Health systems engineering for a new symptom-focused MLTC pathway in remote and rural settings

About the Project

Aim:

This project researches the translation of systems engineering expertise into healthcare practice. This, with a particular focus on supporting the definition, modelling, and implementation of a new whole-person symptom-focused health delivery pathway for people living with multiple long-term conditions in remote and rural settings.

Background and need:

Healthcare challenges: Health systems across the world, including the National Health Service (NHS), are severely challenged, facing economic constraints and skill shortages while experiencing an increasing demand from an overall ageing population and increase in people living multiple long-term conditions. Multiple Long-Term Conditions (MLTC) are a defining challenge for the NHS: patients’ experience fragmented, condition-by-condition care, with repeated referrals, long waits, duplicated assessments, and poor continuity across primary, community, and secondary services together with potentially extra geographic challenges in remote and rural areas affecting access and reach.

Clinical scientific challenge: The wider research programme SEISMIC SHIFT that this PhD is embedded in proposes shifting from condition-based models of care to symptom-focused delivery pathways in the context of MLTC poses significant clinical scientific challenges, particularly in integrating clinical knowledge and care processes across specialties, as exemplified by symptoms such as breathlessness or pain that traverse multiple diseases and service boundaries. This shift and their consequences both for clinical health outcomes as well as health system performance more widely has to-date not been researched in clinical MLTC literature or clinical symptom science literature.

Interdisciplinary scientific challenge: There is increasing recognition, across both media discourse and the scientific literature on health and care, of the need for a fundamental shift.  In parallel, there is growing recognition in policy reports and the scientific literature of the need to adopt a systems approach. In particular, systems engineering has been identified in the literature (Clarkson et al., 2017; Dodds, 2018; Aulja et al., 2024) to supporting the reconfiguration of healthcare delivery pathways. However, despite growing interest, research into the accessible and effective translation of (technical) systems engineering language and expertise from engineered artefact-based domains such as defence, aerospace, space, and automotive sectors to complex living socio-technical systems like healthcare is still at an early stage (Maier et al., 2022), with few documented real-world clinical implementations. This opens a new paradigm for health systems engineering that this PhD project proposes to define, develop, real-world apply and evaluate within the NHS.

The novelty of the PhD project lies in pioneering a real-world health systems engineering-informed intervention of a new symptom-focused health delivery pathway for people living with MLTC in remote and rural settings. It goes beyond the technical systems engineering task also to recognise and address key barriers including varying adoption and awareness of systems engineering and systems thinking in the NHS and limitations in data consistency across the health boards when moving from conceptual mapping to computational models at scale.

Principal objectives:

• to gain an in-depth understanding of the as-is state-of-the-art in health systems engineering and clinical symptom science and to gain an in-depth understanding of MLTC delivery pathways in the context of rural and remote healthcare practice settings;
• to develop, model, implement, and evaluate ‘to-be’ system architectures of a to-be rural MLTC symptom-focused pathway;
• to establish an accessible, verified and validated translation framework that bridges systems engineering- and healthcare languages.

Main research questions:

• What does rural MLTC care look like ‘as-is’ when viewed as an integrated socio-technical system (patients, carers, clinicians, data, interfaces, technology, geography), taking case examples in NHS Highland?
• Which ‘to-be’ symptom-focused pathway configurations reduce fragmentation and improve continuity of care under rural constraints?
• What system-level consequences and trade-offs emerge when shifting healthcare delivery closer to home (remote monitoring, community provision, hybrid clinics)?
• How might we organise and evidence training and learning offerings sufficient to support adoption of systems engineering methodologies into healthcare for pathway development?

Funding Notes

This PhD project is funded by the John Anderson Research Studentship Scheme (JARSS). It covers UK home tuition fees and an annual tax-free stipend. For Academic Year 2026/27 this will be £21,805.00 (pro-rata).

International applicants are strongly encouraged to apply and to seek funding to cover the difference between the home and international tuition fees

Research expenses: essential research expenses, travel and accommodation expenses, including expenses incurred in connection with research visits to NHS sites across Scotland and UK will be re-imbursed