ORIGINAL ARTICLE Geographical modelling of patient episode flows and hospital catchment populations: a case study in Northern Ireland Adam J. Hindle 1 , Giles A. Hindle 2 and Tony Hindle 3 1 Lancaster University Management School, Lancaster University, Lancaster, U.K.; 2 Hull University Business School, University of Hull, Hull, U.K.; 3 HCS Ltd, Preston, U.K. Correspondence: Giles A. Hindle, Hull University Business School, University of Hull, Hull, HU6 7RX, U.K. Tel: 01482 463457; Fax: 01482 463484; E-mail: Giles.Hindle@hull.ac.uk Received: 24 April 2012 Revised: 8 August 2012 Accepted: 8 August 2012 Abstract This paper describes the development of a decision support framework, which contributed to the strategic management of radical changes in hospital services in Northern Ireland. The approach employed geographical modelling to esti- mate patient episode flow effects between geographical areas and hospitals under different hospital configurations. Such effects are central to the evalua- tion of key strategic issues such as catchment population characteristics (and the funding of such), capacity planning and achievement of access/travel time targets. The approach is illustrated with an evaluation of a new-build hospital development in a region within the Province. With respect to the modelling of episode flows, this research has investigated proximity to the nearest ‘appro- priate’ hospital as a primary explanatory factor determining hospital choice and has explored ways of defining and quantifying appropriateness. Health Systems (2013) 2, 53–60. doi:10.1057/hs.2012.13; published online 5 October 2012 Keywords: OR in health services; decision support systems; hospitals; OR in strategic planning Background Historically, the approach taken to the provision of acute hospital services in Northern Ireland has been similar to that in the U.K. National Health Service (NHS) – generally, the provision of local (district) general hospitals that supply the majority of the hospital needs of resident populations in defined districts, where such districts are typically natural and coherent population settlements. Such hospitals are backed up in the cities (Belfast in the case of Northern Ireland) by larger, more comprehensive, ‘teaching’ hospitals that provide a wider range of specialisations and higher levels of diagnostic and treatment technologies. This structure has proved popular, with the public often engendering fierce loyalty to their ‘local’ hospital, and has provided high levels of accessibility for patients and visitors alike. However, over the recent past, many down sides have been recognised, mainly associated with concerns for the sustainability of quality services in relatively small hospitals. Des Browne, Minister of Health for Northern Ireland, February 2003, says: With the changes in medicine I have mentioned, this [current] profile of hospitals is no longer appropriate. All of our hospitals are under pressure, but it is the smaller hospitals that are at the greatest risk, since they cannot meet the standards of the specialties that are the essential core of acute care. This is a matter of safety and the quality of services and we cannot compromise on it. Health Systems (2013) 2, 53–60 & 2013 Operational Research Society Ltd. All rights reserved 2047-6965/13 www.palgrave-journals.com/hs/