‰ÛÏWargame‰Û identifies key barriers to wider uptake of IR

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Results from a simulation role play inviting two hospital trusts to overcome the barriers to wider adoption of interventional radiology have just been made available to NHS Trusts as a tool to assist in managing change. This “wargame” was held at the NHS Healthcare Innovation Expo in London, UK, earlier this year. Interventional radiology was chosen for the game because of its enormous potential to provide minimally invasive treatment, yet limited adoption to date within the NHS. The simulation was commissioned by the Department of Health.

The background for the wargame was that provision of interventional radiology (IR) services is patchy across the UK, particularly for emergency work out of hours. This wargame aimed to find innovative solutions to surmount the barriers limiting adoption of interventional radiology services within NHS hospital trusts.


“The format of the game consisted of two similarly sized and provisioned, ‘rival’ acute hospital trusts, bidding to become the provider of services for a regional vascular centre with interventional radiology as a key element. Each team had to consider how they would provide interventional radiology services in a robust, resilient and sustainable fashion,” said David Kessel, author of the book, Interventional Radiology: A Survival Guide, and the IR lead for the wargame.


He told Interventional News the key messages that emerged were, “Recognition of the increasing importance of elective and emergency interventional radiology across a vast range of hospital services; acknowledgement that there is insufficient provision of interventional radiology, especially out of hours; recognition that there should be an obligation for every trust to describe how they will contract and provide interventional radiology services and ensure that this occurs; agreement that solutions must involve cooperation amongst providers and training to increase the numbers of interventional radiologists.”


One interesting finding from the wargame, Kessel noted, was the confirmation that decisions regarding the provision of healthcare do not always have the patient’s best interests at heart and tend to be driven by self-interest of individuals and institutions.

In fact, a report released by simulstrat, the company that ran the wargame, said that in a longer version of the game, the teams would have been forced to confront and overcome turf wars, which was chosen by most individuals as the key barrier to adoption of interventional radiology services. The report also finds that there was a significant gap in awareness about the benefits and potential of interventional radiology within the NHS, and in patients. A high profile communication campaign is required to overcome this barrier, suggested participants.


Another factor that emerged was that “there was a failure to grasp the interventional radiology is a ‘small specialty’ that is to say that the acute hospitals would both have insufficient elective work to justify employing the number of doctors required to provide round-the-clock care,” said Kessel.


“There is a recognition that patients want as much healthcare as possible to be provided locally whilst wanting high quality care around the clock. This is a conundrum which can readily be solved by taking a patient-centred big picture view. There is a need for cross provider collaboration and cooperation. Clearly there is potential for outpatient, imaging and minor therapy to be provided in almost any hospital. Conversely, 24/7 specialist services cannot be sustained everywhere. This is not new or unusual and patients would expect to travel for cardiac and neurosurgery. In addition there is evidence that outcomes are improved in high throughput centres.


“The political challenge will be to convey to the public that their care and the service will be improved, but they will have to travel for some aspects of treatment. For this to occur we need a new mindset which extends beyond individual trusts and considers provision of service for small specialties across regions. Options will include centralisation of services with hub and spoke arrangements, centralisation of the acute aspect of service and networking across several sites,” he said.


“It was striking that the teams became truly immersed in the game play, and immediately developed allegiances to their hypothetical trust. This led to the teams becoming more concerned with winning rather than stopping to consider what might be best for patients and how to cooperate to ensure this! This parochial tendency tended to overwhelm attempts to find radical and fresh perspectives on how to solve an important healthcare issue. In this way, the game mirrored how healthcare provision has evolved in recent years,” he noted.

This game also showed that international radiology services might benefit from collaboration rather than competition between foundation trusts, said the simulstrat report. Wargames can help the NHS explore situations where collaboration as opposed to competition might provide the optimum mechanism for innovation, it noted.


“There was agreement that the wargame, conducted by the company, simulstrat, was a useful format, especially as there was representation from many bodies. To explore the full potential would require more time, more sophisticated rules of engagement and also input from politicians, primary care trusts, the Department of Health and all other stakeholders,” said Kessel.


Barriers


The wargame showed that there is general consensus on the key barriers to more rapid expansion

of IR:

1. Cultural and hierarchical divisions (turf wars)

2. Poor out of hours IR provision

3. Lack of clear patient pathways

4. Inadequate tariffs

5. Lack of infrastructure for IR

6. Lack of awareness of IR services

7. Lack of incentives to provide IR services

 

Innovative solutions


1. Publicity campaign to communicate benefits of IR to patients, commissioning bodies and clinicians

2. Creating an internal tariff system to incentivise and reward adoption of IR

3. Integrated patient pathways

4. Collaborative training programmes and use of simulators for training

5. Retraining existing radiologists and clinicians on simulators

6. Mobile angiography units

7. Tele-radiology

8. Network approach to staff and service provisions

9. Introducing new roles such as “Nurse sedation”


Source: simulstrat report

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