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CORU article highlights challenges in implementing modelling toolkits

22 October 2012

CORU’s work on the NIHR funded project “Developing evidence based and acceptable stepped care systems in mental health care: an operational research project” has highlighted some of the challenges in implementing modelling software and distributing it effectively to healthcare managers. Our work on this has just been published in the Journal of Operational Research.

As part of a multidisciplinary team, CORU developed a modelling toolkit accompanied by a comprehensive manual to assist managers and service leaders for introducing stepped care systems to local mental health services in the UK. The toolkit was used in, and calibrated for, four pilot sites that were in the process of introducing their own implementations of stepped care system design.

Two analytical models were developed and coded as part of the toolkit to provide insights concerning workload, patient throughput, and changes in waiting times and waiting list size. An interface was built to allow users to specify their own stepped care system and input their own estimates of service demands and capacities at different steps.

The toolkit and an accompanying manual were distributed across various additional NHS primary care sites in England and the use of the toolkit was investigated using qualitative methods. As was intended in the overall design of the entire study, these additional sites received very little support apart from the manual and an installation CD-ROM with the tool.

The qualitative data revealed a number of factors that were involved in limiting the use of the tool and manual including change and the pace and timing of change (such as the almost concurrent implementation of a relevant new national programme), technical and personal factors. The non-pilot sites by and large missed out on the learning opportunity arising from the modelling process itself and insights that could be generated through better use of the toolkit.

The article concludes that additional training, technical support and perhaps some consultancy work would most likely need to be made available to new users to increase chances of frequent and effective use of the toolkit. Despite the challenges and limitations, the use of modelling to inform the design of new service configurations is an important step in the right direction.