by James Barlow  

We know that health services need a shake-up. How else can we meet ever increasing demand while holding down costs and improving quality and productivity? But shake-ups, involving novel combinations of technology, services and infrastructure, can do a lot of damage – and still fail to achieve their goals.

Pilots can help but may not reflect the resource-constrained realities of mainstream roll-out. We need better ways to link up the context, process, costs and outcomes of potential innovations at different system levels.

Simulation models can do just this, allowing experimentation with different courses of action in a safe, quick and cheap way. They often temper perspectives that tend to over-estimate the reliability of prediction and bring uncertainty out in the open.

Such models for healthcare planning have been developed since the 1960s, improving communication between diverse stakeholders by creating a shared representation of the whole system. Latterly, powerful computers plus improved graphics and animation have helped, increasing both the potential and accessibility of models. Yet, despite success stories and academic endorsement, the technique has yet to catch on with many clinicians, health managers and policy-makers.

What’s the hold-up? As in many fields that require the adoption of sophisticated communications technology, it’s the ‘Steve Jobs’ problem. Simulation modelling needs to be a lot easier for the non-technically minded, so it feels like a dream, not a scary nightmare. In short, models and their results should be accessible to stakeholders with no or limited experience of modelling.

The pressure is mounting for this development. There is an increasing push on academia, the health services and the health care consultancy industry to ensure that appropriate analytical tools are created, driven partly by the new Cumberland Initiative (www.cumberland-initiative.org). But policy makers, though accustomed to simulation modelling at a Whitehall level, have yet to recognise fully its potential more locally.

We need all these sectors to back a step-change in presentation and usability now if simulation modelling is to become truly embedded in healthcare decision-making at all levels. Sadly, we can’t recruit into healthcare planning the current generation of 10 year olds who would probably find all of this technology more intuitive and easier to use than do their parents. We also cannot afford to delay important changes in service delivery until those 10 year olds find themselves running the NHS.

James Barlow is Professor of Technology and Innovation Management at Imperial College London. He is a co-investigator with PIRU and Co-Director of the Health and Care Infrastructure Research and Innovation Centre.