The Balance of Care Project: Modelling the Allocation of Health and Personal Social Services

The Balance of Care model was designed to predict from aggregate health and personal social service plans the care which will be received by different types of potential client. Planners can use the model to assess the implications of various competing strategies and hence choose the one which will yield a pattern of care closest to that desired. In order to predict the pattern of care inherent in a service strategy it is necessary to establish the priorities governing the allocation of services to clients. This paper concentrates on the structure of the model and the techniques developed to deduce priorities from the past behaviour of the health and personal social service system. Applications of the model are described more fully elsewhere.     

A Strategic Model for University Planning

With limited resources and operating in a rapidly changing environment, universities need to formulate strategies for making the most effective use of these resources. This paper shows how modern portfolio planning concepts can be used for this task. A strategic model is developed for a British university and its use in evaluating existing courses, planning new ones and allocating resources is illustrated.     

Robustness in Practice—The Regional Planning of Health Services

Earlier work has criticized the dominant tendencies in operational research contributions to health services planning as characterized by optimization, implausible demands for data, depoliticization, hierarchy and inflexibility. This paper describes an effort which avoids at least some of these pitfalls. The project was to construct a planning system for a regional health council in Ontario, Canada, which would take account of the possible alternative future states of the health-care system's environment and would aim to keep options for future development open. The planning system devised is described in the paper. It is based on robustness analysis, which evaluates alternative initial action sets in terms of the useful flexibility they preserve. Other features include the explicit incorporation of pressures for change generated outside the health-care system, and a satisficing approach to the identification of both initial action sets and alternative future configurations of the health-care system. It was found possible to borrow and radically 're-use' techniques or formulations from the mainstream of O.R. contributions. Thus the 'reference projection' method was used to identify inadequacies in performance which future health-care system configurations must repair. And Delphi analysis, normally a method for generating consensus, was used in conjunction with cluster analysis of responses to generate meaningfully different alternative futures.     

A Decision Simulation Model for Health Services Management

This model has been designed to assist decision making in the Health Services by predicting the effects on a local population of proposed policy decisions. Policy decisions are considered to:

1. 1
   Change the amount of certain resources available, e.g. manpower, hospital beds; or
    
2. 2
   Alter the methods of using resources, e.g. changing the emphasis of health care to the community rather than the hospital; or
    
3. 3
   Change the characteristics of illnesses, e.g. by vaccination or screening.
    

The model predicts the incidence of morbidity and mortality in a specified population and the changes in resource use over a period of years. Thus it is possible to see the long term effects of changes in population size and structure alongside the effects of management decisions on the use of health resources.The model has been designed principally for research purposes but has been used in the context of a health services management game. The validity of the model's predictions have yet to be tested. It is hoped to run the model in parallel with management decision making in a single health district in order to test the model's validity and improve its predictive ability.     

A Simulation Model for Planning Services for Renal Patients in Europe

A discrete-event simulation model is being developed to provide information for national and regional health planners about the effect of different treatment policies and practices on the increasing numbers of patients with irreversible kidney failure. The simulation program, written in Pascal using Pascal-SIM, describes the activities of individual patients whose progress through treatment depends on their characteristics and treatment history, as well as on treatments availability. Programming techniques have been developed to cope with the multiple scheduling of patient entities and the resultant queue-management problems. In order to provide simulation runs on request, for any population group, appropriate data is selected from the European Dialysis and Transplant Association Registry data base for use in the simulation program. Results are shown on a computer screen while the simulation is running, and are saved for further analysis to provide feedback to the requesting organization.     

The Development of a Decision-support System for Planning Services within Hospitals

The planning of services within district health authorities is a complex task, but the process of planning is often crude: few options for addressing issues are considered, and these are inadequately assessed. These deficiencies led to research of which the aim was to identify the types of information and systems needed for improved planning. This paper describes the product of that research, the Hospital Planning Model. It is a decision-support system which gives planners fast access to relevant information for planning hospital services. This allows them to consider quickly a range of options for addressing a particular planning issue, and to test how sensitive the implications of proposals are to differing planning assumptions. The system has been shown to be generalizable, and is currently used in 28 health districts and other health organizations throughout the United Kingdom. The proposed reforms of the NHS are likely to increase the relevance of the system: the purchaser/provider market will result in a greater awareness by hospitals of the importance of identifying measures to improve the cost-effectiveness of care. Purchasers too may want to scrutinize hospitals in terms of their efficiency.     

The Application of a Decision-support System for Planning Services within Hospitals

A paper in a previous issue of this journal described the development of a decision-support system for planning services within hospitals, the Hospital Planning Model. A crucial test of such a system is the actual change in the planning process its use brings about. Does it change and improve the planning process or do planners prefer to continue with historical practice? To demonstrate the potential impact of a decision-support system on planning, this paper describes a major application of the system undertaken in an inner London DHA. In this study, use of the system helped overturn management's original intention and resulted in savings of around £ 2 million.     

Project Planning and Prioritization in the Social Services–an OR Contribution

This paper describes a study carried out for the Social Services Department of a UK County Council towards the development of a system for the evaluation and prioritization of project-based work. There are three major components of the study; an activity analysis to investigate how managers in the department spend their time, with a view to establishing a time budget for the project work; a pilot study to introduce a simple system for project planning and workload balancing with a specialist team; and the development of a multiple criteria model for the evaluation and prioritization of projects. We envisaged a Decision Support System which integrated all of these elements; however, this was never developed; instead, the resultant benefits were of a very different nature. We reflect on the reasons for this and the implications for the success of the study.     

A Model to Assist Planning the Provision of Hospital Services

One of the most important health service issues concerns the level of provision of acute hospital beds. To assist resolution of this issue a model is proposed which simulates how hospital beds are used in terms of admission rates and lengths of stay for different categories of disease. The model can be used to predict the likely effects of changes in the provision of beds. Thus if it is proposed to increase the supply of beds, the model will estimate, by disease type, how much of an increase this will cause in admission rates and lengths of stay. The ability of the model to make reasonably accurate predictions is demonstrated by testing it with hospital data from Quebec Province, Canada. Some ways of improving the model's predictive power are discussed and possible future applications to hospital policy issues are outlined.     

A Literature Analysis of the Use of Management Science Tools in Strategic Planning

A literature analysis was conducted to examine the application of Management Science (MS) tools in Strategic Planning. The 766 abstracts were classified into a series of strategic categories to identify their contribution to specific phases of the Strategic Planning process. A functional classification was used to indicate the key issue or type of problem involved. Industry, publication date, and publication source were also considered. To identify potential application areas for the MS tools, beyond those found in this sample, a gap analysis was performed using Reisman's methodology for finding researchable topics.     

Planning for a Single Specialty in a Health District

This paper discusses planning in the National Health Service. An outline of a general method for planning at the district level is illustrated with a case study in which a strategic plan was produced for the maternity services in Cambridge Health District. Some of the problems of ensuring implementation of proposals are then discussed.     

The Use of Models for Environmental Forecasting and Corporate Planning

This paper presents briefly, the forecasting and planning activities which have evolved over the years in Esso Petroleum Company. It describes three computer models developed in the Corporate Planning Department for these activities an econometric model for short-term environmental forecasting and economic analysis; a horizon year optimization model for long-range corporate objectives setting; and a multi-time period simulation model for financial forecasting and planning both in short and long term. The structure, use and limitations of each of the models are discussed.     

Calibration of a Mathematical Model for Urban Planning

The operational value of the mathematical models used in regional or urban planning is mainly dependent upon the possibility of adequate calibration so as to make them actually represent the social and economic problem under study. In this paper we give a formulation of the calibration problem for a singly constrained exponential model, use it to calibrate a specific model that is actually being used to plan the development of a large Italian town, and obtain results that improve by about 30% a standard currently used calibration procedure.     

Some Systems Aspects of Strategic Planning

This paper is concerned with the strategic planning process and the contribution that analysis can make to it. It develops a conceptual model of the strategic planning process based on the traditional control system model and identifies a number of basic elements of the process. Four groups of analytical tools are presented and their relevance to the planning process discussed. It is suggested that tools from the different groups may be used concurrently at different parts of the process, although the use of analytical tools in some parts of the planning process is not well established. Finally the role of the analyst in the overall planning process is discussed.