Neha Puntambekar: Exploring the efficiency of a UK ambulance service through discrete event simulation
For my summer project on the MSc Business Analytics Consulting programme, I completed a consulting project with the East Midlands Ambulance Service (EMAS) looking at how the organisation could increase their effectiveness and reduce inappropriate attendances at A&E departments. The ambulance service has increasingly become a ‘default’ service to the public. People are more likely to pick up the phone and call 999 for less serious and non-life-threatening situations. Therefore the pressures placed on the UK’s ambulance services are continuously growing, meaning that the organisation must become proactive rather than reactive to these issues.
During this project, I worked closely with the ambulance service to understand their call cycle system and the various pathways that patients are taken on. I engaged in observations during ambulance ride outs, in the call control centre in Nottingham and worked onsite alongside other EMAS staff members. During this project, I undertook a facilitated modelling approach in order to build a representative and meaningful simulation model of the EMAS call cycle. While facilitated modelling was a new experience to me, I used the PartiSim approach, which prescribes a set of stages and activities to be followed in a facilitated and participative simulation study. For this approach it was important that key stakeholders were included in the process. Together with my supervisor (Dr Antuela Tako), we ran four stakeholder workshops with EMAS stakeholders, including clinical team mentors and paramedics. Facilitated simulation modelling is an emerging modelling approach in the field of simulation. So far there are limited cases of using such an approach and these happen to be in the healthcare field where this approach is especially useful due to the complexity and the interconnectedness of the system. I particularly found useful the PartiSim tools, available to support the process. These enabled me as a novice to facilitated modelling to prepare for the workshops and to organise the information collected at the workshops in order to develop and discuss the simulation model with the stakeholders. Having worked closely and alongside my academic supervisor, who is one of the developers of the PartiSim approach, I felt privileged to have learned and applied this innovative facilitated modelling approach during my dissertation project.
In this project, I created a simulation model of the ambulance call cycle system using a simulation software called SIMUL8. The model used real organisational data during the busiest months of the year, focusing on a particular division covered by the service. Parameters, distributions and percentages were depicted from analysis of the dataset in order to represent the likelihood of certain pathways throughout the call cycle. The model created included some simplifications to the system but it was representative and validated by the stakeholders and my industrial supervisor. It measured: how many patient cases resulted in A&E visits; or to alternative healthcare providers; how many patient cases ended in treatment at the scene; or over the phone; how many individual red (emergent) patient cases met their response time targets of 8 minutes; how many red (emergent) cases met their conveyance target of 19 minutes and how many green (non-emergent) cases met the target of 30 minutes. The latter time targets are government set and are the main ambulance quality indicators across the UK.
The first two workshops with EMAS stakeholders elicited the necessary information to inform the simulation model. We then used the model in two subsequent workshops in order to explore, how improvements could be made within the system and to discuss an action plan for future changes. The model demonstrated that improvements could be made at the beginning of the call cycle when their team of paramedics or nurses intervene with calls in order to upgrade, downgrade the call or offer advice to patients. If activity, scope or authority is increased here then improvements could be made to the time target measures, also the number of cases where patients are treated over the phone increases and A&E visits decrease, reducing the costly delays that occur during visits to these departments. I prepared a report, which I also presented to the EMAS Board of directors. This report presents these findings along with other alternative scenarios that were created to explore different impacts to the call cycle. The report concludes with recommendations and a plan put forward to implement the findings of the project back by the clinical team mentors who attended the workshops. The findings are currently being considered within EMAS by its Executive team and I am looking forward to find out about future developments within the organisation.
All in all, my summer project has been a very rewarding experience. I found particularly useful using the PartiSim approach, which provided me with tools to integrate the information and outcomes produced from the facilitated workshops carried out in order to develop the simulation model. I really believe that PartiSim tools should be used more in future consultancy style projects in order to provide organisations with effective solutions, that tackle issues that the most important stakeholders are facing. My industrial supervisor stated that the work I produced was ‘a perfect mix of qualitative and quantitative research’ and also that my ‘ability to grasp a very complex organisation very quickly is genuinely amazing’, these responses were due to the facilitative approach taken on the project. This project has equipped me with consultancy, modelling and facilitation skills that I am certain I will make use of in my next job.
This Blog post was written by SBE MSc in Business Analytics Consulting student Neha Puntambekar.