Its self-evident that one of the greatest management challenges facing the NHS is that of balancing valuable resources with growing demand. This is an all-year-round objective which is often exacerbated by a winter bed crisis.

Most NHS management teams would accept the need to devise strategies for coping with various crises. Resources are always apparently stretched to breaking point and growing numbers of elderly, more treatments being developed and more emergency admissions mean that demands are ever increasing. Even where more funding has been made available, how can you be sure that youre making the most of the resources that are available?

The occasions where coping with demand becomes problematic are well documented:

Seasonal crises: The annual influenza epidemics often mean increases in patient demand and more staff sickness resulting in a chronic shortage of staff and beds when they are most needed.

Waiting times: The on-going challenge to reduce waiting lists has proved a difficult one there are now fewer beds, more elderly people in need of care and more emergency admissions. At the same time, advances in medicine mean that new treatments and operations are being demanded by yet more people.

Screening: Prevention should be better than cure, but screening is expensive and the benefits are invariably in the future. In breast cancer screening, for example, there are doubts as to whether the benefits justify the expense.

In this challenging context, health managers have to balance the needs and demands of many different groups of people. The NHS Executive and commissioners are asked to determine priorities for the present budget as well as for the future. This process is currently being undertaken in many different ways which can result in conflicting conclusions.

How can Operational Research help?

Operational Researchers look at the functions an organisation exists to perform and work to find practical and pragmatic solutions to operational and strategic problems. Most of the problems OR tackles are messy and complex, usually entailing considerable uncertainty.

OR uses qualitative problem structuring techniques and simulation as well as advanced quantitative methods to examine assumptions, facilitate an in-depth understanding and decide upon practical action.

By using appropriate techniques, OR is capable of helping with many of the current NHS resource management challenges:

Winter Bed crises: Simulation can be used to model fluctuations in events, such as sudden surges of emergency patients, and to ask what-if questions to find the best ways of improving potential crisis situations (for example, what if we had x more beds and n more nurses). The relative effect of staff shortages and theatre shortages can also be determined; simulation models can also be used to demonstrate and predict the effects of providing additional resources on both a long and short term basis. Models can show the effect of Christmas on the rate of discharges to Residential and Nursing homes and the extent to which bed blocking might exacerbate a crisis.

On the wider perspective, other kinds of model can be deployed to determine the most appropriate salary levels required to optimise nurse recruitment, and other manpower planning techniques can be used to consider recruitment, training and wastage matters.

Waiting List Management. Queuing Theory can be used to evaluate the relationship between queue length, queuing times and service provision. For the patient, waiting time starts from the time when they first visit their GP. From this moment on, there may be a long series of queues before the patient eventually receives the required surgery. For example, someone in need of a knee replacement may join one queue for X-ray, another for an outpatient appointment, then a scan, then arthroscopy and another outpatient clinic before joining a long list for the knee replacement.

OR can model these queues and identify the bottlenecks and determine the best policies to reduce waiting times.

Patients needing a knee replacement will join several queues en route to the operating theatre. A simulation model can indicate the distribution and lengths of the various activities. Scenarios that might be explored include:

• discharging patients earlier to a rehab hospital or home
• getting GPs to put patients straight on waiting lists accepting that some patients may prove unsuitable
• providing more short term catch up resources

Outputs would include waiting times, number delayed, number of outpatient appointments.

Screening

Mathematical modelling and simulation techniques can determine the expected outcome of screening programmes in terms of years of life saved and improved health. Cost benefit analyses can also help to determine the ways that benefits should be weighted against costs.

Priority setting

Multi-criteria analysis techniques can be used to clarify some of the assumptions that are typically used and form a sound basis for choosing priorities. Scenario analysis helps planners to look into the future and to identify needs and priorities in a systematic way.

Work which incorporates OR techniques is ongoing within many University and Health departments and many clinically relevant subjects are being covered. However, there is no doubt that more can be done with OR to help health managers at the Trust and Health Authority level to make more of the resources currently at their disposal.

What can you do?

The techniques mentioned are usually deployed by Operational Research (OR) practitioners who can design systems that make the most of existing resources. OR practitioners are found within OR groups attached to some organisations and as part of both independent networks and major Consultancy organisations. Practitioners are associated with The OR Society in the UK and a list of contact addresses can be obtained by getting in touch with the Society.

Further explore the use of OR in your organisation: