Cost overruns, a major cause of project failure in construction, are attracting increasing attention from construction stakeholders. Cost overrun model development is a useful tool to identify the factors that cause cost overruns and improve cost estimates. A machine learning application based on historical data is currently being developed to estimate the cost overrun in construction. We were motivated by this and applied the Extreme Gradient Boosting machine (XGBoost), which analyzes historical data for construction projects completed in Ghana between 2016-2018. Comparing the predicted and actual costs produced a good model. The RMSE values, MSE values, MAE, and MAPE are 0.202, 0.041, 0.069, and 0.306, respectively. We used SHAP values for each feature to visually illustrate its effect on model interpretability. The SHAP ranking reveals that initial contract amounts, number of floors, scope changes, and initial duration are variables that accurately predict cost overruns and project completion costs. This study explores a new way to evaluate and understand the essential variables that can be used to develop a model for cost overruns.
Working with patients and the public
It is important to involve patients in the design of services from the very beginning. Discussions about community pharmacies should include local communities in order to gain insight into what works, what’s important to patients, possible improvements, and the impact of language when speaking to people outside of the profession.
The community pharmacy system is complex, and many pharmacies offer different services. This can confuse and lead to a variety of experiences. It would be beneficial to help people and health professionals understand the community pharmacy system. This will improve expectations, understanding, and, hopefully, patient experience. Sharing information with national bodies and ICBs can help develop realistic expectations and a better understanding of local variations.
Understanding the needs of local areas
It isn’t easy to balance the need for a national community pharmacy offer that people can understand with opportunities for local innovations. Several pharmacy leaders shared their views on the importance of regional innovation when it comes to providing services that meet local community needs. As an example, the pharmacists at our roundtable suggested that they could have a conversation with their local community pharmacists about COVID-19 to increase uptake.
Innovation was a hot topic. First, commissioners must address barriers such as the digital integration of patient data and workforce issues. It is important to address these issues to increase the capacity for innovation because, until then, the basic need for reliable access to medication will take precedence over any ‘added value’ services community pharmacies might offer.
Evaluation and Learning
It is possible to scale up and learn from innovative schemes. This culture of sharing learning could help reduce hospital admissions, prevent disease, and tackle inequalities. Participants stressed the importance of detailed plans that include how to evaluate, scale up, and measure success before implementation. The innovation process should be simple, and it should be added to an existing national framework for community pharmacies that is consistent and recognized.
Community pharmacy staff should be given the opportunity to develop their research skills and train in academic evaluation. Evaluation can include cost-benefit effectiveness and patient experiences. Then, there is the question of how and where this knowledge can be shared. To expand successful pilots, it is necessary to have adequate funding, plan, and evaluate. The commissioners of ICBs play a key role in supporting infrastructure development to support evaluation, innovation, and education.
The community pharmacy system will continue to need to adapt, learn, and evaluate. In the recent plan to recover access to primary health care, community pharmacies are expanding their services. By 2026, all newly registered pharmacists will be prescribing independently. It is an exciting time for community pharmacy, with many changes happening at a national level. Commissioners can play a key role in helping local systems take advantage of these opportunities by developing relationships with patients and the public and understanding local needs.