Optimising complex care pathways for inflammatory rheumatic disease using a practical simulation tool Norfolk and Norwich University Hospitals NHS Foundation Trust

Musculoskeletal conditions affect one in four adults in the UK. However, there is considerable variation in the management of, and outcomes for, people with these conditions, and understanding of how best to improve quality of care is complex.

This project involved extending and refining an existing national level model of rheumatoid arthritis and ankylosing spondylitis for use within Norfolk and Norwich University Hospitals NHS Foundation Trust. The tool utilises ‘agent-based simulation’ – computer models that simulate a whole system by capturing the behaviour of individuals and the way in which they interact.

Working with managers and analysts at the Trust, the project team reviewed how the simulation modelled each patient’s disease progression and developed the model to work with the target systems, structures and patient journey.  

One of the key strengths of this modelling approach is that it enables the whole system to be modelled, and so links economic decisions and patient outcomes. However, the organisation of the Trust reflects the traditional split; with staff administration and organisation being the remit of managers, and patient health being the remit of clinicians. Managers fed back that they were not convinced of the value of this more complicated approach and preferred simpler capacity and demand models.

The project team believe the model can be used to support dialogue between departments, reduce silo thinking and improve understanding of how decisions affect other seemingly unrelated areas.

Developing an existing model proved more time consuming than anticipated and demonstrated that there are advantages and disadvantages of developing an existing model as opposed to building a new model from scratch.

The team will host demonstration and engagement sessions with interested partners in the future and an academic paper on the work will be developed.

Contact information

For more information about this project, please contact Professor Alexander MacGregor, Consultant Rheumatologist Epidemiologist, Norfolk and Norwich University Hospitals NHS Foundation Trust.