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Sheffield Teaching Hospitals NHS Trust use WITNESS simulation software from the Lanner Group to model the Trust’s in-patient waiting lists, and secure £150,000 of additional funding


Sheffield Teaching Hospitals NHS Trust has purchased Lanner Group’s WITNESS software to model the Trust’s in-patient waiting lists. The simulation-based software has been used to analyse the impact of proposed Purchaser contract targets on the waiting time for patients needing general surgery, ophthalmology or urology operations. The findings revealed that the proposed contract targets would not have allowed the Trust to keep within the Government’s 18-month Patient Charter guarantee. Through the use of WITNESS, the hospital has been able to persuade Health Authorities to commission additional elective activity valued at approximately £150,000 and also to appreciate the inter-dependencies of the out-patient and in-patient queues.

CSUH is no different from any other NHS Trust in England in that it has to provide services to Health Authorities, which purchase these from annual budgets. The Health Authority uses these funds to purchase specific numbers of episodes from a range of the specialities. These targets are historical in nature, but are modified over time by demand assumptions. Many hospitals are unable to back up or prove the assumptions that they make about additional resource requirements. This has led to problems convincing Purchasers of the need for additional investment, whereas the ability to simulate the problem provides a more objective view of the available options.
CSUH approached Lanner Group after seeing WITNESS being used to simulate ambulance service route planning. It was looking for a method of simulating the procedures used in the hospital so that by posing ‘what if’ questions the hospital could identify any lack of resources or requirements for new equipment.

Paul Harriman, Information Development Manager at Royal Hallamshire Hospital states:

“In the past, decisions such as these have been made through intuition and experience alone. This is the first time that we have been able to simulate the hospital environment and provide ourselves and, in certain cases, the Health Authority, with valuable proof to back up our predictions, for issues such as waiting list length or facility layout changes.”

Lanner Group worked initially with CSUH using WITNESS to produce a model of the X-ray department. This model outlined the differences between the present configuration and future possibilities for the department. The Executive Director of Corporate Strategy was shown the product and was very impressed with its use and potential.

Previously, the hospital had modelled procedures and efficiencies using Excel spreadsheets. This had always been helpful to give an idea of the various options available to managers, but there was no way of actually visualising or quantifying the options.

David Jones, Lanner Group’s director of marketing, commented on the hospital’s needs: 

“WITNESS not only allows CSUH to visualise and quantify the results, but also presents a tool that can be used on an ad-hoc basis to demonstrate the implications of different business decisions. When they invested in WITNESS, CSUH acquired a tool which proved to be very versatile.”


There were initially three projects for which the hospital needed WITNESS. First, the hospital needed to model waiting lists and to identify whether contracting requirements were sufficient for each speciality, or whether there was a requirement for an increase in the activity levels to be purchased. Another project was in the radiology department assessing where additional resources and money could be used. Thirdly, WITNESS was to be used to model the new theatre facility for layout and admissions options.

Contracting requirements

Health Authorities have agreements with the Trust that waiting lists must be kept below eighteen months at all times, in line with national Patient Charter guarantees. The Trust has to ensure that the guarantee given to a Health Authority will not be breached. The prediction of the movement of in-patient queues is extremely difficult. Each queue is fed from an out-patient queue, which in turn is fed by a referral system from General Practice. Even in a single Consultants queue, there are in excess of twenty variables and modelling these is almost impossible. Multiplying this by the number of Consultants and the number of Purchasers compounds the problem.

Before using WITNESS, they had believed that the agreement would be breached at some time in the future but, because of this complexity, were unable to prove their theories. This made it difficult to persuade the Health Authorities to increase their purchasing targets. With WITNESS, through a combination of workload and waiting list pattern analysis over the previous eighteen-month period and simulating different contract targets for the three specialities under scrutiny, a final contract model was produced. The model allowed a number of these complexities to be better understood, in addition to providing quantitative information. The Trust soon realised and importantly, could now prove, that the eighteen-month waiting time would indeed be breached by the end of the financial year. This finding, along with the WITNESS model, was presented to the relevant Health Authorities so that they could understand the implications of their proposals. After a short negotiation period, the Health Authorities provided the additional funding needed in order to maintain the waiting list positions. WITNESS paid for itself many times over within the first month.

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