The design and construction of a decision-support system for planning local hospital services
This research addressed a major and widespread problem in the NHS: information for operational planning. The approach has been to analyse the needs of management in this field in a particular health district and to develop a system in response to these needs of use in the particular District and generally in the NHS. The emphasis had been on the identification and quantification of relationships between elements of the District important to corporate planning, so that the feasibility and effects of planning choices can be assessed. Particular attention has been paid to the attitudes, values and concerns of senior managers and doctors in the NHS throughout the project. Research began in October 1979 on the development of a database and model of the former North East District of KCWAHA. This health district contained a large undergraduate teaching hospital (The Middlesex), two large psychiatric hospitals, and several smaller specialist hospitals. The purpose of the decision-support system is to enable management to explore rapidly the implications of operational planning optlons over several years. It does not recommend which option should be followed. Plans are tested in terms of the bed capacity of general wards and specialist units. The revenue costs of an option are estimated using a detailed analysis of which types of change cause which types of cost to vary within the District. The model then assesses the non-financial consequences for the operating theatres and service departments, and the effects on nurse training. The research has shown that it is feasible to build and maintain such a model and database with very limited clerical support. The output from the system has been found useful by management. This development has generated considerable support for further research. The assumptions of the model and the procedures for updating the database are fully documented. Procedures for implementing the system in another health district are also available. The model runs on the computer at Imperial College, University of London. The research programme continues with the extension of the model to cover the whole of the new Bloomsbury District (including University College Hospital), where the use of the system has had a substantial impact on decisionmaking at the most senior level.