Service re-design in healthcare: the impact of innovative methods to compare costs and benefits

This article describes research conducted by University of Strathclyde academics that has successfully impacted upon policy implementation. Specifically, we describe the innovative application of Discrete Event Simulation (DES) in an action research framework to develop bottom-up micro costing models to determine the cost effectiveness of a radically new ‘virtual clinic’ pathway for orthopaedic trauma patients. The use of DES allowed stakeholders to compare the costs of the new approach (virtual fracture clinic) against the baseline (traditional fracture clinic) in sufficient detail. The insights generated from this research enabled health policy stakeholders to build a convincing case for the diffusion and reliable implementation of virtual pathways for orthopaedic trauma patients in other hospitals in Scotland and well beyond. Wider dissemination of this work has seen continued government funding for the use of DES for cost effectiveness studies in other healthcare settings, as well as training and capacity building in DES-supported service redesign amongst healthcare professionals throughout NHS Scotland.