How to use the SIMTEGR8 approach

You may wish to use the SIMTEGR8 approach to analyse a healthcare pathway with the view to helping providers deliver a patient-centered, efficient, high-quality service, and here are the steps to follow together with some useful tips on each step.

Stage 1 - Project Briefing
The first step is project briefing. Our top tips for this step concern:
  • Participants:  This is the perfect opportunity to discuss with the project leads about workshops participants. The service practitioners group should be made up of a range of stakeholders. Invite CCG commissioners, clinical leads and representatives of hospital trusts, social services and physiotherapy teams. Eight or Nine participants should be sufficient.
  • Project Champion:  Ask the project leads to appoint one person within the intervention who will ensure everyone involved is on board and behind the success of the project.
Stage 2 - Conceptual Modelling Workshop

The next step is the conceptual model workshop where you carry out a workshop to discuss planned pathway of each intervention and reflect on its efficiency. The discussion in this workshop revolves around the aims of the evaluation, the patient pathway, the effectiveness of the service and the performance measures.

The Conceptual Model workshop is in many ways the most important step of the SIMTEGR8 methodology.

To make sure that your workshop is successful:
  • Appoint a facilitator: You might use only a simulation consultant, but we found it was useful to also have someone to focus on leading the discussion.
  • Appoint a note-taker: This person role is to ensure nothing important is missed during the course of the discussion.
  • Give thought to timing: The workshop should be long enough to encourage meaningful discussion but not so long as to invite a loss of focus among participants. Between two-and-a-half and three hours is about right.
To make sure that you will get the process right, our top tips are:
  • Let them draw the process map. Ask participants to use post-it notes and prompt them to stick them on a whiteboard in the right sequence. This may require a number of iterations before an accommodation of views is reached as to how the process of the service should be delivered.
  • Get the Purpose of the Evaluation Right: After having built the process map, re-consider their aims and decide which can and cannot be evaluated by this study. Consider, too, whether the process map is relevant to their aims.
Stage 3 - Simulation Model Development

Having developed the conceptual model, it is now time to move into building the model. In this step, you have to change the Conceptual Model into the Computer Model.

Our key tips on how to build a simulation model for a workshop are:
  • Work closely with the Project lead and analysts: Generally speaking, data collection is best achieved by working with the relevant local authorities and staff throughout the modelling process. Thus, it is essential to consider who might be ideally placed to provide information about each component of the overall patient pathway. Your local authority systems analyst and the project lead for the service you are analysing should be able to help you at this stage. After collecting data, it is usually necessary to transform these into model’s inputs. This analysis can be very useful and insightful for the stakeholders. So, do aim to meet with the project lead of the service to talk them through your data analysis  and show them the model a few weeks before the date of the workshop. This will allow you enough time to revise the model following the discussion at the meeting and to run the workshop smoothly. Otherwise, it will be very challenging to do this during the 3-hour workshop.
  • Don’t be driven by data availability: We found that it was not a simple matter to collect data for two main reasons. First, relevant data may not be available at the time of the evaluation. Second, getting the required information may require to contact a number of services within the patient pathway, and consequently it can be a very time-consuming process. But remember that you should collect the “right” data and not the data currently available in order to build a model relevant to the problem. When making the decision of what to include it is important to understand what elements are having an effect on the system and of these which are important to the problem at hand. Do suggest/ask for assumptions, estimations and simplifications.
  • Keep it simple but focus on presentation
    The model for all four interventions were by no means detailed or perfect, but it did not need to be. Remember that each model is a simplification of the real system, which is why such simulations need only be sufficiently accurate to demonstrate the basic process at work. But as we said before you have only one chance to gather people in the same room and perform this evaluation in a 3-hour workshop so you have to think through how to present in a nice and concise way the model pathway, bottlenecks and system performance. To achieve this, we suggest you create customised graphics to describe the activities, add buttons onscreen linked to settings, key performance indicators and other model elements that will help you present the pathway and the system performance with great accuracy and very quickly. In SIMUL8 software, this is related to adding onscreen customizable buttons, creating dialogs and use Visual Logic commands that give you total control over the visual display of your simulation.
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Stage 4 - Project Leads Workshop

The next step is to carry out a workshop with Project Leads using the model to facilitate discussion on the intervention and how it can be improved.

TO MAKE SURE THAT YOU WILL have a meaningful discussion on ways of service improvement, OUR TOP TIPS ARE:
  • Predefine “what-if” scenarios and the levels of each change. Do meet with the projects leads to ask them what scenarios, what changes, they think that they will have a positive impact on the service performance. Based on project’s leads input, you could then add a button on screen called “Scenarios” linked to some customised dialogs you will have created that will enable you to make the necessary model changes directly and very quickly. In this way, you could run the model with new settings to get the results of different scenarios during the workshop and help stakeholders identify and discuss the issues and possible actions revealed by the simulation.
  • Go beyond the model.  As these models are only a simplification of the real system and therefore all models are wrong, you should not aim to restrict the discussion only on the results of the model and the predefined scenarios. The idea is to use the model as a means for debating and developing a shared understanding of the problem understanding as well as the ways of resolving this issues. Very often, the participants of the workshops have generated insights about system’s performance and consider ideas for improvement that they would have considered before the workshops.
Some other useful tips are:
  • Invite the same people who attended the first workshop.
  • Start with summarising the aim of the evaluation
  • Present the process map to introduce participants to the concept of simulation modelling and to confirm the maps’ accuracy.
  • Run the approximate dynamic simulation to demonstrate the agreed process.
  • Invite the project lead to present the model to the other participants
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Stage 5 - Service Users Workshop

The last step of our approach is to carry out a workshop with the service users (patients or carers) using a user mode model to facilitate discussion on how the service can be improved.

Our top tips on how to build a user mode model are:
  • One patient per run: Make the necessary model coding changes so that the model looks even simpler and only one patient enters the model per simulation run. This will help you to focus on each patient story per time.
  • Add text on screen to describe patient journey: Ask the project leads to provide you with some patients case studies. Based on these stories, you can write some text to appear on the screen to communicate the patient journey within the service while the model is running.
See the model here
Some general tips on how to run the workshop smoothly are:
  • Avoid using Acronyms: Acronyms should not be used as they may cause some confusion amongst the participants.
  • Staff members: The presence of the staff members helped the smooth progression of the workshop. This was mainly because the participants were familiar with those staff members and a positive rapport had been already established.
  • Participants: A good mix of participants with different experiences with the service stimulates a good discussion.
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