FLEXIBLE ESTATE
Figure 3: Two cycles of development to illustrate the form of Agile applied to the drive-through clinic.
phases, and taken measurements of the cycle time through each.
Well-worn engineering practices This process wasn’t an accident, but followed well-worn engineering practices that rely on iteration and prototypes. Try something simple and see how it works and where it fails; then try something more complicated. Ironically, the pace of the pandemic provided an evolving rationale for trials lasting a few months at a time before stepping up to the next level. There is also an information story. As
we look back on the pandemic, we can see that some people did well under lockdown, and some were devastated. Many aspects of care went on hold, or were disrupted or delayed, while almost everyone – from pre-school toddlers to university students – has lost a year or two of their education that they will struggle fully to recover. Meanwhile, knowledge workers traded their appalling commutes for online connectivity. A large fraction of them drove the networks and logistics that surged under lockdown and kept the rest of us fed and supplied so well. Business boomed for them, their smart algorithms and tracking systems
guaranteeing the success of grocers and retailers who leaped online.
Exploiting ‘smart information’ The drive-through clinic, too, exploited smart information. In the pilots, the team was able to take referrals directly from GPs and refer patients back, but they created the same connectivity to and from A&E – and there are not many networks in the NHS that communicate freely with both hospitals and GPs. The information narrative is less visible than a service that migrated from canvas and portacabins to a warehouse, but it is at least as important, and so we will have to track those developments down.
‘‘ 24 Health Estate Journal April 2022
Many aspects of care went on hold, or were disrupted or delayed, while almost everyone has lost a year or two of their education that they will struggle fully to recover
Complexity can be managed if you model it first Most invisible of all is the modelling story. Manufacturing industries build computer models of big systems before they commission them. In cases where there is hazard, or where the cost of failure is high – chemical plants or refineries, for instance – such models are developed alongside the installation, and used for day-to-day management of the business. Indeed, the concept of a ‘digital twin’ has re-emerged recently to describe a test bed that mimics the real system, but where one can explore the impact of operational decisions without the risk of physical danger or going bankrupt. Even the simplest of models can be used to help stakeholders develop their ideas or to communicate how something works to customers. Figure 2 shows a scale model using little more than toys and ‘Post-Its’. In a similar way, models were built to
predict demand in the form of the number of patients likely to need treatment in the pandemic.
Simulating clinics in operation Other models were built to simulate the clinics in operation, and even to see how they might perform in another role – as vaccination centres, for instance. Not all
Figure 4: Before (left) and after (right) – the deployment of a rapid assessment centre in an NEC car park.
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