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)

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

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)

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

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

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

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HOW IT WORKS

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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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