a systems dynamics model for acute care patient flows in new zealand a dynamic system model created...
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A Systems Dynamics Model A Systems Dynamics Model for Acute Care Patient Flows for Acute Care Patient Flows
In New ZealandIn New ZealandA dynamic system model created byA dynamic system model created by
Dr Peter Carswell – Investigator
Dr Alana Harper – Emergency Medicine Research Fellow
Dr Peter Jones – Co Principal Investigator
For the Shorter Stays in Emergency Departments National Research ProjectFor the Shorter Stays in Emergency Departments National Research Project (SSEDNRP)
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A Whole System A Whole System Approach to HealthApproach to Health
The following model is a tool that you can use to trial interventions that you think may improve how your service works, and to see how the whole system may be affected by your intervention, before rolling it out in the real world.
The health of people and populations reflects interactions between individuals, health professionals, the health system, sources of support, lifestyle choices and opportunities. These interactions are diverse, complex and interrelating.
Taking a whole system view is important when working to improve healthcare, allowing you to: •Understand the complexity of the systemAssess the impact of an intervention across the system before it is rolled outFacilitate collaboration between different parts of the health sector
VIEW WHOLE MODELHOW IT WORKS
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How it works (1)How it works (1)
The model provides an overview of patient flow through the health system, and indicates variables that affect patient flow. Using the analogy of a bathtub and taps….
A bathtub can be filled to a certain level. Once capacity is reached, the bathtub overflows and creates flooding.
Taps control the flow of water into and out of the bath tub, and turning the tap in the right direction ensures that the bath does not become flooded
VIEW WHOLE MODEL HOW IT WORKS (2)
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How it Works (2)How it Works (2)Similarly, patients occupy many parts of the health system and each of these has a capacity depending on funding, staffing and resources.
In the model squares represent where patients may accumulate in different parts of the system.
Arrows represent the flow of patients and taps represent factors that can be changed to impact patient flow
VIEW WHOLE MODEL
VIEW EXAMPLE
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ExampleExample
ED WARD
Access Block
Patient Flow
Wards unable to take new patientsIn the ideal world, when a patient is
ready to go to the ward from ED they go immediately, and patient flow is
unimpeded
Hospital Access Block turns off the tap, so patient flow from ED to the ward stops.
This leads to ED overcrowding and long patient stays, which are associated with poor outcomes for patients
Patient Flow
HOW TO USE THE MODEL
Left Click Left Click to see how hospital access block affects patient flow from ED to see how hospital access block affects patient flow from ED
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Viewing the ModelViewing the Model
HOW IT WORKS
VIEW MAIN MODEL
VIEW MAIN MODEL
The main model is a navigation page to explore each sub-model of the health system
1) Read the explanation of the model by clicking on in the main model.
2) Navigate back to the main model at any time by clicking on
3) In main model, click on any to view the part of the system you are interested in
4) To view the Key click
5) To view Abbreviations list click
6) Use the scroll of your mouse to enlarge the model for easy viewing.
7) To Submit feedback by email click on
8) Use of ‘Ctrl’ key + scroll of your mouse to enlarge the model may not work for some internet browsers.
SUBMIT FEEDBACK
KEY
ABBREVIATIONS
VIEW MAIN MODEL
HOW IT WORKS
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Main ModelMain Model
HOW TO USE IT
Click Click a Blue Button to go to your area of interesta Blue Button to go to your area of interest
Community Care
ED
Residential Care
Main Ward
Short Stay
Intensive Care
Electives
GP
Outpatients
Other Hospital
HOW IT WORKS
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Emergency Department Sub-ModelEmergency Department Sub-Model Use ‘Ctrl’ key + scroll of your mouse to enlarge the model Use ‘Ctrl’ key + scroll of your mouse to enlarge the model
SUBMIT FEEDBACK
BACK TO MAIN MODEL
KEY
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Short Stay Sub-ModelShort Stay Sub-Model Use ‘Ctrl’ key + scroll of your mouse to enlarge the model Use ‘Ctrl’ key + scroll of your mouse to enlarge the model
SUBMIT FEEDBACK
KEY
BACK TO MAIN MODEL
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Intensive Care Sub-modelIntensive Care Sub-model Use ‘Ctrl’ key + scroll of your mouse to enlarge the model Use ‘Ctrl’ key + scroll of your mouse to enlarge the model
SUBMIT FEEDBACK
KEY
BACK TO MAIN MODEL
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Ward Sub-modelWard Sub-model Use ‘Ctrl’ key + scroll of your mouse to enlarge the model Use ‘Ctrl’ key + scroll of your mouse to enlarge the model
SUBMIT FEEDBACK
KEY
BACK TO MAIN MODEL
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SUBMIT FEEDBACK
Ward – Ward – General Surgery General Surgery Use ‘Ctrl’ key + scroll of your mouse to enlarge the model Use ‘Ctrl’ key + scroll of your mouse to enlarge the model
KEY
BACK TO MAIN MODEL
BACK TO WARD MODEL
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Ward – Ward – SubspecialtySubspecialty Use ‘Ctrl’ key + scroll of your mouse to enlarge the model Use ‘Ctrl’ key + scroll of your mouse to enlarge the model
SUBMIT FEEDBACK KEY
BACK TO MAIN MODEL
BACK TO WARD MODEL
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Ward – Ward – General MedicineGeneral Medicine Use ‘Ctrl’ key + scroll of your mouse to enlarge the model Use ‘Ctrl’ key + scroll of your mouse to enlarge the model
BACK TO WARD MODEL
SUBMIT FEEDBACKKEY
BACK TO MAIN MODEL
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SUBMIT FEEDBACK
KEY
BACK TO MAIN MODEL
Primary Care Sub-modelPrimary Care Sub-modelUse ‘Ctrl’ key + scroll of your mouse to enlarge the modelUse ‘Ctrl’ key + scroll of your mouse to enlarge the model
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SUBMIT FEEDBACK KEY
BACK TO MAIN MODEL
Outpatients Sub-modelOutpatients Sub-modelUse ‘Ctrl’ key + scroll of your mouse to enlarge the modelUse ‘Ctrl’ key + scroll of your mouse to enlarge the model
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SUBMIT FEEDBACK
KEY
BACK TO MAIN MODEL
Electives Sub-modelElectives Sub-modelUse ‘Ctrl’ key + scroll of your mouse to enlarge the modelUse ‘Ctrl’ key + scroll of your mouse to enlarge the model
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Long-term Residential Care Sub-modelLong-term Residential Care Sub-modelUse ‘Ctrl’ key + scroll of your mouse to enlarge the modelUse ‘Ctrl’ key + scroll of your mouse to enlarge the model
SUBMIT FEEDBACKKEY
BACK TO MAIN MODEL
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SUBMIT FEEDBACKKEY
BACK TO MAIN MODEL
Community Care Sub-modelCommunity Care Sub-modelUse ‘Ctrl’ key + scroll of your mouse to enlarge the modelUse ‘Ctrl’ key + scroll of your mouse to enlarge the model
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Provide FeedbackProvide FeedbackAs health professional we encourage you to view the
model that best represents your speciality. Please comment if you feel we can improve the model, or if
there is something you are unclear about.Thank you for your time and insights.
VIEW MAIN MODEL
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The Shorter Stays in ED National The Shorter Stays in ED National Research ProjectResearch Project
Stream
One
Stream Two
Stream
Three
Stream Four
A mixed methods approach to improve health service delivery in NZA mixed methods approach to improve health service delivery in NZ
Stream 1: Model patient flow though NZ EDs and detail interventions that were implemented at a hospital level to achieve the ‘Shorter Stays’ target – Led by Dr Peter Carswell - Investigator
Stream 2: Determine what changes occurred in clinical markers of quality of care in the ED and the wider hospital, across different ethnic and age groups - Led by Dr Peter Jones – Co Principal Investigator
Stream 3: Identify themes to explain the perspectives, experiences and actions of clinicians and managers in response to the ‘Shorter Stays in ED’ time target – Led by Linda Chalmers – Co Principal Investigator
Stream 4 Integration of all findings to address broader aims of the project – Led by Dr Tim Tenbensel - Investigator
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