Stress testing a new Community Diagnostic Centre with simulation modellingTesting planning assumptions and identifying optimal ways of working for Norfolk and Norwich University Hospitals NHS Foundation Trust

NNUH was already working closely with Siemens Healthineers in the form of a pre-existing Value Partnership - a long-term, performance-oriented collaboration supporting its ambitious expansion plans, and enabling improved access to innovative cancer treatment and imaging.

Using existing healthcare consulting days allocated within the Value Partnership, the Siemens Healthineers consulting team mapped patient flows supporting workflows, stress testing these against planned activity trajectories for each modality, and then co-designed mitigations for any bottlenecks, resource assumptions or operational processes that could constrain the CDC’s imaging capacity. This utilised:

• Input from key stakeholders and clinicians on patient flows and current ways of working 
• Data on the planned CDC operating model, opening hours, equipment numbers, floor plans, staff roles and responsibilities and WTE figures
• Forecast activity trajectories and waiting list figures for each modality

Using this, Siemens Healthineers Consulting created a simulation model, establishing a digital twin of each CDC modality. The simulation enabled clinical leads to run multiple scenarios to identify optimal ways of working that were used to inform patient flow, staffing model and scanner booking slots. Insights from the simulation modelling included:

• A definition of CDC maximum capacity for year 1, 2 & 3 aligned to a workforce recruitment trajectory
• A detailed report outlining the optimal operating model for each modality, including booking slots, and patient arrival frequencies, to meet business case assumptions
• The identification of potential bottlenecks, with mitigations through changes to workforce, patient flow and operational processes

The development of simulation models allowed NNUH to stress test different operational scenarios with small investment, surfacing insights and recommendations to optimise the service model to help the new CDC meet target patient volumes and ensure optimal flow.

The simulation modelling provided NNUH with a patient-centric visualisation of clinical processes and workflows, and transparency on resource allocation, capacity and utilisation. By comparing baseline and simulated outcomes with metrics such as patient throughput, patient waiting time and resource utilisation, the project identified opportunities to improve patient flow and resource utilisation. Insights and recommendations included:

• How to mitigate an image acquisition utilisation spike using Radiology Department Assistants (RDAs) roles and/or volunteers
• The variation of an RDA staffing model to cross-cover X-ray and ultrasound, where possible
• The definition of modality appointment and staggered arrival times to inform booking templates and avoid over-crowding
• Testing the skill mix of the CDC workforce recruitment trajectory to improve productivity and retention

Seshni Mohammed, Radiology Service Operations Manager at Norfolk and Norwich University Hospitals NHS Foundation Trust, says: “The Siemens Healthineers team worked with our service and modality leads to stress test CDC patient flow, workforce and equipment assumptions and helped identify potential flow optimisation opportunities that we were then able to consider before and during go-live.

“The simulation modelling approach provided a robust external assessment of our planning assumptions and gave us confidence we had made the right planning decisions and assumptions.”