Published March 2020
Significance
- Frontline emergency service providers in Queensland are struggling to serve unprecedented growth in demand, and it is putting patient lives at risk. There has been no change over the last 10 years in wait times for emergency departments (AIHW).
- Administrative and territorial boundaries can lead to siloed decision making in health care, wherein decisions within one part of the system are made without considering their impact on other parts. System Dynamics (SD) is a scientifically rigorous, evidence-based approach that can span system level boundaries and provide decision-makers with an aerial view of the system and an understanding of the consequences, both intended and unintended, of their decisions.
- Participatory SD methods integrate ongoing stakeholder deliberation into the process of model development, incorporating diverse knowledge and perspectives, and fostering relationships among stakeholders that can accommodate changing information and conditions. These methods have been used extensively in supply chain management, operations management and human resource management for decades to find robust strategies and policies and to test the resilience of systems.
What’s new
- The WHO, OECD, UN and the National Academy of Sciences are calling for the use of systems thinking and an engineering/healthcare partnership to strengthen healthcare systems. Systems “engineering” tools can unpack how complex chains of cause and effect and feedback loops determine system behaviour, highlight the structural source of patterns and modes of behaviour and identify points within the system where interventions could improvement performance. The current pilot model can replicate Emergency Department (ED) flow accurately showing patient backlogs and delays. “What if” decisions can be tested in a risk-free virtual system twin.
- The key outcome? A flexible tool enabling teams on the ground to make decisions under complex conditions. An NHMRC partnership grant (CBEH, Mater, QAS, West Moreton HHS, AusHSI, Mercy Community Aged Care) has been sought.
- The key delivery? An intervention testing tool to improve the operational and strategic decisions that support access, efficiency and quality outcomes in the Emergency Department. Operational decisions include workforce rostering and distribution decisions matching bed availability to patient flow. Strategic decisions can include bed platforms and planning enhancements for ambulance units and crews.
Bottom line
- Access to emergency care will not be solved by any one individual, discipline, or policy; hence, there is strong value in adopting a participatory SD approach. Whilst a focus on clinical level innovation is paramount to improve patient outcomes, research and innovation focussed on optimising the operational and strategic decisions that drive efficiencies can empower better delivery and ultimately, better care. This is a tool capable of being scaled and delivered to all Australian hospitals.
Learn more about Future of Health.
McAvoy, S., Staib, A., & Treston, G. (2020). Can a System Dynamics Model of the Emergency Department show which levers reduce bottlenecks and delays to improve access to care? System Research and Behavioural Science.” In press” http://dx.doi.org 10.1002/sres.2663
McAvoy, S., Staib, A., & Birch, S. (2020) Models of evaluation under ceteris imparibus: System dynamics and the example of emergency care, Systems Research and Behavioural Science, Vol 37, Issue 2, 211-222 http://dx.doi.org/10.1002/sres.2615