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US experts trial airline systems in hospital revolution

AMERICAN experts are to lead a revolution in Scotland's health service by applying lessons learned from managing airline passengers and supermarket customers to hospitals in a bid to ease pressure on the over-worked system.

Ministers are just weeks away from launching a £4.5 million pilot scheme with the Boston-based Institute of Healthcare Optimisation (ICO), which has been credited with masterminding radical improvements at hospitals in the US and Canada.

The institute's analysts will work alongside NHS Scotland staff, collect-ing and analysing data using complex mathematical models before applying a "queueing theory" to healthcare.

Professor Jason Leitch, clinical director of NHS Scotland, described the system as a "fairly radical redesign" of the way doctors have worked over the past six decades.

The project, which will initially be introduced at NHS Forth Valley, aims to lessen peaks and troughs in patient demand which can leave hospitals too quiet at some periods and struggling to cope at others.

It will be based on the US analysts' knowledge of the experiences of airports and supermarkets, which cope with frequent spikes and dips in demand.

Under the proposals, consultants will be asked to spread different aspects of their case loads throughout the week. Currently they can be left to solely run clinics on one day and carry out opera-tions on others, causing other parts of hospitals to become log-jammed.

It is hoped the model will improve the flow of patients through hospitals from admission to discharge and lead to a substantial reduction in the practice of "boarding". This is when patients are treated in beds in inappropriate parts of hospitals because of a lack of space.

The model will seek to bring in separate teams for emergency patients and those with scheduled appointments. Professor Leitch said it could also cut the length of patients' stays in hospital and see fewer operations cancelled.

He added: "We know God will break hips and crash cars. The variation in unscheduled, emergency care is quite small and we can predict it.

"When humans get involved, with scheduled care, the variations are much bigger by the day. You get a busy Monday and a quiet Tuesday. If you do all your operations on Friday, Saturday is busy as all the beds are full.

"If you divide work over the whole week, and maybe move to seven-day working, you smooth it out. There are differences in our system and this isn't simple. But I have seen this work. We are not suggesting we do it without care and compassion, but why not try to learn from people who run airports if we can apply the same methods?"

After Forth Valley, the system is to be introduced at Scotland's biggest health board, NHS Greater Glasgow and Clyde, Tayside and the Borders. It may be rolled out across Scotland if successful.

The system resulted in surgery waiting times at a hospital in Cincinnati in the US falling by more than 25% on weekdays and one-third at weekends, despite a rise in cases. The hospital cancelled a planned £60m extension as a result. The system was also a success in Florida, Boston, South Carolina, Maryland and Ontario, Canada.

Another, gentler method of managing hospitals, which has already been used in England, will mean more resources and services are available during evenings rather than mornings. The testing of how these small changes impact on the service will be trialled in NHS Lanarkshire.

The overhaul is likely to lead to a redesign of doctors' job plans, but the Scottish Government anticipates that the trials will attract broad support.

Dr Dan Beckett, a consultant physician at NHS Forth Valley who will be national clinical lead for the project, described the work as "a genuinely exciting opportunity" to work with experts redesigning hospital systems.

He said: "It has the potential to transform hospital healthcare over the next three years, if it works as we hope it will. This is a radical shake-up about trying to reduce queues. If you're in Tesco and there's more than two people in a queue you get a bing bong and two more people appear, and the queues get shorter. It's using that kind of modelling in hospitals."

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