isee Exchange™ Hosting Brings System Dynamics to England’s National Health Service

Peter Lacey

The National Health Service of England (NHS) is the epitome of a complex system. It employs over 1.7 million people, provides care for every legal resident of England and other United Kingdom regions (Wales, Scotland, and Northern Ireland), and trains physicians and nurses across the country. While centralized, the NHS includes 13 regions that have their own population characteristics and challenges.

Peter Lacey has been applying system dynamics to NHS projects for over thirty years, first as an NHS planner and, since 1998, as Director of Whole Systems Partnership (WSP). “We’re a strategic consultancy using system dynamics modelling to look at health care and social issues,” says Lacey. Using the isee Exchange, WSP provides clients across the NHS with easy, password-protected access to the NHS models it builds with Stella®.

“We first used the isee Exchange about six years ago when we built a collaborative simulation platform to share workforce planning models,” says Lacey. “The isee Exchange hosted the models for 13 areas, allowing people to build their own scenarios and compare these with other areas.

“With the isee Exchange, we could report 13 different outcomes at the same time using the same model. Clients could note, for example, differences between workforce needs in the north and southwest of England. Rather than a central office describing the whole system in a way that didn’t apply to a particular area, the model took a bottom-up approach to understanding how the medical school and patient populations, health needs, and social and demographic factors of each area impacted the number of trainee medics needed.”

That first experience showed WSP and its NHS clients the convenience and economy of using the isee Exchange to share models. “Clients across the NHS gain access to the models and reports they need without requiring a lot of licenses,” says Lacey. “We normally bundle six months of access into modelling projects to accommodate the typical shelf-life of the NHS models we build but have, on a number of occasions, extended these repeatedly.”

That experience prepared WSP to tackle COVID-19 outcome projections for the NHS. “Early on, we began looking at local health care needs and risk exposures – age, health status, vaccination status, work location – across a wide range of NHS areas,” says Lacey. “After consulting with each area, we built the model using evidence-based assumptions and first calibrated it for 20 care (hospital) systems. We’re still looking at 14 care systems and continue to update and recalibrate the model every two weeks.”

Using the isee Exchange, clients see how outputs reported for their own care system change as new COVID-19 information becomes available. Many use the dashboard to change assumptions and run their own tests.

“The ability to test new assumptions and project COVID-19 outcomes beyond a couple of weeks is building appreciation for system dynamics and modelling inside the NHS,” says Lacey. “We’re seeing more interest in developing modelling skills inside the NHS. Adoption is being encouraged.”

While WSP could have delivered useful COVID-19 planning information to NHS central administration alone, Lacey figures that the isee Exchange added 20% more value to the engagement by allowing clients across the system to see model outputs for every area. “Clients can interrogate a model that is accurate for their area even if they aren’t experienced modelers,” says Lacey. “By comparing their own modelled outcomes with other areas, they can learn from one another, which improves the whole system. With the isee Exchange, we’ve been able to show clients who understand system dynamics, as well as those who are new to the discipline, how agile modeling helps us learn in a constantly changing environment.”

Lacey sees an opportunity to use the isee Exchange to share simple models. He has started a non-profit called Really Useful Models which will do just that for the United Kingdom health sector. “People recognize the value of open-source programming and we can mimic that with the isee Exchange and model sharing,” says Lacey. “When you need a model, it’s really useful to not have to build it yourself.”

Interview with Barry Richmond Scholarship Winner Mariana M. Torres Arroyo

Mariana M. Torres Arroyo

The Barry Richmond Scholarship Award was established in 2007 by isee systems to honor and continue the legacy of its founder, Barry Richmond. The award is presented annually to a deserving Systems Thinking/System Dynamics practitioner whose work demonstrates a desire to expand the field or to apply it to current social issues.

Congratulations to Mariana M. Torres Arroyo for winning the 2022 Barry Richmond Scholarship Award for her work “How New York’s Food Donation Policies Might [or Might Not] Improve Fresh Produce Rescue and Reduce Wasted Food?”. It was wonderful to meet Ms. Torres Arroyo and recognize her accomplishment in person at the ISDC in July. We were able to sit down with her recently to learn more about her and her work.

isee: First of all, congratulations on winning the Barry Richmond Scholarship!

Mariana: Thank you, Thank you so much. I was very excited about it and being able to go to the conference in Germany.

Tell us a little about yourself and how you came to the University of Albany.

I am originally from Mexico. I studied there for my bachelor's in food engineering and my masters. I then applied to the University at Albany for the school of public health for my PhD.

Had you ever been to the ISDC before?

Last year, I presented a paper in the student-organized colloquium. This year was the first time I joined the conference, and I am so happy that I did!

Let’s segue to your project, reducing food waste. What made you focus on that issue?

I was trying to find an intersection between the environment and public health. I was trying to see the overlaps with public health. I was interested in food waste material and found several projects in the US working on food systems, and the one I chose focused on food rescue. This is such an important topic right now. A lot of food goes to waste, and, at the same time, there are people that need not only food but food with nutritional quality.

Did you use dynamic modeling in previous projects? What drew you to use it on this project?

This was my first project that used system dynamics. I started working on it while doing other types of analysis and participating in different phases of a bigger project focused on food recovery and redistribution in New York’s capital region. I was making participant surveys and analyzing data through typical methods or qualitative analysis, and then I got interested in looking for any other tool or framework that could be useful to see the interconnections within a system. To see the problem as a whole, rather than just having the data from surveys or the data from the region. My advisor, Beth Feingold, put me in touch with system dynamicist Luis Luna-Reyes, who is a professor at the Rockefeller college at UAlbany. He started mentoring me and providing me with materials that I needed for my workshops with the food rescue organizations.

It looks like you started this project right at the beginning of the pandemic. Do you feel the pandemic affected food waste and food rescuing?

That was not a direct part of the model I have been working on, but I know from projects conducted by other students and professors that the pandemic caused changes in food waste. I collaborated in a project with Dr. Christine Bozlak, where we created a survey for local organizations and some reported changes in food waste. We focused on what aspects of COVID-19 and its disruptions led to more or less waste in organizations. Several policies like Nourish NY were set in place during the pandemic, as there was a concern about food going to waste because there were no outlets, such as restaurants, open. There were reports of farmers leaving crops in the field or dumping milk. There was a need to support the agriculture sector, the outlets for this food, and people struggling more with food insecurity, which increased in both low income and minority populations. Policies were put in place to help address those, so we used the model to better understand how they were working.

While you were building the model, did you ever have a breakthrough moment or a moment when you felt like you were on the right track with your research?

It was when I saw that the stakeholders – executives at food banks and food rescue organizations – were interested in the model and its results. They provided feedback that they were excited and even emotional about what was going on in the model. I was thinking, “OK, it makes sense to do this because it matters. It matters to people.”

What are you hoping the stakeholders will be able to do with this information and what are the next steps in your project?

I am actually not sure what the stakeholders could do with this specific model. I know making an interface for them to play with the model would be another step, and we would need funding and time to complete that. As of now, the whole process of having workshops for stakeholders and showing them the results of the simulation has been like a conversation with them. They are using this information in their daily work; it’s a way we can collaborate and keep the conversation going. I would really love to say they are going to just use the model or do something with it, but I am not sure of their direction. For now, I am still working to finish the model, making sure it’s robust and preparing it for publication.

What is next for you? What is your next project?

I really want to continue to work on food systems. Right now, we are about to run some interviews related to the policies I mentioned earlier. One later project would be trying to use different methods to find ways to better see the overlaps between health and the environment. There are limited resources and so many environmental and health problems. We need to find ways to focus not only on the small problems but on the big picture. I feel learning more about system dynamics and using those tools would help.

Employee Spotlight: Hilary Allen

Hilary Allen

When lead developer Billy Schoenberg returned from teaching System Dynamics in Norway, he brought back one burning question: who is popular customer service representative Hilary Allen? In this interview, Hilary tells us all about her work at isee, her surprising educational history, her rural mountain home, and more.

isee: How would you describe your job?

Hilary: I do service, sales, and marketing. I’m the front line for all customer inquiries, so if you’re talking with someone, it’s usually me!

What do you like most about your job?

I’ve gotten to know a lot of our customers very well. We don’t always have to talk professionally. Sometimes we catch up on family life and just chat.

How long have you worked with us? What brought you here?

I’ve worked here almost nine years (it’ll be nine in January). Previous to this, I worked with isee's former bookkeeper at an inn. She knew isee was looking for a customer service agent and passed on my resume.

Now for the fun part. Tell us about yourself. Do you want to talk about your history with bones?

Yes, let’s start with bones! I’m a trained biological and forensic anthropologist. I’ve done digs and worked for the state of Colorado, when I did a biological profile on a skeleton discovered while digging a foundation. The problem with forensic anthropology is that there are three or four good schools producing anthropologists, but about twenty available positions globally. You can also join the Navy, but they can ship you out to dangerous places. I didn’t want to go for a PhD because I was burned out from grad school and had not received a return on my education yet. So I decided to get a different job. Bones are cool, though.

What about your mountain life?

We built a house on a mountain in 2018. We lived in a camper for the summer during the construction. Currently we have one cow, two sheep, seven chickens, one dog, two cats, and, historically, some pigs. It’s a big time investment. We cleared six or seven acres of our total of twenty-seven to be open pasture for farming and gardening. We’ve had fun trying to make our property as edible as possible. We grow apples, blueberries, lingonberries, honeyberries, hazelnuts, chestnuts, and have a veggie garden.

There are some hard parts. We do have interactions with wild animals all the time, like moose and bear. Winters are longer because of the elevation, and we choose to heat our house with wood.

Thanks! I’m sure everyone will be excited to hear your story.

No problem!

Stories of the Month

Since our previous newsletter we have published two exciting models for our ongoing series “Story of the Month.” Here is a brief summary of each with links to the full models on the isee Exchange™.

Microchips and the Auto Industry: A major ripple effect of the 2020 pandemic shutdown was the auto industry microchip shortage. This shortage is estimated to have caused a loss of 11 million units in 2021 alone and is expected to continue for several years. This model looks at the shortage and its effects on both new and used car prices, as well as how long it will take for this industry to recover.

Baby Formula Shortage: In February 2022, the Abbott production plant in Michigan shut down due to possible contamination, resulting in a months-long baby formula shortage in the USA. This shortage rocked the nation and became so bad that the government was forced to import millions of pounds of formula. This model looks at the dynamics of this shortage and how parental anxiety played a part to worsen it.

On the Road

The International System Dynamics Conference (ISDC) this past July was an excellent hybrid conference that allowed us to attend in person for the first time since 2019! While many of us were still virtual, lead developer Billy Schoenberg represented isee systems in Frankfurt, Germany. As always it was wonderful to talk with many long-time users and meet new users. The user group attendees were given a sneak peek at a new product in the works and their responses and comments were very helpful as we continue to develop it. We would like to congratulate the three winners of this year’s ISDC raffle, 1st prize: Amy Westgate from Regent University, 2nd prize: Zhenghua Yang from University of Oslo, and 3rd prize: Rachel Lynn Thompson from CUNY. We look forward to seeing many of you in person at next year’s ISDC in Chicago, Illinois.

The fifth annual South African Chapter System Dynamics Competition began accepting applications in March. The winners will be announced at the tenth annual South African System Dynamics Conference in November. We wish all the participants good luck!

Tell Us Your Modeling News!

We love hearing from our customers but never more so than when they have great news on their modeling projects. If you have presented your work at a conference, published an article or book, or made a breakthrough that has bettered your community, we want to hear about it! Not only will we be excited for you, but we will happily share your news on our social media channels and, in the case of articles or books, add it to our bibliography for others to learn of and from your accomplishments.

Partner Corner

Partner Corner introduces our consulting and training partners and shares their latest news.

Symmetric Scenarios

There has been an upsurge of interest in System Dynamics from the NHS in England, which has kept them busy. This work has been done in conjunction with Whole Systems Partnership. They’re looking for more training and mentoring opportunities.

Whole Systems Partnership (WSP)

WSP’s population cohort model was originally commissioned by the Kent system in an aspirational and ambitious attempt to understand long term population health needs and the impact of changing risk factors and prevention strategies. Over the last five years, the modeling has stood the test of time and been fundamental to providing the backcloth against which demand and capacity, workforce, and most recently COVID modeling has been undertaken.

The concept of WSP's population cohort model

Kent County Council have now set out how they wish to see this vital tool refined and updated to take account of COVID, but also to refresh other assumptions that help drive the model. They’ve also set us the challenge to explore how the wider determinants of health impact on long term health needs. At a time when we face another significant impact on physical and mental health through the cost-of-living crisis, this type of modeling is becoming even more critical.

WSP recently contributed to an NHS webinar on SD modeling for Urgent and Emergency Care.

Additionally, after many years encouraging those in the field to press ahead with the Level 7 Apprenticeship program for System Thinking Practitioners, courses are now starting to take place. Peter Lacey, WSP Director, is about to deliver the introduction to System Dynamics modelling to the first cohort in one of these apprenticeship programs. Participants will be led through an interactive online session exploring the nature of systems thinking; how causal loop diagrams help us to think differently about the world around us; the building blocks of SD modelling; and the importance of the organizational culture within which we seek to see systems thinking and modelling flourish.

Business Simulations

This year marked an important milestone for Business Simulations with the release of their 15th Business Simulation. All their Simulations are modelled using Stella Architect and powered by the Stella Simulator simulation engine. Business Simulations’ partnership with isee systems has helped us continue to deliver challenging and engaging experiential learning in a wide range of leadership disciplines including Change Management, Business Acumen, and High Performing Teams.

Pontifex Consulting

Several of Chris Soderquist’s recent projects highlight the importance of using Stella to build systemic insight. He developed a community game with ReThink Health℠ to help communities respond to shocks like COVID. The game teaches the importance of orchestrating resources to address issues like equity and social capital while at the same time investing in urgent services and social determinants. During the interactive exercise, headlines pop up and simulation results are shown on a scorecard.

It’s been used with hundreds of public health professionals and community leaders, helping them understand strategies for strengthening community well-being and the adaptive leadership skills required. A write up about the underlying model by Bobby Milstein, Jack Homer, and Chris Soderquist appears in the latest issue of Systems.

The interface of the ReThink Health community game

Chris also developed a Net Zero simulator for PepsiCo that they demonstrated at the Corporate Eco Forum. The scenario tool is hosted on their internal intranet using Stella Server. The scenario tool allows them to look at their entire life-cycle emissions and has been used internally as an educational tool about climate dynamics, as well as a decision support tool to better understand strategic tradeoffs at regional and global levels.

ReThink Health℠ is a service mark of the Rippel Foundation.

Software Update

In the last year, we made six updates to the Stella software, including the game-changing Stella 3.0. Stella 3.0 revolutionized interface creation with Designs, pre-made interfaces that you can customize to fit your needs. Designs are a revolutionary way to create sophisticated interfaces with consistent aesthetics and color palettes. They provide a multitude of styles that you can incorporate in your interface and customize however you want. They can even be used to add interfaces to your Vensim® models (which you can then publish to the isee Exchange™ for easy sharing).

We made many other tweaks and upgrades to both the model and interface layers, including flow valve sizing, extensive find and replace, improvements to Stella Live™ and Loops that Matter™, and more. For a complete list of new features, please check out our Feature Updates.

Vensim® is a registered trademark of Ventana Systems, Inc.