Some years ago I was a member of the IProdE. Do you remember The IProdE? Yes Production Engineers. Do they still exist? I'm interested in Service design in the NHS and the nearest engineering equivalent I can think of in Production Engineering. I'd love to hear from any Engineers working on Service Design in the NHS.
Alan, Thank you for your comment. My area of interest is certainly Service design. How is this done in the NHS. Co-design with patients is not the answer. Co-design of the requirement specification with patients certainly. A very important output from the design process is 'standardized work' and this is a key area of my research. I good starting point for a systems analysis around service design is to understand exactly the work activities of the people delivering the service and their integration with IT systems. I do this using a flowcharting technique and detailed task analysis. For my research, I'm a Research Fellow at the University of Birmingham, I'm keen to work with a NHS Trust to help with the analysis of service design if you are interested in Collaborating.
For some context. I am Data Scientist working for a South London Mental Health Trust and currently researching multi pronged applications of Deep Learning and AI to Mental Health. My current sub project is analysing the operation challenges of running a Children and Adolescent Mental Health Service.
I have started my work from the NICE guidelines perspective (Find guidance | NICE) and correlated these to our internal Standard Operating Practices. These documents set out to define the optimum projected pathway for a nominally standard patient. This I have found to be very far from the reality on the ground, predominately as there is no such thing as a standard patient, and for that matter a standard clinician. To date I have focused my work on deriving a rating methodology that aims to quantify the intensity of a given patient, factoring in multi dimensions such as Acuity, Demographics, History, Need etc, all quite difficult to accurately assess and weight, and all with highly complex interaction within the model..
Additionally we have looked at key bottle necks in the smooth and efficient flow of patients through the various pathways, leveraging things like waiting lists, Demand and Capacity Models and Delivery Patterns. So far we have used common flow diagramming but I am investigation the use of Graph Database techniques and Complex Network Analysis to help provide insight to these time series events.
I would be very please to discuss further and if parallels exist in our research we could potentially present a proposal of some collaboration to the trust Ethics Committee for a research license. This is required due to the sensitivity of the data being mined as I am sure you will appreciate.
Looking forward to hearing more from you and other on the forum.
Alan. Thank you for your message. One of the drivers for my research is the fact that SOPs do not represent what is done. This is a very dangerous situation for any organisation as it leaves the organisation open to litigation and also prevents managed process improvement never mind process management. SOPs are not based on work processes. My approach to service design is to identify work processes, not an easy task in the NHS, and then establish a degree, initially, of process management. The structure of the resulting process documentation must show, amongst other things, links to IT systems in use and record keeping. This is the only way to remove the variation that the NHS is plagued with. Clinical aspects are not documented here but linked to relevant NICE guidance documents. As you so rightly say there is no such thing as a standard patient or a standard clinician. Process documentation must take this into account but not attempt to regulate it. Your work, I think, is to gain more understanding of the complexity of the clinical aspects of the process. It does seem to me that there is a deal of synergy to be gained from a joint approach as the process/service design must be a combination of these two aspects. The Service consists of a number of discrete but linked processes. The final design must comply with the requirements of the relevant SOPs or the SOPs must be changed. It is my view that if a Process Management System is established within a Trust then SOPs could be done away with. I think I’m alone in that view at the moment!
You are absolutely right, the on the ground picture is hugely variant, and does not closely correlate to SOPs. But the reason for this, certainly for us in mental health, is down to the fact that the SOPs state, in generalities. i.e. "Patients with conditions/diagnosis A,B,C should receive Treatments/Therapy X,Y,Z for a prescribed number of sessions." Now although there may be some consistency in describing some Acute Physical Conditions in these terms, ie A broken Leg will heal with-in predictable bounds for most patients, mental heath recovery is much more a chaotic system, with recovery considerably more randomly distributed and complete and successful outcomes far less identifiable.
As a result clinical opinion becomes a far greater determiner of pathway that normalised predicted pathways or in defining clear decision points along the patient recovery. Similarly measures of improvement are far less tangible than those in Physical Health. An X-Ray or blood test can give very strong evidence of degree of recovery in ways not yet so objectively available to Mental Health practitioners.
As a response, to this objective test short fall, my wider research project is investigating the use of bio-markers, endocrine products in the main, as a means of charting the psycho-physical changes through a mental health condition progression and the hope is that by better understanding these relationships between Mental and Physical Health, to give feedback of medication efficacy and treatment impact..
I think we could best progress this discussion if we spoke. Please email me at alan.smith1@nhs.net if you would like me to send you my phone number. I hope we can speak soon.
