Scenario Generator - Simulation Software for Healthcare
Contents
1. Figure 22 Allocate ICD Conditions to Pathway To assign prevalence codes to a pathway first select Assign Entries to Pathway and then select the Generic Pathway of which your sub pathway is part Then select the relevant codes you wish to assign to your pathway by clicking on them To assign multiple conditions hold Control and click Now select the pathway you wish to assign conditions to this will appear at the bottom of the dialog Once selected click Assign ASSIGN PERCENTAGE SPLIT You may wish to allocate a simple percentage split to your new pathway without using the ICD10 prevalence data To do this access the pathway manager directly through Population and Activity gt Pathway Manager You will be presented by the below dialog and should select Specify Percentage Split Scenario Generator powered by SIMUL8 Simulation Software for Healthcare Improvement 23 Pathway Manager Select Option to Assign Activity to Pathways Q Specify Percentage Splits Auto Calculate by Prevalance Figure 23 Pathway Manager Remember that if later you decide to try and use prevalence codes to assign activity to pathways you must first change back your option to Auto Calculate by Prevalence before assigning codes Once selected you can now manually change the percentage splits to each sub pathway by double clicking on the one you wish to change Pathway Manager x Cancel Figure 24 Percent2. Figure 1 Opening Screen To get started on using the Scenario Generator click Create New Scenario Saved Scenarios stored in C Program Files Scenario Generator Scenarios will appear here Open Scenarios From other locations Scenario Generator powered by SIMUL8 Simulation Software for Healthcare Improvement 2 ON SCREEN DISPLAY On creating a new scenario you will be displayed with the following screen Figure 2 On Screen Display Step Properties Pathway Navigator The pathway navigator shows the five generic pathways built into the tool these being Mental Health Urgent Planned Unplanned Maternity and Social Care To view another pathway double click the pathway you wish to view from the Pathway Navigator If any step within the pathway is clicked the Step Properties box will show all the properties associated with that step These properties can also be edited from here Scenario Generator powered by SIMUL8 Simulation Software for Healthcare Improvement 3 TOOLBAR Take a minute to look over and play about with these tools Refresh Scenario Applies a grid to the screen Run Scenario Draw Function Clock shows the time day and week in the simulation Zoom Stop Scenario jue e Eee rd Creates a Parallel Creates a Walt Step Creates a Step js w Figure 3 Toolbar Together these menus will provide you with all the ability to build and input
3. 18 COSE c M m 19 PUTICLHICIM 19 Waits eie ner iren E Dm d E OE D rd n PII RES EO rd ee CE Fre a Pom arde x Pk Sea Pea D a veda 20 Parallel Steps 20 Unassigned Pathways 22 Step 4 Pathway Activity 22 Allocate ICD Conditions to Pathway Assign Percentage Split 23 Direct INPUut Of ACCIVIRY ET 24 Exercise 2 Creating PathWays teer tinte eint cvsersasstavaateeetaneacanesigtdavsaci deeds seabivgecisserasdsenasanesogeastan 26 Step 5 Developing Running and Comparing Scenarios ccceeseeeceeceeseeseeeeeeeeaeeseseaeeaeeseseaeeaeeeteseaeeaees 30 Population Growth Exercise 3 Healthcare Using Projections M aiglitilnBS ceci reino us tU ecd pL LL EE Scenario Generator powered by SIMUL8 Simulation Software for Healthcare Improvement Arrival Rates Year Variability Time in step Time in System Waiting breaches 36 Random p M 37 R nning Mial sceccseasaeasccaceucwncacoessssescdiaee sass seacnsa cde Ta a A E 37 CAVC 39 Step 6 Setting Capacity seciicccsscessasetciacesicasseceecdaxecesdecoavevsssadeaxhvusaeeviducvessavectveckeysavevesyessaavadexvibedvaevea lect edocs 40 Exercise 4 Wsing Capacity p 44 Step 7 Inter
4. You need to run a simulation multiple times to remove the aspect of the model that is purely influenced by chance leaving us only with the true outcome of the model To make this easier when you want to run a scenario to look at variability you can use the Trials function You do this by selecting Run gt Run Trial You can then choose the number of trials you would like to run as well as the number of years you wish them to run for The minimum number of trials you can run is 3 Scenario Generator powered by SIMUL8 Simulation Software for Healthcare Improvement 37 Run Trial Enter Number of Runs in Trial Cs Enter Run Length Years 5 Figure 32 Run Trial The High Level Display will then produce results which include confidence levels as can be seen below The csv file will also produce results with confidence limits Mental Health Number 195 254 Social Care Number 0 SZ Figure 33 HLD for Trials For a more detailed comparison select Results gt Scenario Comparison and check the box compare trials Then select all the trials you wish to compare You will then be displayed with the below dialog which allows you to compare steps across all the trials you have run It also gives you the confidence limits surrounding each step Scenario Generator powered by SIMUL8 Simulation Software for Healthcare Improvement 38 Scenario Comparison Type of Resu
5. 13 554 13 740 13 740 13 554 Figure20 Parallel Process Step The above shows how a parallel process Step can be used You can select the step by selecting the option on the toolbar The parallel process step will batch out a number which is set automatically according to the number of connections from it in figure 20 above for example if your patient or service user is having a district nurse service as well as home care and a specialist nursing service you can use the parallel step to split the activity into three parallel sets of activity The likelihood of patients needing each service will be set as a route out percentage from each decision point of requirement The parallel step will be act as a dummy step having no time associated with it and no other characteristics meaning there will be no results for these steps WAITS You can set a planned wait between steps by using the oval Create Wait on the toolbar This allows the flow of activity to wait for a period of time ensuring that activities do not flow through the simulation too quickly This is essential in pathways like the maternity pathway and also useful when trying to model care pathways where patients use a service over a number of months of years but perhaps only an hour or so a week You can set the maximum and minimum length of wait required and apply a distribution to this Loops are covered in more depth in the User Guide Wait steps are also used where you want to an
6. ScenarioGenerator Simulation Software for Healthcare Improvement SCENARIO GENERATOR WORKSHOP European Office SIMUL8 Corp Cochrane House 29 Cochrane Street Glasgow UK G1 1HL tel 44 141 552 6888 0870 850 8886 fax 44 141 553 2331 0870 240 5589 support scenario generator com www scenario generator com Copyright SIMUL8 Corporation 2013 Scenario Generator powered by SIMUL8 Simulation Software for Healthcare Improvement Scenario Generator powered by SIMUL8 Simulation Software for Healthcare Improvement G ScenarioGenerator a Simulation Software for Healthcare Improvement Scenario Generator Training Manual TABLE OF CONTENTS Introduction WliatisSimiulatiOriss s uis consecetur aei aara eaea Ete easier E ATE 1 MUT dog 1 Mattia M 1 DIS PNAS T stats 2 Welcome to the Scenario Generator eessssessesesesseeseeeenee nennen nennen nenne tnn tnter aaia AAEE SA TENSA ES 2 OnsScreenm DIS LAY fa coves cease rore eiie edere Dr bera evene aere Ert eva ERR PETERE ERE AT E RAE EETA RENE EXER AER 3 CDI 4 Step by Step APProae RR 5 Step 1 Run Your Health Economy Default Scenario essent nnne nenne tn
7. 10 12345277 11809493 11812694 118 158 95 118 190 97 Total 20 24 187 977 85 185 207 08 182178 20 17940433 17637221 16845828 15311072 15801619 Total 2534 29748200 30525821 313 038 60 32082320 328 611 98 336 404 97 341 376 62 346 350 94 Total 35 44 371 596 05 363 744 65 356 145 56 348 285 66 340 934 93 333 323 40 32545085 318 087 88 Total 45 54 354 5745 355 536 03 356 915 33 35829535 3599328 361 314 35 362 696 60 36407958 Total 55 64 31543350 31885374 32253240 32621303 329 638 90 33332340 336 753 01 340 184 45 Total 65 74 228 753 40 232 150 15 236 061 90 240 489 07 24543208 250 891 34 256 610 42 26310338 Total 75 84 152 844 20 152 629 10 15267047 15322516 15378014 15459221 15591844 15724538 gy gt 3e 006 Bl Total o 25e 006 Bi Total 1 4 Wl Total 5 15 2e 006 Total 16 19 4 564006 Bl Total 20 24 E Total 25 34 1e 006 I Total 35 44 Wl Total 45 54 Bl Total 55 64 3 z 5 s Wl Total 65 74 Bl Total 75 84 Bl Total 5 500000 Figure 26 Population Forecast You know that you can import your own population forecasts by using the import and export function on the population manager but what if you want to model the impact of lower or higher levels of population growth For this you can use the Projections Function PROJECTIONS You can add or reduce the expected population year on year using the Projections by selecting Advanced Projections To add a population projection select Population from the right hand side
8. 7 day weeks as 18 to test the likelihood of meeting 18 week targets Once you have run the simulation you can look at the results in Results Scenario Comparison Summary Results It will tell you the number of standard breaches and the number of possible breaches see below Scenario Generator powered by SIMUL8 Simulation Software for Healthcare Improvement 36 Scenario Comparison Type of Results to Compare Summary Results El vo Load Results Show Graph Result Scenario PCT_5QC 1 Pathways Costs 0 00 2 Steps Costs 4 499 756 44 3 Workforce Costs 6 00 4 Block Contract Costs 0 00 Tota Scanaserer 409 256 44 lo Wait Standard Breaches 333 00 Possible Breaches 0 00 Figure 31 Wait Standard Breaches For further information on all of the above see the User Guide Section 8 Results Generation RANDOM SEED The Scenario Generator is a stochastic tool which means that it uses randomness as events move through steps in the pathway This occurs in the duration property unless the fixed option has been selected and the in the referral property Running one scenario will not produce a statistically significant result If you want a result which is statistically significant you need to run the same scenario 20 times by varying the random seed number This function can be found at Scenario Management gt Preferences gt Random Number Seed Settings RUNNING TRIALS
9. User Guide Section 6 Projections Scenario Generator powered by SIMUL8 Simulation Software for Healthcare Improvement 31 Add Step Projection Day Po Pathway Mental Heath MentalHeath v Step lE x Parameter Duden wd Capaci Prevalence Projections Year h s Add Chapter 400 B93 Certain infectious and parasitic diseases z X Cancel Only display Conditions with Prevalence data Condition 400 0 Cholera due to Vibrio cholerae 01 biovar cholerae A Prevalence 14 515 1619 20 24 2534 3544 4554 5564 E574 7584 85 Total Age Bands O Ratio b Ww fe bh hb hb hb hb hb b fp b p Figure 29 Step amp Prevalence Projections Try running scenarios for 10 years with different population projections and compare activity and cost Scenario Generator powered by SIMUL8 Simulation Software for Healthcare Improvement 32 EXERCISE 3 HEALTHCARE USING PROJECTIONS In exercise 2 you identified that there could be savings in GP s referring activity to GPwSI rather than outpatients However in the real world it may take a while for this policy to be rolled out and for all GP s to comply Therefore you want to model this into our pathway and to do so you will use projections First you want to run the pathway you created but this time for three years remember to name the scenario Now you want to reset the scenario to its original state by changing the referral rate from GP to GPwSI b
10. import one year of data be sure to click Apply to Future Years as this will ensure a population forecast is produced for 50 years If you are inputting your own population forecast for a given number of years do not press as this will override years 2 onwards RUNNING A SCENARIO The next stage is to run the Scenario Generator to get some results To do this select the Run Menu then Run Scenario You are going to run the scenario for one year so select one from the drop down menu At this stage you are running the scenario with the capacity disabled This means that results will only be useful for activity levels and costs Capacities have to be entered by step and depend on local economies See Step 6 RESULTS On running the simulation the display will change to show the High Level Display HLD as shown below POPULATION 13 147 Mental Health Urgent Planned Unplanned Social Care Number 10 579 Number 66 707 Number 98 170 Number 241 Number 11 434 Figure 6 High Level Display Run with GP population J82007 You will also notice a bar at the bottom left which shows how long the simulation will take to complete Scenario Generator powered by SIMUL8 Simulation Software for Healthcare Improvement 7 When the simulation has finished running check the High Level Display by clicking on the relevant boxes to display activity This gives you the aggregated results across the whol
11. of costs across the system in relation to activity which will give you an idea of the affordability of your scenario against projected budgets The capacity function will also help you to see where the system needs more capacity in order to function and where queues will build up if capacity is not available When you move from the High Level Display back to the pathway screen you will see a series of green amber and red dots which indicate where steps which have not processed all the events that have entered the step On some steps you will also see a blue line denoting increasing occupancy of a step i e a positive difference in the number of events at the step If you click on the relevant step and go to the property window you will see a new line Step results has appeared If you click on this a graph will show you the activity relating to that step in graph form Scenario Generator powered by SIMUL8 Simulation Software for Healthcare Improvement 48 nE Step Results r Pathway Information Throughput Pathway Mental Health Mental Health Activity In 1418 00 Activity Qut TOTE 1 068 00 2 Wait z Percentage Complete 75 32 Time Series Average Occupancy 308 58 C Histogram eee J E Occupancy 8 e 100 OV042012 OVOR2012 01062912 01 08 2012 0109 2012 OW 102012 D1112012 01012013 01 02 2013 D103 20123 Figure 40 Step results If you have enabled the ca
12. social workers coping with demand Save your scenario Now there are local authority cuts and 2 social workers in the team take voluntary redundancy Reduce the capacity available Scenario Generator powered by SIMUL8 Simulation Software for Healthcare Improvement 46 Can the 3 remaining social workers cope with demand What is the impact on waiting times Scenario Generator powered by SIMUL8 Simulation Software for Healthcare Improvement 47 STEP 7 INTERPRETING RESULTS By now you will have created a range of scenarios to help to answer some of the questions you have about the impact of change on your system Where possible try and validate results using other data sources and then look for differences The Scenario Generator is a demand based model and will sometimes produce different results from an activity based model For example if your population is expected to increase by 8 an activity based model might increase activity by 8 The Scenario Generator will increase the activity by a smaller percentage reflecting that whilst a population may increase not all of its members will necessarily use secondary care activities Both results represent two possible scenarios for future demand The results produced from Scenario Generator should be seen as indicating trend rather than predictions In particular the costing methodology used will not equate to your specific budget but you will be able to see the distribution
13. steps whose results you are interested in To do so first ensure that from Results Capture Preferences record all time in step results is not checked Next click the step for which you wish to record the time and from the Step Properties Window change Record Time in Step to Yes On running the scenario the results can be accessed from Results gt Time in Step Results or Time in System Results Scenario Generator powered by SIMUL8 Simulation Software for Healthcare Improvement 35 i ZE 3 Genetic Pathway Sub Pathway Mental Health z Time In Step Results Days Step Name Minimum Average Maximum Observations First Outpatient 0 03 0 04 0 05 348210 Pharmacy 0 00 0 00 0 00 8051760 Time in System Percentage observations to graph 95 95 of observations within 0 days Bl Within specified observation Wl Outside specified observation 350000 300000 250000 Wi 200000 150000 I i 100000 50000 0 0 days Figure 30 Time in Step Results WAITING BREACHES The property window allows a wait standard to be set between a section of steps e g referral to treatment and the tool will measure whether the standard has been breached Select a start point for your wait say primary care in the planned care pathway set Wait Standard to Start Next pick an end point say outpatient treatment set Wait Standard to Stop and also set the Wait Duration
14. you through the steps you have just read and apply them This exercise is based on Bristol health and social care system and will enable you to alter the default mental health model using NHS Comparators data on mental health to better reflect the current situation in the mental health in Bristol Go to Population Input Manager and choose CCG population for Bristol CCG_11H Name your scenario Before by going to Scenario Control gt Scenario Name Run the Default Scenario Look at the results for the mental health pathway In reality Bristol has 4850 total first outpatient appointments and 1825 admissions What are the results in the model How far away is this from the real situation Reset the Scenario and rename it After by going to Scenario Control gt Scenario Name Let s assume that there are far more admissions from the crisis resolution service than the default model suggests with fewer patients managed in the community Change the referral rates from the Crisis Resolution step to increase the flow to admissions to 2 and increase referrals from the primary care step to first outpatients to 2 75 taking those patients from self care Also increase referrals from primary care admissions to 1 taking those patients from community care services What results do you get now Can you improve on this In fact NHS Comparators also reports that there are 2045 DNAs Create a new step for DNAs and work out what perce
15. 216 253 LAXE Male Female Gender Spit E 49 18 50 82 Stating Population Male Female O 0 65 3458 0 62 328 678 is 255 tastes 244 1 283505 5 15 6 48 3435210 617 3270871 16 18 2 59 1373024 249 1 320 011 20 24 342 181398 3 37 1 786 521 25 34 6 74 3573043 676 3 583 545 35 44 5 96 3683570 z07 3 747 984 j 45 54 68 3504850 533 3 673 766 55 64 5 73 3037616 ss 3127738 l 65 74 4 12 2184115 4 46 2 364 358 75 84 241 2780 212 1 653 880 i 85 0 73 386890 149 789 886 Totalby Gender 4918 26071548 5082 26940 8953 i LS A Figure 5 Population Input Manager The Scenario Generator ages the population year on year scroll through the bar at the top Select Year to View and watch as the figures change year on year Now select Population Forecast and choose different information to view various forecast graphs of your population Once you are comfortable at navigating the Population Input Manager select OK to populate Scenario Generator with your chosen population Scenario Generator powered by SIMUL8 Simulation Software for Healthcare Improvement 6 If you want to replace the population data with your own you can use the above method or press the Export button This will export all this information to a CSV file which you can easily change After making changes you can then import this data back in by selecting the Import button and choosing the appropriate file Note If you only
16. Improvement 21 4 Wait Outcomes Duration Information Time Units G BitourBays J 0K C Hours Minutes cancel Distribution C Fired more Normal C Triangular C Log Normal Mean jo Figure 21 Wait Examples UNASSIGNED PATHWAYS You can create a pathway under the unassigned pathway in the same way as outlined above These pathways are designed to model activity derived from existing pathways For example if you want to model end of life care you can create an end of life pathway under unassigned care and then send activity from individual steps from within the planned and urgent care pathways To do this you select the relevant end step from the main pathway and select referral rates This will give you the option of sending activity to the relevant step within the end of life unassigned pathway STEP 4 PATHWAY ACTIVITY The Scenario Generator has several methods available to allow you to determine how much activity runs through each pathway these are discussed below There are 5 generic pathways which form the basic framework which have pre defined activity set to them If you want to make changes to these or add activity to new pathways you create you can do so by following one of the below methods ALLOCATE ICD CONDITIONS TO PATHWAY This option is accessed through Population and Activity gt Allocate Prevalence Entry to Pathway Scenario Generator powered by SIMUL8 Simulation So
17. ack to 2 196 Now using the projections function input the following Referral Projections you are going to gradually increase the amount of activity that the GPwSI sees over the next few years Year Referral Rate 2 GPwSI to 3 196 3 GPwSI to 4 1 Now rename your scenario Dermatology with Projections and run the scenario for three years Compare your scenarios l What is the financial difference in gradually introducing this change Scenario Generator powered by SIMUL8 Simulation Software for Healthcare Improvement 33 EXERCISE 3 SOCIAL CARE USING PROJECTIONS In exercise 2 you identified that there could be some savings in increasing the use of Telecare for older people living alone with illness However in the real world it may take a while for this policy to be put into practice with some service users and their families needing to be convinced that it is the right course of action Let s assume that people take up the opportunity more slowly To do this you need to use the projections function First you need to run the pathway you created but this time for three years Remember to name the scenario and to set the scenario back to its original state changing referrals to telecare back to 30 Now using the projections function input the following Referral Projections you are going to gradually increase the amount of activity that is referred to Telecare over the next 3 years Year Referral Rate 2 Referrals to Tel
18. age Splits DIRECT INPUT OF ACTIVITY You may have access to or wish to model very precise activity data into your pathway If this is so then go to Population and Activity Activity into Pathways where you will be able to input your own figures direct by exporting the table and importing your own data Scenario Generator powered by SIMUL8 Simulation Software for Healthcare Improvement 24 Activity By Pathway Figure 25 Activity into Pathways Note If your prevalence percentage reflects the level of the condition which is present in your population rather than the level of activity seen in the health service remember to reflect the difference between the potential demand and the actual activity which you will be basing on historic activity for the default by allocating some of the demand at the start of your pathway to self care using the referral rates FOR MORE INFORMATION ON HOW TO INPUT ACTIVITY INPUT PATHWAYS REFER TO SECTION 4 4 CONTROLLING ACTIVITY OF THE USER MANUAL Scenario Generator powered by SIMUL8 Simulation Software for Healthcare Improvement 25 EXERCISE 2 HEALTHCARE CREATING A DERMATOLOGY PATHWAY In the Planned Care pathway create a new pathway and call it Dermatology recreate the pathway below using the same referral rates Note Referral rates have been calculated using evidence that dermatology accounts for approximately 10 of a GP s workload DIP Volume 8 Numb
19. alyse the buildup of queues before a constrained step When using waits this way no maximum or minimum duration is set it is a dummy step to enable you to measure waiting times Scenario Generator powered by SIMUL8 Simulation Software for Healthcare Improvement 20 The figures below show examples of each type of wait The first shows a planned wait in the maternity pathway the planned wait time before the next appointment The second shows a loop wait where there is a minimum weekly wait before the next Early Intervention The third example shows a dummy wait where capacity has been enabled and the wait times and queues resulting from the constrained Primary Care step are being measured The fourth shows how you can set a maximum waiting time for a wait after which a service user or patient will exit the wait and go down an alternative pathway This is useful when modelling the impact of waiting on outcomes A p Time Units 24 Hour Days Hours C Minutes Duration Information p Distribution C Fixed Normal Triangular C Log Normal Mean 70 7 Planned Wait tn Duration Information Duration Infermaton Time Units 34 Hou Days C Hous C Minutes x Cancel p Distribution Normal Triangular Time Unis Log Normal 2 Loop Wait 3 Dummy Wait Scenario Generator powered by SIMUL8 Simulation Software for Healthcare
20. an also account for miscarriages and non resident pregnancies here by entering the additional percentage of these in your selected area Then by selecting recalculate activity algorithm percentages for all age groups will automatically update Scenario Generator powered by SIMUL8 Simulation Software for Healthcare Improvement 9 r Activity Algorithm Weightings Pregnancy Freva v OK Age Range X Cancel 045 1618 20 24 25 34 35 44 45 54 Pregnancy Prevalence Calculation Amend the rates below as necessary and click Recalculate to update the Pregnancy Prevalence percentage Additional for miscaniage 5 Recalculate Additional for non residents 5g 0155 1619 2024 2534 3544 4555 3 654 108 125 374 27 d Figure 8 Activity Algorithm Weightings To view and change Condition Prevalence select Population and Activity gt Prevalence Scenario Generator uses ICD 10 codes to classify the prevalence of disease by age band As before they can be changed by double clicking and entering a replacement value The import and export function like the population input manager is also provided here to allow you to override those provided by default Code A00 899 Planned 34 2 Multiplying Factor 300 Urgent 65 8 Code Title Prevalence O 1 4 5 15 16 19 20 24 400 0 Cholera due to Vibrio c
21. and activity You will cover capacity later in this manual If you remember you covered referral rates earlier on so the focus now will be on the first three Step Properties HLD The high level display HLD tab allows you to aggregate the results from a particular step together with other step results There are default categories and details set within the tool which you can use or you can create your own This is useful for example if you are adding multiple sub pathways and each pathway has a step that would be counted as an Admission By setting each steps HLD to Category Secondary Care and then Detail Admission the tool will aggregate these allowing you to validate that your total admissions equates to what it should Scenario Generator powered by SIMUL8 Simulation Software for Healthcare Improvement 18 COST If you click on cost you will be taken to dialogue box which gives you various options If you select Basic this allows you to put in a Basic cost for each event You can specify an optional fixed cost for each unit of activity processed by the step and or an optional variable cost based on the number of days or hours the activity spends in the step E A Formatted English United States Cost Cost Options OK Basic C User Defined Advanced gt gt gt X Cancel Cost Fixed Cost Cost per Day Cost per Hour Figure 18 Costs Selecting other cost types by clicki
22. ary care centre and run again Can GPs still cope How long are events waiting Is this acceptable Scenario Generator powered by SIMUL8 Simulation Software for Healthcare Improvement 45 EXERCISE 4 SOCIAL CARE USING CAPACITY In exercise 2 you looked at the financial impact of increasing the use of Telecare on social care costs Now you are going to consider the social work resource implications of this scenario doing this Using the Telecare scenario you created create a social worker capacity of 5 social workers working in 3 teams 3 queues Add a further social work assessment step before the traditional care package step with a wait Soce rw ork Traditmai ae Wan 15 psciegs BPF OSLAS Assign your social work capacity to each step that needs a social worker there are 3 social work assessment joint visit with social worker social work team assessment Let s say that each of the social worker steps require an hour of the social worker s time 60 minutes normal distribution In the wait step before the social work is used you also need to record the Time in Step remember this is set in the step properties window Ensure your Telecare pathway is reset to the default scenario and that auto scale is switched off Enable the capacity name your scenario Telecare with Capacity and then run the scenario What is the utilisation of your social workers How long are activities waiting Are the
23. ation Propert Value 1 2 1 0 08 E Name Primary Care 2 2 1 0 07 Description GP 3 3 2 0 07 HLD 4 4 1 0 08 Unit Cost E E 2 ae Duration Auto calculated E 5 1 0 08 Referral Rates W 4 sssssssss 7 gt Capacity l Record Time in Step No Where Resource used in Scenario Wait Standard None Pathway Step Activity Wait Duration 7 day we 0 Step Fie Mental Health Mental H Qut of hours 263 Mental Health_MentalH Primary Care 1456 E Urgent Urgent Primary care 0 Urgent_Urgent Out of hours Consultati Urgent_Urgent Primary care 2 0 i Urgent Urgent Primary care 3 Selected Primary Care Planned Planned Primary care 0 Planned_Planned Primary care 2 0 Hi Planned Planned Fallout un nriman care n Figure 39 Resource Utilisation Scenario Generator powered by SIMUL8 Simulation Software for Healthcare Improvement 42 Note The Scenario Generator will run more slowly with the capacity enabled if you record all time in step values It will speed up if you only select individual steps to display the time in step For more information on Capacity refer to Sections 3 1 7 and 8 12 of the User Guide Scenario Generator powered by SIMUL8 Simulation Software for Healthcare Improvement 43 EXERCISE 4 HEALTHCARE USING CAPACITY In exercise 2 you looked at the financial impact of GP s reducing referrals to outpatients and instead referring activity to GPwSI Now you are go
24. ces through to A amp E or self referrals e Your population has a higher or lower admissions rate for urgent elective or daycase and alter referral rates from A amp E to admissions in urgent care or from outpatient diagnosis to admissions in planned care e Your population is more or less likely to self fund their care needs Scenario Generator powered by SIMUL8 Simulation Software for Healthcare Improvement 12 CHANGING REFERRAL RATES To change a referral rate double click on the step you want change the referral rates from A dialogue box will appear select Referral Rates Edit Step Properties Properties of Primary Care Step Name Primary Care Description GP Duration Referral Rates Capacity Figure 12 Edit Step Properties A second dialog box will now appear double clicking on each entry will allow you to change the referral rates and also the priority If you only want to change two referral rates checks the boxes of those rates you wish to remain the same This will lock them Referral Rates Lock Step Percentage Priority Ll Phamacy 71 222 Routine LH Self Care 4 798 Routine D Outpatient attends 35 Routine d D Community Care 6 8 Soon o Admission 0 8 Urgent D Counseling Wait 1288 Routine Current Percent 100 Figure 13 Referral Rates The Scenario Generator is based on the flow of events so change a referral rate at the start of the pathway first and run the scena
25. ct of change THIS MANUAL This manual aims to take you through the steps you need to follow in using the Scenario Generator This manual should be used in conjunction with the User Guide which is accessed from the Help menu within the tool At the end of the session you should understand the purpose of the tool and how you will use it with your local health and or social care economy You should be e familiar with the functions of the tool and how to use them e able to create a pathway run a scenario and interpret the results e able to use the tool with your local health and social care economy and to continue to develop your skills in using the tool with support from the SIMUL8 team Scenario Generator powered by SIMUL8 Simulation Software for Healthcare Improvement 1 DISPLAYS WELCOME TO THE SCENARIO GENERATOR The next few pages will take you through the various displays you will see when using Scenario Generator Take your time in getting familiar with these as it will make the learning process much easier On starting the Scenario Generator the first screen that will appear to you is shown and described below Latest News amp Offers amp E Welcome to the Scenario Generator Create New Scenario Open Recent Scenario before S8 scenario raror Current Version 5 Keep up to date with Scenario Generator news CLICK HERE for more details WWw sce nario generator com
26. data into your pathways Pathways Run Run Save and Name pathways Scenario Management and analyse all your results Results The help menu is also important and provides you with a detailed User Guide that should be used alongside this training manual Scenario Generator powered by SIMUL8 Simulation Software for Healthcare Improvement 4 STEP BY STEP APPROACH This stage will take you through a Step by Step approach to help you understand how to use Scenario Generator STEP 1 RUN YOUR HEALTH OR SOCIAL CARE ECONOMY DEFAULT SCENARIO The first step is to run your population through the default scenario The reason for this is that the default is based on National Average and any inconsistencies must be identified POPULATION INPUT MANAGER Scenario Generator holds information for healthcare populations in England Scotland and Canada This will need to be set to ensure you can access your chosen healthcare population and can be done at Scenario Management gt Preferences gt Population Preferences once you have selected your population you should get a message saying Base Model Updated To select your population go to Population and Activity menu and select Population Input Manager Population Input Manager Options Please Select Population Type National SHA CCG GP PCT Local Authority D Last Revised D User Defined Run Preferences Figure 4 Population Input Ma
27. de Title Prevalence 0 1 4 515 1619 20 24 1 Older People 100 0 0 0 0 0 3 2 People with Moderate Severe LD 100 0 0 0 0 0068 0 0061 3 People with Challenging Behviour 100 0 0 0 0 0024 0 0024 l 4 People with LD 100 0 0 0 0 0277 0 026 5 People with autistic spectrum disorder 100 0 0 0 0 01 0 0102 6 People with Down s Syndrome 100 0 0 0 0 0062 0 0062 7 People with severe LD 100 0 0 0 0 002 0 002 8 People with visual impairment 100 0 0 0 0 0 E 3 People with hearing impairment 100 0 0 0 0 001 0 001 10 People profoundly deaf 100 0 0 0 0 11 People claiming Disability Living Allowan 100 0 0 0 0 021 0 021 12 People with moderate physical disability 100 0 0 0 0 041 0 041 13 People with severe physical disability 100 0 0 0 0 008 0 008 14 People permanently unable to work 100 0 0 0 0 024 0 024 15 People own house 100 0 0 0 0 0 16 People in council rented 100 0 0 0 0 0 17 People in social rented 100 0 0 0 0 0 ws m J D Only show entries with prevalence percentage greater than zero Export Import X Cancel v OK Figure 10 Social Care Prevalence CALCULATING SOCIAL CARE PREVALENCE FROM POPPI AND PANSI To input your local social care prevalence from POPPI or PANSI choose your local authority area and category of interest and download the data Then using the same age bands as Scenario Generator calculate the prevalence as a proportion of the total population number in that age band as in the example be
28. e health and social care economy Do the inpatients outpatients births and A amp E attendances broadly reflect the pattern of health or social care service activity in your economy The default for the SG has been set to reflect the national picture so there may be some differences in what you see Click on the Close High Level Display button You will be taken back to the main screen where the activity for each step is displayed Each time a scenario is run you will also generate a CSV file Pathway_Details for that run Have a look at this now you can find it at C Programe Files SCENARIOGENERATOR Scenarios Scenario Results This file describes step by step activity volumes and costs by pathway Filtering on the HLD column will help you see what parts of the system contribute to the overall result Try recreating the table shown in Figure 6 A z o 1 Pathway Step Current Activity Total A x Minimi Maxim HLD HLD Result x 11 Mental Health Mental Health Admission 3 40 0 12 MENTAL HEALTH Admissions 45 Urgent Urgent Admission 8 1052 0 28 SECONDARY CARE Admissions 65 Urgent Urgent MAU 0 124 0 4 SECONDARY CARE Admissions 84 Planned Planned Admission 4 291 0 9 SECONDARY CARE Admissions 85 Planned Planned Day Surgery 0 1245 0 7 SECONDARY CARE Admissions 88 Planned Planned Private Admission 0 91 0 4 PRIVATE HEALTHCARE 145 Unplanned Unplanned Spontaneous 0 66 0 4 SECONDARY CARE Admissions 146 U
29. e sharing your pathways easy To export a pathway select Pathways Export Pathway This will create an XML document which can then be shared and imported by selecting Pathways Import Pathway and selecting the relevant XML file For more information on pathways see section 2 of the User Guide STEP PROPERTIES The properties of each step can be changed by double clicking the required step Figure 17 shows the Edit Step Properties dialog Scenario Generator powered by SIMUL8 Simulation Software for Healthcare Improvement 17 Edit Step Properties Properties of Primary care Step Name Primary care Description Primary care HLD Duration Referral Rates Capacity Cost Figure 17 Step Properties For each step you can define the HLD Category Cost Duration Referral Rates and Capacity associated with it In the default pathways all these have been set for you however you can change these to fit your local context If drawing a pathway from scratch you will also have to set these parameters You can set properties by double clicking on the step Capacity always has to be set by you as this varies in each health and social care economy those used in the default are for display purpose It is suggested that to start with you set the duration cost and High Level Display for the steps in the pathway you are entering or amending This will give you results surrounding costs
30. ecare 32 5 3 Referrals to Telecare to 35 Now rename your scenario Telecare with Projections and run the scenario for three years Compare your scenarios l What is the financial difference in gradually introducing this change Scenario Generator powered by SIMUL8 Simulation Software for Healthcare Improvement 34 WEIGHTING In the Population Input Manager you will find a set of weightings which can be used to simulate expected demand for particular types of population These can be switched on and off they are set at off in the default and different weightings applied ARRIVAL RATES YEAR VARIABILITY You can also change the Yearly Variability to reflect how the seasonality of demand may affect your system This can be accessed by selecting Advanced gt Seasonality you can then enter how weekly activity compares to the of the norm You can also set the time you wish to run your scenario from Double click on the clock on the main screen and use the calendar function to change the start date TIME IN STEP TIME IN SYSTEM Scenario Generator allows you to measure the time spent in all steps or the time spent in the whole system To measure the time in system or measure all time in step results you must switch these preferences on to do so select Scenario Management gt Preferences gt Results Capture Preferences and check the option you wish to record To speed up the simulation you can select only the individual
31. er 4 and from NHS Comparators data for dermatology outpatient first and follow up appointments _ Set costs as follows Step Cost GP 21 First Outpatient 120 Outpatient Follow up 120 Outpatient Procedure 140 GPwsl 48 GPwSI Follow up 48 Allocate the whole of the ICD 10 Chapter relating to skin conditions to this pathway Select only the dermatology pathway to run Now run the pathway using the North East Essex Population Scenario Generator powered by SIMUL8 Simulation Software for Healthcare Improvement 26 What is the financial impact if you reduce referrals by GPs to outpatients by 2 instead sending activity to GPwSI TIP Remember to name your Scenarios to allow easy comparison after scenario runs Scenario Generator powered by SIMUL8 Simulation Software for Healthcare Improvement 27 EXERCISE 2 SOCIAL CARE CREATING A TELECARE PATHWAY In the Social Care pathway create a new pathway and call it Telecare recreate the pathway below using the same referral rates JdnVistwth Note Referral rates have been calculated assuming that only 3096 of people living alone with life long limiting illness will use Telecare that senior staff assessment is required in complex cases and that 30 4096 of those using Telecare will need reassessment at different times during the year Set costs as follows Step Cost Traditional care packages Select social care cost codes 190 205 and 210 221 Telecare
32. existing by double clicking them Constrained Resources Default merum Resource Name Resource Descri Number of Queues FTE Per Week Use Step Duration Minimum activite Typical activities X coca 10 185 185 axs A and E departm es CMHT 20 Yes Comm Hospital B Comm Hospital B 200 Yes Diagnostics Tests Diagnostic Tests 3 Yes GP Consultation GP Consultation No Delete Inpatient Beds Inpatient Beds 500 Yes Resource MH Inpatient MH Inpatient 20 Yes Midwives Midwives 25 No Nursing Home B Nursing Home B 200 Yes Outpatients Outpatient Beds 100 Yes Social Worker Older Peoople 15 Yes Add Resource Delete Assignment Figure 35 Constrained resources When setting the resource you need to identify the number of FTEs or beds etc the amount of activity they can be dealt with each week the number of days and hours the resource is available and the number of queues The queue numbers refer to the number of locations of the resource For example your system might have 100 GP practices 100 potential queues but 340 FTE GPs each of whom can deal with 140 consultations per week This is understood as your total GP consultation capacity Scenario Generator powered by SIMUL8 Simulation Software for Healthcare Improvement 40 Resource Cost per annum E Anrum FTE 0 Days per Wosk Hours Per Day fs Figure 36 Edit Resource To associate a step with that re
33. far away is this from the real situation Reset the Scenario and rename it After by going to Scenario Management Scenario Name Let s assume that the population of North East Essex is less likely to access health services through the urgent care route hence the lower number of A amp E attendance Change the referral rates from the Urgent Care start step to reduce the flow to self referral by 1 and the calls to 999 emergency services by 1 with the activity flowing to self care instead Let s also assume that GPs tend to deal with most urgent episodes in primary care and attendances from Primary Care are reduced by 10 with the activity flowing to self care instead What results do you get now How much do you need to decrease the conversion of Leave A amp E attendance to admission by to get around 19 000 admissions Now compare your scenarios go to Results Scenario Comparison Load results and select the Before and After scenarios you have just run Note As you are only making changes to the Urgent Pathway the simulation will run quicker if you only run one pathway at a time To do hits go to Run gt Select Pathways to Run and uncheck the pathways you do not wish to run Scenario Generator powered by SIMUL8 Simulation Software for Healthcare Improvement 15 EXERCISE 1 SOCIAL CARE HEALTH AMENDING THE DEFAULT PATHWAY TO REFLECT A LOCAL SOCIAL CARE AND HEALTH SYSTEM The aim of this exercise is to take
34. ftware for Healthcare Improvement 22 You will be presented with age banded prevalence for ICD10 codes and social care prevalence and asked to assign the relevant codes and or age bands to your pathway You can select as many codes as are relevant to your pathway condition and the SG will automatically calculate the percentage of the generic pathway that this represents r Pathway Assignment Select Generic Pathway Mental Health v Select Subpathway to view assigned entries ze The selected Subpathway has entries assigned to it in the following Chapters All Chapters X The selected Subpathway has the following entries from the selected chapter assigned to it X Prevalence in Age Band not assigned to selected pathway Code Description Prevalence O 14 F03 Unspecified dementia 0 18 0 0 F F06 2 Organic delusional schizophrenia ike 0 04 0 0 E FO6 9 Unspecified mental disorder due to br 0 07 0 0 F10 5 Mental and behavioural disorders due 0 01 0 0 F10 9 Mental and behavioural disorders due 0 27 0 0 F19 5 Mental and behavioural disorders due 0 01 0 0 F133 Mental and behavioural disorders due 0 21 0 0 F20 3 Undifferentiated schizophrenia 0 15 0 0 F20 9 Schizophrenia unspecified 0 06 0 0 F25 8 Other schizoaffective disorders 0 64 0 0 2 Fa Linenanifiad nanctasnin nonnhasie nna n n 4 m v Only show Chapters Entries with prevalence percentage greater than zero 2
35. holerae 01 biova 0 0 0 0 0 0 m i 400 1 Cholera due to Vibrio cholerae 01 biova 0 0 0 0 0 0 400 9 Cholera unspecified 0 0 0 0 0 0 401 0 Typhoid fever 0 0 0 0 A011 Paratyphoid fever amp 0 D 0 0 0 0 401 2 Paratyphoid fever B 0 0 0 0 0 0 01 3 Paratyphoid fever C 0 0 0 0 0 0 A01 4 Paratyphoid fever unspecified 0 0 0 0 0 0 402 0 Salmonella enteritis 0 02 0 3 1 05 05 402 1 Salmonella septicaemia 0 0 0 0 0 0 A022 Localised salmonella infections 0 0 0 0 0 0 A028 Other specified salmonella infections 0 0 0 0 0 0 402 9 Salmonella infection unspecified 0 0 0 0 0 0 A03 0 Shigellosis due to Shigella dysenteriae 0 0 0 0 0 0 403 1 Shigellosis due to Shigella flexneri 0 0 0 0 0 0 403 2 Shigellosis due to Shigella boydii 0 0 0 403 3 Shigellosis due to Shigella sonnei x 0 0 0 m D Only show entries with prevalence percentage greater than zero dii LS A Figure 9 Condition Prevalence Scenario Generator powered by SIMUL8 Simulation Software for Healthcare Improvement 10 Note For further information on Condition Prevalence Estimates please refer to the User Guide section 4 2 To view and change social care prevalence select Population and Activity gt Prevalence and choose the Chapter 23 the social care chapter r Prevalence P e 0m 000 C m ocial Care Code SC Social Care A 100 Multiplying Factor 100 Co
36. ing to consider the resource implications of doing this Using the dermatology scenario you created create a GP capacity of 9 GPs and 1 queue You will be running this scenario with 1 GP practice Ensure that this capacity is assigned to all the steps that need a GP including the steps that are in the new dermatology pathway In the dermatology pathway create a new wait step between GPwSI and GPwSI follow up this is to allow us to measure the queue build up In the wait step you create you also want to record the Time in Step remember this is set in the step properties window Enter GP population J82007 Ensure your dermatology pathway is reset to the default scenario that all the pathways are switched on and that auto scale is switched off Enable the capacity name your scenario Dermatology with Capacity and then run the scenario Scenario Generator powered by SIMUL8 Simulation Software for Healthcare Improvement 44 What is the utilisation of your GPs How long are activities waiting Are the GPs coping with this additional demand Now save your scenario Now the system wants to send 10 of outpatient referrals for all other conditions to a primary care enhanced service In the main planned pathway set up the new service as follows 100 Primary Care Centre Referral Discharge Wait Mana ge ment x ar Qe CL 0096 E wait 7 Z 90 Prioritiz Refer Allocate your GP resource to the prim
37. low Scenario Generator powered by SIMUL8 Simulation Software for Healthcare Improvement 11 People with a limiting long Calculation Age banded term illness living alone by popuation People with LLI Age banded population age People aged 65 69 1 667 800 342 900 eople aged 80 84 eople aged 85 and over 3 o convert to SG age bands eople aged 65 69 70 74 4 472 000 492 12 eople aged 75 79 80 84 2 920 000 698 400 1 193 000 424 589 Edit Details Title Older People living alone with illness ance Prevalence M00 Age Banding Ratio O 1 4 5 15 16 19 2024 25 34 35 44 45 54 55 64 65 74 75 84 85 Figure 11 POPPI PANSI prevalence PATHWAY REFERRAL RATES You will see that each pathway is made up of a series of steps each connected by arrows There are a number of properties associated with each step and referral rates determine the flow of activity through the steps If the default scenario reads higher or lower than you might expect you need to decide whether e Your population is more or less demanding than the national average and alter the referral rates going to self care at the start of the pathway accordingly e GPs refer more or less patients to outpatients and alter referral rates from primary care to referral management in the planned care pathway accordingly e Your population has a higher or lower user of A amp E and alter referral rates either to emergency services or from emergency servi
38. lts to Compare HLD Results Category SOCIAL CARE Load Results ul Result Home care Hide Graph Result Scenario Trial 3 Trial 4 Trial 5 Low 95 Mean High 95 Urgent_Urgent_Home care 154 00 159 1 Urgent_Urgent_Home Care 2 120 00 123 Planned_Planned_Home Care 560 00 465 Planned_Planned_Home care 2 7 00 1 TOTAL 841 776 lll SOCIAL CARE Home care TOTAL 200 0 Trial 1 Trial 2 Trial 3 Trial 4 Plot Multiple Series Clear Graph Figure 34 Scenario Comparison CAVEATS If you are running the tool just using the 5 generic pathways you have already simplified a huge number of processes in your health and social system so running tests of statistical significance will not necessarily give you a more accurate picture It will be more helpful to you to vary the scenario you are running e g change the population number alter the referral rate and then compare those results to understand the potential trend and range of possible outcomes This is why you are given the option of varying the random seed so that you can tell whether the changes in results are because of your scenario changes or because of random variation If you are running the tool with a small population or with a single care pathway then you can set it up to reflect processes much more accurately It would then be useful to use the random seed to run tests of statistical
39. nager From the population options shown in Figure 4 choose your population type and then enter the relevant code The codes can be found in the User Guide Section 13 Appendix A accessed from the Help Menu Scenario Generator powered by SIMUL8 Simulation Software for Healthcare Improvement 5 OTHER POPULATION OPTIONS From Figure 4 you can see that there are two options that do not relate to a Health or Social Care Economy Last Revised and User Defined When selected the last revised option will bring up the last selected population together with any changes you made to it The user defined option allows you to create and store your own populations for further details please see the User Guide Section 15 Appendix C After selecting your population you will be shown the following screen this is the Population Input Manager At this screen you can make changes to the data simply by clicking in the appropriate box and making the required change F x Input Manager Year 1 Jc Select Year to View OK LI gt Year1 s Age Gender Life Expectancy Demographics Exercise Living Alone Behavic_4 gt X Cancel Start or Year Population Data Population Name ENGLAND Population ID NATIONAL Export 2 Import Births 688 120 a Starting Population Size 53 012 500 n LL Population Deaths 484 367 Forecast Apply to Modelled Population 53
40. ng the Advanced button then clicking add remove costs allows you to select from activities with a tariff You can apply more than one tariff to each step however you will be required to input the percentage of the activity in that step that is relevant to each cost By default the tool will apply an equal percentage for each tariff DURATION Duration allows you to set the time spent in each step by minutes hours or 24 hour days You can also apply a selection of distributions to this duration which are highlighted below Duration Information Time Units C 24Hour Days SK 400 00 C Hours r Distribution C Fixed less Normal Triangular C Log Normal Mean 14 667 10 2669 14 667 19 0671 Figure 19 Duration Scenario Generator powered by SIMUL8 Simulation Software for Healthcare Improvement 19 PARALLEL STEPS In Social Care Models Scenario Generator does not use activity Instead we are using population based prevalence which means that we are dealing with individuals in the pathway We therefore need to be able to model how patients access their services and in reality patients can be accessing several at once this can be modelled using Parallel Steps Heath and social care team 27 294 27 294 Specabst nurse Home Care required requred District Nurse required No home care No Specinist Nurse service No District Nurse Home com service 13 618 13 676
41. nplanned Unplanned Caesarean Elective 0 14 0 2 SECONDARY CARE Admissions 147 Unplanned Unplanned Breach 1 0 0 1 SECONDARY CARE Admissions 148 Unplanned Unplanned Ventouse 0 10 0 2 SECONDARY CARE Admissions 161 Unplanned Unplanned Non NHS 0 7 0 1 PRIVATE HEALTHCARE Admissions 162 Unplanned_Unplanned NHS 0 19 0 1 SECONDARY CARE 163 Unplanned Unplanned NHS Agency 0 22 0 1 SECONDARY CARE 164 Unplanned Unplanned Medical Management 0 6 0 1 SECONDARY CARE Admissions 165 Unplanned Unplanned Surgical Management o 4 0 1 SECONDARY CARE Admissions 166 Unplanned Unplanned Observation 0 3 0 1 SECONDARY CARE Admissions 177 Unplanned Unplanned Admission 1 124 0 5 SECONDARY CARE Admissions 187 Unplanned Unplanned Caesarean Emergency 0 20 0 1 SECONDARY CARE Admissions 188 Unplanned Unplanned Forceps 0 17 0 1 SECONDARY CARE Admissions 226 Figure 7 Filtering on HLD Result for Admissions It is important to rename these files if you make an important scenario run If you do not and then run another scenario it will rewrite the results with those of your current run The best way to ensure you do not lose results is to name your scenario before you run it To do this go to Scenario Management gt Scenario Name and name your scenario This then automatically renames the CSV file to namechosen_PathwayDetails csv Note Also you must remember to close this file before running another scenario if you don t rename it as Scenario Generator will not be able to
42. nt nnne 5 Population Input Manager 2 2 ciet tin tete einn ce tipa d cde eig eine egeta bet begun pee a rii EEE aaa aE aaae 5 Running Scenario cert reif p eto i EH ERROR RR ELE EAE EFLER ETE FERE XRE ERR UE RU EEPE ASEENA RE ER ER RE 7 DH c 7 Step 2 Configuring the Scenario Generator sessi nennen nnne nn nnne nnne nn enne enne 9 POptuilatiOnss 2 tiri freres ore tess cre Po E uro De EE reda Fei ae Fe rr a ree vel Fe FREE Rare pa ERE TIRE Read 9 dir ll 9 Calculating Social Care Prevalence From Poppi and Pani ceceeeceeseeseceseeeeeeaeeeeeesaeseseeceeseeceeseesseecetsneteeeenes 11 Pathway Referral Rates iiec reri ctetu ag e ai rA deed Ya Mara E atop EVE drag aka 12 Changing Referral Rates oerte trenta eerte oe e ae hose esta odndaqied cetadessedacitesastutnsdeeasaverateenss 13 BEIC TE H R R 14 Exercise 1 Amending the Default Pathway to Reflect a Local Health System sese 15 Step 3 Creating Pathways ix iscceccvsssiscecciatsiateesverdetessexe entvsaentssninesevecsuned ental eonebarsel inia berba bye esee ne oup ipeo rep un 16 Ieri EE E 14 Ebchul lm 17 1o
43. ntage of referrals are DNAs Now compare your scenarios go to Scenario Results Scenario Comparison Load results and select the Before and After scenarios you have just run Note As you are only making changes to the Mental Health Pathway the simulation will run quicker if you only run one pathway at a time To do this go to Scenario Control Select Pathways to Run and uncheck the pathways you do not wish to run NHS Comparators gives a health warning to mental health data published Scenario Generator powered by SIMUL8 Simulation Software for Healthcare Improvement 16 STEP 3 CREATING PATHWAYS To develop pathways within Scenario Generator you can e Copy Existing Pathways e Modify Existing Pathways e Create New Sub Pathways e Import amp Export Pathways e Delete Pathways There are five default pathways of Mental Health Urgent Planned Unplanned maternity and Social Care these can be copied or can be broken down into sub pathways to reflect specific conditions If you decide that one of the default pathways or one you have created would be a useful base for your new pathway select Pathways Copy Pathway then name the pathway and define what category you want the sub pathway to be a part of If you decide that you want to start a pathway from scratch select Pathways New Pathway then name the pathway and assign it to one of the five categories It is also possible to import and export pathways to mak
44. or Healthcare Improvement 41 the resource is being utilised across the system The Scenario Results menu will also display results for time spent in the system or in a step Resource Number Resource Utilisation Average Name Serving in Use Queue 10 i a om ooa r 10 2 2 8596 01729 2 10 4 2 8772 04M5 3 10 s 3 87576 0273 3 AandE AandE AandE 10 3 2 87427 017483 AandE AandE Figure 38 Resource Details File It is important when you are running your scenarios constrained that you remember to remove scaled population Scaling the population clusters events together and enables the simulation to run much quicker However this is unsuitable if you are running with capacity enabled as your resource will not deal with multiple events simultaneously To turn this off select Scenario Management Preferences Run Preferences and deselect Auto set scaling for faster run Results for resource Utilisation and a summary of where that resource is used is provided in the Step Properties Window Simply click the Step Resource Utilisation and the results will be shown in window as you can see below From here you can look at the results for all resources you have set by selecting them from the drop down menus Resource Utilisation Category Resource Default GP Consultation x Epas 1 Queue Resource Available Maximum in Use Utilis
45. pacity you will also get a Step Resource Utilisation option which will show you how much capacity of the resource is being used and where Using the Scenario Generator should help you to e Test your assumptions e See any unintended consequences of a plan e Ask better questions Scenario Generator powered by SIMUL8 Simulation Software for Healthcare Improvement 49 USING THE TOOL You need to decide how to use the tool with your local health and or social care economy From work undertaken to date the team would recommend the following 1 Define the question you want to answer e Involve key stakeholders in this and determine the kinds of scenarios you are wanting to test 2 Configure the tool to reflect your local population e You will need a data analyst to support this work as well as public health input on demographics and prevalence 3 Set up new pathways scenarios that you will want to test 4 Run the Scenario Generator at events with key stakeholders to produce results which can help inform the discussions and subsequent decisions SUPPORT As development on Scenario Generator continues there will be new releases which should be installed on your computer Existing scenarios are compatible with the new releases To discuss progress and share pathways with other users you are invited to join the User Community This can be reached via the following link www scenario generator com You can share pathway
46. preting RESU IES tess irc rari eR derer e erroe ect t cbe e d RH ak SR 48 Using the TOON e 50 keep 50 This tutorial applies to Scenario Generator version 5 Scenario Generator powered by SIMUL8 Simulation Software for Healthcare Improvement G ScenarioGenerator Simulation Software for Healthcare Improvement Introduction WHAT IS SIMULATION Simulation is the recreation of any kind of process on a computer It allows a process to be built up and then experimented with This will highlight where and why problems occur such as why a bottleneck builds up This enables areas for improvement to be identified new ideas tested out and most importantly users can understand how a system works without taking any significant risks THE SCENARIO GENERATOR The Scenario Generator SG is a simulation tool which works by generating a virtual population with the demographics of an actual population and with conditions which are randomly allocated in line with known prevalence data This gives a number of potential health and social care events for the population that move through a set of care pathways Each interaction between patient event and pathway step has an impact in terms of resourcing duration and capacity and these interactions are simulated and their effect captured and reported to the User The User can then consider the impa
47. rio before making further alterations After making an alteration and running the scenario always click the restart button before rerunning a scenario or making a change it LIT Figure 14 Restart When you are happy with your local default save your scenario by selecting Scenario Management Save Scenario and use this scenario as your baseline model Scenario Generator powered by SIMUL8 Simulation Software for Healthcare Improvement 13 Note Further information on Referral Rates can be found in the User Guide Section 3 1 6 Also remember that when you reload your saved scenario you will need to select last revised population in the Population Input Manager if you have made changes to your population DRAWING STEPS You can add steps to your pathway using the Create Step Create Parallel Step or Create Wait function and linking them using the draw function You can also remove steps by selecting the required step and pressing Delete Remember you looked at these when looking at the displays section Fle Run Population and Activity pone Create oo Draw Functions Figure 15 Draw Step Tools Function Practice by creating a New Pathway by selecting Pathways gt New Pathway then on the dialog box that appears selecting your chosen pathway type and clicking OK Now click on the Create Step box and drop a few on to the screen Then select the arrow Draw Function as shown and move the cur
48. s using the Import and Export Pathway link in the Structure menu The User Guide can be accessed under the Help menu and gives more detail on the functionality of the tool For further support with the tool contact Support scenario generator com Scenario Generator powered by SIMUL8 Simulation Software for Healthcare Improvement 50 NOTES Scenario Generator powered by SIMUL8 Simulation Software for Healthcare Improvement 51
49. service and Telecare service 2 Fixed cost 500 Allocate social care prevalence relating to older people living alone with illness Select only the Telecare pathway to run Scenario Generator powered by SIMUL8 Simulation Software for Healthcare Improvement 28 Now run the pathway using the Bristol Population What is the impact if you increase use of telecare by 596 TIP Remember to name your Scenarios to allow easy comparison after scenario runs Scenario Generator powered by SIMUL8 Simulation Software for Healthcare Improvement 29 STEP 5 DEVELOPING RUNNING AND COMPARING SCENARIOS You will want to run a range of different scenarios depending on the question you wish to answer The Scenario Generator has some additional functionality which can help you with this POPULATION GROWTH The Scenario Generator automatically ages the population year on year A growing population will generate additional demand As previously mentioned you can compare population growth estimates with local estimates select Population and Activity gt Population Forecast Population Select information to view EES z Year 4 2 3 4 5 6 Total O 2923530 26 934 55 26 941 85 26 949 15 26 956 45 2696376 26 971 06 26 978 37 Total 1 4 11155575 11286858 1122340 111 133 16 110 393 09 108 111 83 108 141 13 108 170 43 Total 5 15 325 178 60 323 471 09 32176263 31979656 31834286 31731554 31543302 31234914 Total 16 19 138 99590 133 646 66 128 551
50. significance To ensure statistical significance you should use convergence theory to determine the number of times you run the scenario However if you are looking for this level of accuracy you might be better using the SIMUL8 core product On the whole it is expected for people to use Scenario Generator more to give comparative guidance rather than a completely accurate answer If you would like to know more about stochastic variation and statistical significance then contact SIMUL8 direct Scenario Generator powered by SIMUL8 Simulation Software for Healthcare Improvement 39 STEP 6 SETTING CAPACITY Once you have established the pathways for your health and social care economy and run them to look at the potential demand and cost to the economy over time You can set the capacity of the system so that you can see where the constraints may lie Note The Pathway Details file in Scenario Results tells you the maximum occupancy of each step when running a scenario with capacity disabled This tells you what capacity you need for your scenario In the Scenario Generator capacity can be understood by the constraint placed on a particular step or set of steps The constraint could be e Workforce workload of a FTE e Beds e Equipment e g for diagnostics or adaptations Using Advanced Edit Capacities you can add any resource which could act as a constraint on the capacity of a step by selecting Add Resource or edit any
51. sor into the centre of the step you wish to connect from and click and then move the cursor to the step you wish to connect to and click When creating pathways ensure that all steps are connected otherwise activity will not flow through all steps in your pathways You will also need to ensure that you have clearly defined end points in your pathway so that activity can leave These will appear automatically when a step has no activity flowing out a start step will also appear automatically when there are no arrows flowing into that step You must ensure that you only have one start in any pathway Figure 16 Start and End Points Scenario Generator powered by SIMUL8 Simulation Software for Healthcare Improvement 14 EXERCISE 1 HEALTHCARE AMENDING THE DEFAULT PATHWAY TO REFLECT A LOCAL HEALTH SYSTEM The aim of this exercise is to take you through the steps you have just read and apply them This exercise is based on the North East Essex CCG model and how to alter this to reflect the current situation in the Urgent Care Pathway Go to Population Input Manager and choose CCG population for North East Essex CCG_O6T Name your scenario Before by going to Scenario Management Scenario Name Run the Default Scenario Look at the results for the urgent care pathway Let s say North East Essex has 75 000 A amp E attendances 19 000 admissions and 24 000 Walk In Centres or MIU attendances What are the results in the model How
52. source select the step on the pathway choose capacity from step properties and then choose the relevant resource in the dialogue box You may have also set categories of resource in which case you would select the category and then the required resource form that category For example if you want to understand how GP s time is used you should associate the relevant GP consultation step in each pathway with this resource these could be named differently in different pathways for example initial appointment in the maternity pathway would be a GP consultation resource To run a pathway with capacity enabled select Advanced Capacity Options and choose Enable Capacity Once enabled you should notice that all the symbols on steps with capacity that were previous crossed out now have a C in them 5 9 Figure 37 Capacity Enabled As previously mentioned you can use wait steps before steps that are constrained to see the effect the resource has on queue size and wait time refer back to Steps 3 and 5 if you need to remind yourself Under the Preferences tab in the Scenario Management menu you can also set the point at which you want the scenario to stop running if queues start to build up When you have run a scenario with capacity enabled a resources details file is created for you in My Documents Scenarios Scenario Results This will show you more detail of how Scenario Generator powered by SIMUL8 Simulation Software f
53. the following dialog will then be displayed Scenario Generator powered by SIMUL8 Simulation Software for Healthcare Improvement 30 Population Projection Po Change Type Increase gt TotalNumber Number By Age Gender r Total Number Number 1 Figure 27 Population Projection Input the year you wish to change the population and define whether this is an increase or decrease as well as by how much You can also make changes to the population by age band and gender to do this select number by age gender and input the changes Projections Yeu Week Day Pathway Step Categoy Parameter Value v ok 3 1 1 Population Inctease 01010101010101010125011 501 0 X Cancel Population Projection Change Type Increase X TotalNumber Number By Age Gender Number By Age Gender Male Female Population Step Prevalence 0 1 4 Figure 28 Population Projections The figure above provides an example of how to model the impact of an increase in 65 in the population that will happen in three years All projections you add can then be seen in the main projection window Projections can also be applied to disease and population prevalence and selected step properties Referrals Rates Duration and Capacity These are added in a similar manner to the population projections for more information see the
54. write out the results Scenario Generator powered by SIMUL8 Simulation Software for Healthcare Improvement 8 STEP 2 CONFIGURING THE SCENARIO GENERATOR At this stage you need to configure the Scenario Generator to reflect your local health and social care economy if your first scenario run does not produce the right levels of activity there are a number of modifications you can make POPULATION In the Population Input Manager you should check that the following are correct e Starting Population Size e Births e Deaths e Gender and Age Breakdown Note Remember you can upload your own population projections to override those in Scenario Generator Refer back to Step 1 or User Guide Section 4 1 which provides full details on the Population Input Manager PREVALENCE You will also want to ensure that e Pregnancy prevalence fits with local fertility rates by age group e Condition prevalence rates reflect those of your local population Social care prevalence data for your local area is entered into the tool The default data is based on the national prevalence taken from the DH tools POPPI www poppi org uk and PANSI www pansi org uk Data for your local authority area can also be found on these sites To view and change Pregnancy Prevalence select Population and Activity gt Activity Algorithm Weightings Select the Pregnancy Prevalence tab and if you wish to change these simply double click and replace You c
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