It is in this work that the 1st Department of Internal Medicine led by TCC has been developing the major operational policies that will provide the foundation for the reorganisation and the development of the Integrated Clinical Pathways.
Ensuring that the patient receives the right care in the right place, first time is a key objective of the reorganisation and thus aligning the care system to serve the specific needs of the patient, is the primary objective. The development of an Acute Medical Assessment Unit will be one part of the clinical reorganisation. Within this multi-speciality environment the Integrated Clinical Pathways will be planned for specific patient types. Experimental pathway models using the sophisticated ‘Occupancy Analytics‘ (TM) simulations are to be developed, so that patient flows can be evaluated. It will be from this analysis that the resource needs for each pathway will be established.
Operational trial: learning from experience
A common observation of implementations of Integrated Clinical Pathways in Western Europe has been a lack of empirical evidence to substantiate the effectiveness of them. The reasons for this can only be speculated. Yet without measurement against key success criteria the benefits to both patients and staff cannot be appreciated, and the drivers for change lose impetus. To evidence the benefits of the Integrated Clinical Pathways, and to understand the operational challenges that they present to the hospital, TCC will be leading an Operational Trial for the experimental pathways using their sophisticated simulation capability to support the work. By this means it is hoped to achieve the required state of readiness for the proposed Acute Medical Assessment Unit, along with the policies and practices on which the trial will be based. Patient outcomes measures, clinical effectiveness and operational efficiency measures are all to be evaluated in the trial.
The British Medical Journal, and the Faculty of Leadership and Management have invited Dr Matthew Bacon, to lead a workshop at this event. Dr Bacon will be inviting delegates to consider the impact of an ageing population on how clinical services are provided to this cohort. With the next 10 years well over 30% of the UK population will be over the age of 75 and associated with this will be a corresponding rise in multi-morbidity. This raises the need to challenge conventional practice built around clinical specialities, and suggests also the need for holistic diagnostics in the treatment of patient health. Delegates will explore what this could mean for clinical service redesign.
In the workshop, Dr Bacon supported by his colleague Professor Oren Lieberman, will introduce the notion of ‘Situated Health Ecology’. This is a method of considering the context in which patients receive their care. It helps us to understand how and why patients respond differently to health care services. We already understand the need for the special consideration of vulnerable patient groups in paediatric and adolescent care for example, but there is limited special-case provision in geriatric care. Yet it is clear from contemporary research that the self-perceived physical and mental wellbeing of this patient cohort is critical to successful health outcomes, reduced demand both for hospital readmission and further follow-up demand on Primary Care services.
Since 2017 The Conclude Consultancy has been a strategic partner of Schneider Electric. The reason? Because uniquely we discovered a way to create new business intelligence from clinical information system metadata and to model it with physical space and other resources used in hospital planning and engineering. In doing so we have been able to create new knowledge to inform building engineering science, in the pursuit of high performance buildings.
It is a win-win. Hospital managers learn how to improve space efficiency through improved patient flow, and in doing so the demand for new space is reduced. This leads to both lower capital and operational costs. Reduced energy consumption and lower carbon emissions are further significant added value benefits.
Earlier this summer The Conclude Consultancy (TCC) completed an analysis of Day Surgery facilities in the northern region of Gothenburg, Sweden. This is now published as a Case Study. This project was typical of many that we work on, where the client wished to understand how clinical service delivery could be optimised to improve both the patient experience as well as improving the efficiency of patient flow through the surgery facilities.
In an ideal world day surgery should be a predictable and systematic process, but it must also recognise that patients come to day surgery with significantly varying needs – both from clinical wellbeing as well as emotional wellbeing perspectives. Whilst this means that the process must accommodate many variables it does not follow that it cannot be effectively managed.
On this project, TCC used their unique patient pathway method, which is one that recognises that different patients can be categorised as ‘patient types’, and as such their specific resource needs can be identified and planned for. An elderly patient with specific emotional wellbeing needs for example, should be managed differently to a younger adult patient who’s clinical and emotional needs maybe quite different. The clinical leadership team originally argued that the process was wholly unpredictable, but in analysis of the patient pathway data, TCC found that patient types could be allocated to procedure time bands, and within these time bands there was substantial predictability.
However, TCC identified that there were still significant outliers in the process where, for example, patients displaying multiple morbidities necessitated greater complexity that often resulted in significantly longer duration in theatre, which could result in hours of delays. Contrasting with a typical time band for the same procedure type this might only require around 90 minutes for example. Working with the clinical leadership team we identified that these outliers could potentially be reduced by instigating an improved pre-operative assessment process, and that through this process patients displaying multiple morbidity, or other complicating factors would be treated on an inpatient pathway for surgery and not a day surgery pathway. By this means it was determined that the incidence of significant outliers should be substantially reduce. Operational trials would seek to quantify this potential benefit.
Optimisation of Day Surgery thus analysed the whole process and sought to develop strategies with the clinical leadership team that would ensure improved predictability of it. Simulation of alternative strategies enables the leadership team to understand ’cause and effect’ and in doing so develop new strategies focused on improving patient flow. Ultimately, it is the clinical leadership team to decide which strategies provide the best overall patient experience – TCC simply provides the data and analysis to support informed decision-making. The Case Study examines these issues.
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