Archive for the ‘Case Study’ Category

Case Study: Optimisation Day Surgery Services

Posted on: November 6th, 2017 by matthew_bacon

Earlier this summer The Conclude Consultancy (TCC) completed an analysis of Day Surgery facilities in the northern region of Gothenburg, Sweden. This is now published as a Case Study. This project was typical of many that we work on, where the client wished to understand how clinical service delivery could be optimised to improve both the patient experience as well as improving the efficiency of patient flow through the surgery facilities.

In an ideal world day surgery should be a predictable and systematic process, but it must also recognise that patients come to day surgery with significantly varying needs – both from clinical wellbeing as well as emotional wellbeing perspectives. Whilst this means that the process must accommodate many variables it does not follow that it cannot be effectively managed.

On this project, TCC used their unique patient pathway method, which is one that recognises that different patients can be categorised as ‘patient types’, and as such their specific resource needs can be identified and planned for. An elderly patient with specific emotional wellbeing needs for example, should be managed differently to a younger adult patient who’s clinical and emotional needs maybe quite different. The clinical leadership team originally argued that the process was wholly unpredictable, but in analysis of the patient pathway data, TCC found that patient types could be allocated to procedure time bands, and within these time bands there was substantial predictability.

However, TCC identified that there were still significant outliers in the process where, for example,  patients displaying multiple morbidities necessitated greater complexity that often resulted in significantly longer duration in theatre, which could result in hours of delays.   Contrasting with a typical time band for the same procedure type this might only require around 90 minutes for example.  Working with the clinical leadership team we identified that these outliers could potentially be reduced by instigating an improved pre-operative assessment process, and that through this process patients displaying multiple morbidity, or other complicating factors would be treated on an inpatient pathway for surgery and not a day surgery pathway.  By this means it was determined that the incidence of significant outliers should be substantially reduce. Operational trials would seek to quantify this potential benefit.

Optimisation of Day Surgery thus analysed the whole process and sought to develop strategies with the clinical leadership team that would ensure improved predictability of it.  Simulation of alternative strategies enables the leadership team to understand ’cause and effect’ and in doing so develop new strategies focused on improving patient flow. Ultimately, it is the clinical leadership team to decide which strategies provide the best overall patient experience – TCC simply provides the data and analysis to support informed decision-making. The Case Study examines these issues.

Decentralisation of clinical services

Posted on: March 20th, 2014 by matthew_bacon

Whilst the concept of the decentralisation of health care services (and by this we mean the relocation of centralised clinical services into the community) is not new, there appears to be a dirth of data to support an informed debate as to the merits of it.  A report in 2011 titled: ‘Getting out of Hospital‘, published by the Health Foundation(1), summarised their analysis of decentralisation in these terms:

“The conclusions are appropriately cautious, however. The majority of the published evidence fails to contain robust cost information on infrastructure, planning and start-up costs. Furthermore, much of the evidence is based on small, highly [patient] selective pilots making it difficult to make system-wide generalisations for a broader range of patients.”

The authors make the following recommendations:

“Developing a consistent framework for research and analysis, identifying key factors that can be monitored and evaluated across interventions and settings, would help to inform commissioning decisions. A consistent analytical framework for summarising information would support the collection of comparable information that could show how to successfully implement systemic and strategic changes to service provision. “

Establishing a framework for research and analysis is where The Conclude Consultancy has focused its efforts in the mid-term evaluation for a Community Eye Centres (CEC) contract in Leeds. Conclude were appointed to analyse the Approved Quality Provider (AQP) contract from the perspective of the ‘Triple Bottom Line’ (2) – a means for evaluating not just the economic impacts, but the social and environmental impacts too. To establish the foundation for an evaluation framework, The Conclude Consultancy developed a CEC Measurement Protocol that would ensure consistent processing of data and standardised norms for reporting the results.  As the primary objective for Conclude’s appointment was to study the environmental impacts of decentralisation, the measurement protocol was developed to analyse the energy and carbon impact of the CEC’s. However the work was also extended to study the impact of space and equipment utilisation, which would inform the economic impacts too.

This latter perspective highlights the need for a framework as advocated by the Health Foundation. It was clear from the analysis that the cost of decentralisation must include the less tangible costs of space and equipment utilisation, as well as other costs such as the carbon tax. This points to the need to establish the evaluation criteria in the planning of decentralisation projects, and to determine what data needs to be managed to enable a proper evaluation (using a measurement protocol) to be conducted. Conclude’s experience mirrors that of the the Health Foundation: the difficulties of obtaining robust data constrained the analysis. Yet despite this, the CEC team now understands what data it needs to manage for the remainder of the contract and how it should analyse the performance of the AQP contract from the perspective of the ‘Triple Bottom Line’.

 A Case Study for the project can be accessed here: Decentralisation of Health care services

1 See:

2 See:


OCCUPANCY ANALYTICS ™: Optimising Endoscopy

Posted on: May 13th, 2013 by matthew_bacon

The Conclude Consultancy has recently completed (April 2013) a detailed study of an Endoscopy Unit. The results provide a whole new insight into the factors that impact the variability of the patient experience in the endoscopy service.  The analsyis carried out by Conclude exposes key factors that cause poor performance in patient experience  when measured against the Global Rating Scale (  The work identifies the strategies that could be adopted by Endoscopy Units in order to improve this aspect of performance, which would directly impact patient waiting times and improve patient flow through the process.

Deatils of the Case Study can be found here: Endoscopy Unit Case Study

The OCCUPANCY ANALYTICS ™simulation model is a unique approach to service analysis where demand and capacity need to be understood, such that both can be optimised.

OCCUPANCY ANALYTICS ™: A new approach to space optimisation

Posted on: November 21st, 2012 by matthew_bacon

The Need

This NHS Trust had been considering the opportunities to rationalise its estate, and had identified two facilities that were both very old, and which required substantial back-log maintenance.  Prior to the identification of this need, The Conclude Consultancy had carried out an analysis of the candidate facility using  their uniqueOCCUPANCY ANALYTICS ™ methodology.   The purpose of the analysis was to forecast potential space under-utilisation within the candidate facility.  Our work had demonstrated the probability of available capacity at each hour of the day based on a statistical analysis of the data from our model.


The analysis of the candidate facility was based on PAS data and forecasts of growth in patient demand. Conclude, also used operational policies to study the efficiency of the clincial processes.  Working with the clinical leadership teams we studied the impacts of alternative operational policies on patient flux and from this dialogue we were able to identify the optimised process  changes that would be required within each department. From this work we produced a schedule of departments with the available capacity at each hourly period of the day.

The analysis of the existing buildings which the Trust wished to consider for redevelopment followed a similar method, but in this case we were forecasting patient demand for each service.  The challenge was to establish the best fit between the functions being provided in the candidate facility and the services to be relocated.

Our OCCUPANCY ANALYTICS ™ specialists provided the core data and this enabled a basic match to be made between the candidate facility and the services to be relocated. However, simply because there is available space within the candidate facility it obviously does not mean that it is desirable to merge the relocated service(s) into it.  Consequently, the planning specialists then assesed the functional, clinical and operational affinities between the them.  It was out of this process that we were able to obtain the best fit between available capacity and the best affinity between the functions.


The table below provides an illustration of the utilsation in terms of room availability relative to each function within the candidate facility. The hours of the day (this is an extract only) are shown across the head of the table.

OCCUPANCY ANALYTICS ™ provides a mean occupancy, as well as a forecast of probability of under-utilsaed spaces. For example: a 90 % probability that in nine days in every ten there would be at least ‘x’ unused rooms over specified hours of the day,  or alternatively a 10% probability that for one day in every ten there would be up to ‘y’ rooms available over specified hours of the day. The study investigated the potential to merge existing facilities into the candidate facility, and through the affinity analysis considered the best fit.  The study is now beeing used to inform the business case for the merging of the functions in the candidate facility.

The Conclude Consultancy has recently been appointed (November 2012) to conduct an analysis for another NHS Trust, to answer a question no doubt being asked by many Trust’s at present: What operational policy changes do we need to make in order to expand capacity of an existing service, WITHOUT having to enlarge the facility?  If we do need to enlarge the facility, how much bigger do we need to make it?  The study will recommend optimised operational policies informed by our OCCUPANCY ANALYTICS ™ studies. May 2013 update: Please refer to this Case Stydy here: occupancy-analytics-optimising-endoscopy )

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