Modelling the feedback effects of reconfiguring health services

The shift in the balance of health care, bringing services ‘closer to home’, is a well-established trend, which has been motivated by the desire to improve the provision of services. However, these efforts may be undermined by the improvements in access stimulating demand. Existing analyses of this trend have been limited to isolated parts of the system with calls to control demand with stricter clinical guidelines or to meet demand with capacity increases. By failing to appreciate the underlying feedback mechanisms, these interventions may only have a limited effect. We demonstrate the contribution offered by system dynamics modelling by presenting a study of two cases of the shift in cardiac catheterization services in the UK. We hypothesize the effects of the shifts in services and produce model output that is not inconsistent with real world data. Our model encompasses several mechanisms by which demand is stimulated. We use the model to clarify the roles for stricter clinical guidelines and capacity increases, and to demonstrate the potential benefits of changing the goals that drive activity

Simulation analysis of the consequences of shifting the balance of health care: a system dynamics approach

Objectives: The shift in the balance of health care, bringing services 'closer to home', is a well-established trend. This study sought to provide insight into the consequences of this trend, in particular the stimulation of demand, by exploring the underlying feedback structure. Methods: We constructed a simulation model using the system dynamics method, which is specifically designed for the analysis of feedback structure. The model was calibrated to two cases of the shift in cardiac catheterization services in the UK. Data sources included archival data, observations and interviews with senior health care professionals. Key model outputs were the basic trends displayed by waiting lists, average waiting times, cumulative patient referrals, cumulative patient activity and cumulative overall costs. Results: Demand was stimulated in both cases via several different mechanisms. We revealed the roles for clinical guidelines and capacity changes, and the typical responses to imbalances between supply and demand. Our analysis also demonstrated the potential benefits of changing the goals that drive activity by seeking a waiting list goal rather than a waiting time goal. Conclusions: Appreciating the wider consequences of shifting the balance of care is essential if services are to be improved overall. The underlying feedback mechanisms of both intended and unintended effects need to be understood. Using a systemic approach, more effective policies may be designed through coordinated programmes rather than isolated initiatives, which may have only a limited impact

Understanding and improving system safety through system dynamics modelling – systematic literature review

System Dynamics (SD) has been widely used in modelling across a range of applications that range from socio-economic to engineering systems, but its potential has not yet been fully realised as a tool for understanding system safety and supporting relevant strategic decision making. We conducted a literature review of SD applications in safety-critical environments, employing a safety taxonomy framework. The result of our literature review provides an overview of SD modelling application in safety-critical environments, highlighting the existing gap and generating future research questions in this area

Self-organising agent communities for autonomic resource management

The autonomic computing paradigm addresses the operational challenges presented by increasingly complex software systems by proposing that they be composed of many autonomous components, each responsible for the run-time reconfiguration of its own dedicated hardware and software components. Consequently, regulation of the whole software system becomes an emergent property of local adaptation and learning carried out by these autonomous system elements. Designing appropriate local adaptation policies for the components of such systems remains a major challenge. This is particularly true where the system’s scale and dynamism compromise the efficiency of a central executive and/or prevent components from pooling information to achieve a shared, accurate evidence base for their negotiations and decisions.In this paper, we investigate how a self-regulatory system response may arise spontaneously from local interactions between autonomic system elements tasked with adaptively consuming/providing computational resources or services when the demand for such resources is continually changing. We demonstrate that system performance is not maximised when all system components are able to freely share information with one another. Rather, maximum efficiency is achieved when individual components have only limited knowledge of their peers. Under these conditions, the system self-organises into appropriate community structures. By maintaining information flow at the level of communities, the system is able to remain stable enough to efficiently satisfy service demand in resource-limited environments, and thus minimise any unnecessary reconfiguration whilst remaining sufficiently adaptive to be able to reconfigure when service demand changes

The processes of reform in Victoria’s alcohol and other drug sector, 2011-2014

This paper explores issues and concerns related to the 2014 alcohol and other drug sector recommissioning process in Victoria. Overview In mid-2014, the Victorian Alcohol and Drug Association approached the Drug Policy Modelling Program, at the National Drug and Alcohol Research Centre, University of New South Wales to undertake a project exploring and describing issues and concerns related to the 2014 alcohol and other drug sector recommissioning process in Victoria. This project commenced in July 2014 and concluded in November 2014. Policy documents and allied material were reviewed, and 20 stakeholders from 18 alcohol and other drug sector organisations were consulted. These stakeholders were CEOs/senior managers during the reform period

A context-aware monitoring architecture for supporting system adaptation and reconfiguration

Modern services and applications need to react to changes in their context (e.g. location, memory consumption, number of users) to improve the user’s experience. To obtain this context, a monitoring infrastructure with adequate functionality and quality levels is required. But this monitoring infrastructure needs to react to the context as well, raising the need for context-aware monitoring tools. Provide a generic solution for context-aware monitoring able to effectively react to contextual changes. We have designed CAMA, a service-oriented Context-Aware Monitoring Architecture that can be easily configured, adapted and evolved according to contextual changes. CAMA implements a decoupled architecture and manages a context domain ontology for modelling the inputs, outputs and capabilities of monitoring tools. CAMA has been demonstrated in three real use cases. We have also conducted different evaluations, including an empirical study. The results of the evaluations show that (1) the overhead introduced by the architecture does not degrade the behavior of the system, except in extreme conditions; (2) the use of ontologies is not an impediment for practitioners, even when they have little knowledge about this concept; and (3) the reasoning capabilities of CAMA enable context-aware adaptations. CAMA is a solution useful for both researchers and practitioners. Researchers can use this architecture as a baseline for providing different extensions or implementing new approaches on top of CAMA that require context-aware monitoring. Practitioners may also use CAMA in their projects in order to manage contextual changes in an effective way.This work was partially supported by the Spanish project GENESIS TIN2016-79269-R, and SUPERSEDE project, funded by the European Union’s Information and Communication Technologies Programme (H2020) under Grant Agreement No 644018.Peer ReviewedPostprint (author's final draft

Dynamic capabilities in private hospitals: a case-based research of Henan Shengde Hospital

China's medical industry is in the stage of transformation. As new reform policies are released frequently and increasing number of private hospitals entry the medical industry, the external environment is constantly changing. Why is Henan Shengde Hospital capable to survive and prosper through market changes but others fail? This study adopts Dynamic Capability Approach and investigates the role of dynamic capabilities in achieving superior medical staff satisfaction. The main purpose of this study is to examine the importance of dynamic capabilities for Henan Shengde Hospital to cope with the external environment as well as their mediating role in the relationship between organizational resources, capabilities and medical staff satisfaction. Both exploratory and conclusive research are conducted in this study. Seven managers were interviewed and a total of 315 questionnaires were distributed and collected in Henan Shengde Hospital. The findings indicate that organizational culture and managerial capability have positive impact on employee satisfaction. Responding capability and reconfiguring capability affect employee satisfaction positively, while sensing capability does not. We also find that reconfiguring capability play a mediating role in three pairs of relationship, namely, organizational culture and medical staff satisfaction, leadership and medical staff satisfaction as well as managerial capability and medical staff satisfaction. When the organization faces a volatile and unpredictable external environment, reconfiguring capability is an important source of medical staff satisfaction.A indústria da saúde na China encontra-se numa fase de transformação. A liberação constante de novas políticas e a entrada de um número crescente de hospitais privados provocam turbulência na envolvente externa. Partimos da seguinte questão principal de investigação: porque é que o Hospital Henan Shengde é capaz de sobreviver às mudanças de mercado e outros falham? Este estudo adopta a abordagem das capacidades dinâmicas para investigar o papel destas na obtenção da satisfação do pessoal médico. O principal objetivo desta tese consiste em examinar a importância das capacidades dinâmicas para o Hospital Henan Shengde lidar com a envolvente externa assim como o seu papel mediador na relação entre os recursos organizacionais, capacidades e a satisfação do pessoal médico. Este estudo conduziu uma pesquisa exploratória e conclusiva. Sete gestores foram entrevistados e um total de 315 questionários foram distribuídos e recolhidos no Hospital Henan Shengde. Os resultados mostram que a cultura organizacional e capacidade de gestão têm um impacto positivo na satisfação dos empregados. A capacidade de resposta e a capacidade de reconfiguraçãção afetam positivamente a satisfaçãção dos empregados, enquanto a capacidade de detecçãção não afeta. Concluímos também que a capacidade de reconfiguração desempenha um papel mediador em três pares de relacionamento, nomeadamente, cultura organizacional e satisfação do pessoal médico, liderança e satisfação do pessoal médico assim como capacidade de gestão e satisfação do pessoal médico. Quando a organização enfrenta uma envolvente externa volátil e imprevisível, a capacidade de reconfiguração é uma fonte importante da satisfação do pessoal médico

Location of services and the impact on healthcare quality: insights from a simulation of a musculoskeletal physiotherapy service

Many healthcare systems are being redesigned to deliver local care with more services within the community. Relocation may enhance access but other aspects of healthcare quality should also be considered, notably waiting times and equity of care. This study examined a musculoskeletal physiotherapy service using a discrete-event simulation with simple heuristics to model patient behaviour. This combination provided an effective mechanism for incorporating the individuality of the patients in the flows along the patient pathways, subject to the varying availabilities of key resources. In particular, it captured the feedback that is critical in system performance, especially where waiting times are important. The model recognised the heterogeneity of patient attitudes and demonstrated how the behaviour of a relatively small proportion can affect the experience of all patients. The study suggested that, with careful operational management, more care could be delivered locally while exploiting many of the benefits of a centralised service