Over the moon: Astronauts, digital twins and healthier services

You may remember Apollo 13 in 1970 because of the astronauts who didn’t step down, due to an onboard explosion. For several days, Mission Control managed the stricken spacecraft and innovated violently to bring the three men home. I remember – or think I do – watching grainy clouds, breathlessly waiting until the parachutes on the screen heralded splashdown and safety.

In Ron Howard’s film of the mission, flight director Gene Kranz (in the white waistcoat), portrayed by Ed Harris, is a great project manager. I bought Kranz’s book, ‘Failure is not an option,’ and decide to watch the film annually with the final year project management students, using the mission as a case study (along with London Ambulance’s Computer Aided Dispatch) on managing out of failure.

So what was pioneered by NASA back then that is so relevant today? First, they built one of the first global information systems for real-time decision-making. With less information than F1 teams collect at the races, they made high-quality decisions at pace and, despite the danger, they did not lose a life in orbit until long after the moon was abandoned. However, it was not just the technology, but the intent that mattered. A clear focus on decision-making yielded spectacular results.

Second, they used simulation all the time. Everything about space was new – the technology, zero gravity, getting through hatches in bulky outfits, aligning and docking spacecraft, the list went on. However, astronauts on a mission had to get it right first time and so NASA pioneered ways to develop mission protocols and test them to destruction, giving everyone the best shot after lift-off. Most obviously, they built mock-ups to train in.

More sophisticated was their quest to discover what might go wrong. Today, computer models run scenarios to see how various interventions play out. Back then, they used competing teams: A simulation team to define a scenario; and a flight control team to run it as a real mission.

Whenever there was a new question, getting into a simulator or simulating a scenario was a natural way to find an answer. Information and communications technology has come a long way since then, as have medical simulators and computer modelling, but the pioneering connections made half a century ago remain valid.

So why doesn’t every healthcare facility or service have a digital twin – a model of how it works, driven by real patient arrival and discharge patterns? And why, every time there is a waiting problem, or extra staff have to be recruited at short notice, or the spend rises mysteriously, is the first port of call not a session with the digital twin? What is wrong with this proven method of understanding the dynamics of a problem and finding what works with the fewest side effects?

We already have the mock-ups, so why are our simulation labs in which we educate our students not closed for education once a month and used for learning about the wider system? A dummy will not die if a simulation exercise can’t process patients quickly enough. The technology is already there: Why don’t we use it?

The appetite for simulation and real-time data in operational decisions drove one of the great achievements of the modern era. What could the same appetite do for healthcare today? Today we have the technology – where is the focus and intent?

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Professor Terry Young worked in industrial R&D before becoming an academic and is now Director of Datchet Consulting. With over 30 years’ experience in technology development and strategy, health systems, and methods to ensure value for money, his current focus lies in designing services using computer models and he set up the Cumberland Initiative to support healthcare organisations wishing to develop their services more systematically. Three of his downloadable papers are:

Using industrial processes to improve patient care (2004, with Brailsford et al., British Medical Journal)

Performing or not performing: what’s in a target? (2017, with Eatock & Cooke, Future Hospital Journal)

Systems, design and value-for-money in the NHS: mission impossible? (2018, with Morton and Soorapanth, Future Hospital Journal)