Design of Orthopaedic surgery SErvices (DOSE)

Lead Research Organisation: Imperial College London
Department Name: Dept of Mechanical Engineering


The NHS is facing an unprecedented level of future pressure due to impending challenges driven by an ageing population, increase in long-term conditions, and rising costs and public expectations. In particular, rising health care demand, rising costs and flat real funding mean that the NHS could face an estimated £30 billion financial shortfall by 2021. If these challenges are not addressed there is a risk that many service providers may become financially unsustainable, and the safety and quality of patient care decline. In response Monitor (the regulator of NHS Foundation Trusts) working with NHS England, the NHS Trust Development Authority and the Local Government Association has instituted a new five year joint planning regime. The intention of this regime is to focus on the robustness of Foundation Trusts' strategies to deliver high quality patient care on a sustainable basis. Foundation Trusts will have to present five year financial projections, develop realistic transformational schemes and align their plans with those of other actors within the Local Health Economy (LHE). Planning on a five year basis and in conjunction with other healthcare providers is a new discipline and differs distinctly from the approach taken nationally to planning during the regime of Foundation Trusts (since 2004) when a more market oriented focus has dominated. Against this complex background, and as part of the new five year planning regime one of the areas that UK Trusts plan to review is elective care, which mainly involves planned surgery. This project aims to develop ideas for service innovation in the orthopaedic surgery domain using a design-engineering led approach. This approach enhances design thinking through the use of system thinking, human factors and engineering analysis. This research will develop and evaluate a patient-centric and system-wide solution for sustainable delivery of surgery services.

Planned Impact

The aim of the proposed research project is to develop design-engineering led and system-wide innovations for orthopaedic surgery services and to establish an evidence base to design healthcare surgery services that maximise the clinical benefit for patients.

The project will benefit the following entities: 1) the healthcare sector; 2) the regulatory authorities; 3) the local government; and 4) the whole society.

We shall support pathways to impact of four types: (i) working closely with the Imperial College Healthcare NHS Trust and the Cambridge University Hospitals NHS Foundation Trust; (ii) producing top-quality academic publications; (iii) organising dissemination events at Imperial College London, Addenbrooke's Hospital and Charing Cross Hospital involving presentation of posters, models, prototypes and videos; (iv) launching a project website; and 5) attending events organised by Technology Strategy Board and Arthritis Research UK.

The involvement of key players in the healthcare sector (i.e. Imperial College Healthcare NHS Trust and the Cambridge University Hospitals NHS Foundation Trust) as well as of the academics in the advisory board will support dissemination of the project outcomes to practitioners and prompt feedback to guarantee the viability and robustness of the proposed service innovations.


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Description We have identified two types of collaboration models for the delivery of orthopaedic surgery services in the East Anglia local heath economy: the elective treatment centre (ETC), and the network of units (NU).

In the ETC, based on the South West London Elective Orthopaedic Centre (SWLEOC) in Epsom, all joint replacements and revisions are referred to the centre after initial assessment in the partner hospital, while day cases are kept on site by the partner hospitals. Patients are added onto the ETC's waiting list, and surgeons, while still employed by their respective hospitals, travel to the centre for their elective cases and then look after the patient back in their local base. This ensures that skills are sent back into all the hospitals and that training remains adequate, as surgeons bring in junior doctors with them for the elective work.

The NU consists of a strongly integrated and regulated network of hospital units, which can together deliver the whole range of elective orthopaedic surgery services, while being organised in a manner conducive to maximising resources and ensuring minimum numbers for each type of operation. For this model, all operations are conducted in the existing hospitals, each with the opportunity to become a hub for one or several sub specialties. The vast majority of operations are hip and knee, and therefore every hospital can reach critical mass for those and is able to perform them together with simple hip and knee revisions. More specialist and complex revisions and operations take place in specialist hubs, which can have trained staff and equipment available for this type of operation, enabling a cost reduction by avoiding duplication of these services.

We have also proposed a methodology to configure networked surgery services for a local health economy.
Exploitation Route The findings might be taken forward by NHS Trusts in East Anglia by developing a plan to implement networked orthopaedic surgery services. The two proposals will be considered as part of the elective care work stream of the Sustainability and Transformation Plan.
Sectors Healthcare

Description The findings have been used to: - support an application to the NHS New Care Models Programme by Peterborough and Stamford Hospitals NHS Foundation Trust, Hinchingbrooke Health Care NHS Trust, Cambridgeshire and Peterborough NHS Foundation Trust, Papworth Hospital NHS Foundation Trust, Cambridgeshire Community Services NHS Trust and Cambridge University Hospitals NHS Foundation Trust. - support proposals for the system-wide Sustainability and Transformation Plan - inform consultants in East Anglia about current issues in the delivery of orthopaedic surgery services and solutions to address them. - inform the development of a plan to implement networked orthopaedic surgery services.
First Year Of Impact 2015
Sector Healthcare
Impact Types Policy & public services