“The UK’s National Health Service (NHS) is facing unprecedented strain,” explains Professor Christos Vasilakis, Director of the Centre for Healthcare Innovation and Improvement (CHI2).

He continues:

“Services and staff are stretched to the limit, and demand is ever increasing. Healthcare innovation and continuous improvement are needed now more than ever.”

Research at the School of Management is taking a multi-disciplinary approach to health. We’re bringing operations management, operational research and information systems research together with hands-on partnerships with clinicians and hospital leaders to solve real-world problems.

We’re one of five universities in south-west England and Wales to have formed LEAP (Leadership, Engagement, Acceleration & Partnership), a new £4.11 million digital health hub aimed at sparking collaboration and research across the region.

“LEAP represents a significant milestone in advancing digital health capabilities in the south west of England and Wales. By leveraging the collective expertise of academia and industry partners, we are really excited to be part of an effort with the potential to unlock new avenues for research, innovation, and partnership, ultimately enhancing the region’s healthcare ecosystem,” says Christos.

The mass vaccination centre at Bristol’s Ashton Gate stadium administered over 235,000 Covid-19 immunisations during its nearly seven months of operation in 2021 – an average of more than 1,000 people per day. With social distancing paramount, experimenting with interventions to keep things running efficiently was risky in a real-world setting.

Professor Christos Vasilakis worked in tandem with Bristol, North Somerset and South Gloucestershire Integrated Care Board, using data on processing times collected over a three month period in early 2021 to develop a computer model that can simulate throughput and identify bottlenecks.

The model proved especially useful in helping to set daily booking levels – with the optimum number to avoid congestion found to be a full 20% less than initial proposals.

Cleanliness is, of course, one of the most important characteristics of an operating room, but need it come at the expense of patient waiting times?

Typically, patients are prepared and anaesthetised for surgery in the theatre itself, but adopting a ‘parallel processing’ model – in which they are prepped in a separate space while the operating room is turned over between procedures – can minimise downtime.

Dr Melih Celik and researchers from TED and Bilkent Universities in Turkey analysed data from a large teaching hospital and used this to produce a stochastic programming model to schedule operating room times in this manner – showing an average of 40% reduction in operating room idle times.

Missed appointments are a huge challenge in healthcare, with around 15 million GP appointments wasted per year.

Analysis from Professor David Ellis of over 500,000 patients’ appointment histories over a three year period found that those who missed an average of two or more GP appointments per year were at least three times more likely to miss other outpatient appointments. Essentially, they stayed ‘missing’ from healthcare. How can attendance be improved?

One intervention could focus on timing. A further study from David, carried out with the University of York and London School of Economics and Political Science, examined the impact of moving appointments in a community mental health clinic to later in the week – which, they found, increased attendance by 10% over the course of a year.

One in five patients requires community care after a hospital stay, particularly older, vulnerable individuals. The NHS funds a six-week Discharge to Assess period for these patients, facilitating assessments for long-term social care needs. However, many face hospital discharge delays due to a lack of downstream service capacity.

To determine the necessary provision within this six-week window and prevent patients from being stranded in hospitals, Dr Zehra Onen Dumlu and Professor Christos Vasilakis worked with the University of Exeter and the NHS to develop the Improving Patient flow between Acute, Community and Social Care (IPACS) simulation tool.

This models how capacity constraints can impact the flow of patients between care settings and how much capacity is needed for a particular timeframe, and can handle different ‘what if’ scenarios to look at the impact of factors such as demand and length of stay.

Read more about IPACS.

In theory, the UK’s National Health Service offers all residents equal access to healthcare. But is that true in practice?

Professor David Ellis, along with researchers from the University of Glasgow, University of Aberdeen and Public Health Scotland compared data from 80 GP practices in socioeconomically deprived areas with 70 practices in more affluent areas.

While they found that patients in more deprived areas had slightly more individual instances of contact with their GP, they actually had slightly less total contact time.

Once those with multiple long-term health conditions were taken into consideration, the differences widened significantly to an average of 14% more contact time for those in less-deprived areas – suggesting a need for a redistribution of resources.

How can you set out an effective strategy for healthcare provision if you don’t have a solid grasp of the needs of your local population?

Professor Christos Vasilakis and Dr Zehra Onen Dumlu are working with NHS Bristol, North Somerset and South Gloucestershire Integrated Care Board to create a tool to model the characteristics of the area’s 750,000-plus adult residents.

The tool groups people into five distinct core segments according to their current health conditions. A mathematical model then takes yearly steps into the future to estimate how many people will be in each segment and the related costs. As a result, it will enable policymakers to make informed predictions and allocate spending appropriately.

Read more about the model.

The number of new cases of cancer worldwide is expected to increase to more than 23 million by 2030, so it’s more important than ever to have efficient scheduling tools for the complex process of chemotherapy delivery.

Dr Melih Celik and colleagues from TED University in Turkey and Wayne State University in the United States carried out a study into the actual infusion times for more than 200 chemotherapy patients, comparing these to the estimates used when setting the appointments.

What they found was that the durations of shorter infusions tended to be underestimated, and longer ones overestimated. They used these findings to build a predictive model that can reduce patient waiting times by 80% and nurse overtime by over 30%.

During the Covid-19 pandemic, healthcare workers had to make difficult decisions about which patients to admit to intensive care units as hospitals were squeezed to breaking point.

Professor Christos Vasilakis worked with local hospitals to develop a simulation model to identify key factors that would reduce deaths due to lack of ICU capacity.

The team found practical interventions such as reducing the length of patients’ stay in the unit by 25% could reduce these deaths by as much as 75% – and were also able to use the model to indicate how much the ICU’s capacity should ideally be increased by. The tool was shared for free with healthcare providers across the country.

Ideally, under the NHS’ Talking Therapies programme, people with common mental health conditions are offered ‘stepped care’ – where treatments escalate in intensity as is clinically appropriate. But does this always happen in reality?

Working with local healthcare technology company Mayden and using process mining to analyse and visualise information from anonymised individual patient referral records from two sites spanning two years, Professor Christos Vasilakis and research assistant Lizzie Yardley modelled patient flow through the programme.

Overall, they found that less than 5% of referrals actually experienced stepped care. Taking this bigger-picture approach also enables bottlenecks in the system to be identified and hopefully addressed, such as longer waiting times for those who ended up discharged from the programme rather than commencing treatment.