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A system dynamics-based simulation study for managing clinical governance and pathways in a hospital

Maliapen, M and Dangerfield, BC 2010, 'A system dynamics-based simulation study for managing clinical governance and pathways in a hospital ' , Journal of the Operational Research Society, 61 (2) , pp. 255-264.

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      Abstract

      This paper examines the development of clinical pathways in a hospital in Australia based on empirical clinical data of patient episodes. A system dynamics (SD)-based decision support system (DSS) is developed and analyzed for this purpose. System dynamics was used as the simulation modeling tool because of its rigorous approach in capturing interrelationships among variables and in handling dynamic aspects of the system behavior in managing healthcare. The study highlights the scenarios that will help hospital administrators to redistribute caseloads amongst admitting clinicians with a focus on multiple Diagnostic Related Groups (DRG’s) as the means to improve the patient turnaround and hospital throughput without compromising quality patient care. DRG’s are the best known classification system used in a casemix funding model. The classification system groups inpatient stays into clinically meaningful categories of similar levels of complexity that consume similar amounts of resources. Policy explorations reveal various combinations of the dominant policies that hospital management can adopt. The analyses act as a scratch pad for the executives as they understand what can be feasibly achieved by the implementation of clinical pathways given a number of constraints. With the use of visual interfaces, executives can manipulate the DSS to test various scenarios. Experimental evidence based on focus groups demonstrated that the DSS can enhance group learning processes and improve decision making. The simulation model findings support recent studies of CP implementation on various DRG’s published in the medical literature. These studies showed substantial reductions in length of stay, costs and resource utilization.

      Item Type: Article
      Uncontrolled Keywords: Clinical pathways, system dynamics, decision support system, diagnostic-related groups (DRG)
      Themes: Health and Wellbeing
      Schools: Colleges and Schools > College of Business & Law > Salford Business School > Management Science and Statistics
      Journal or Publication Title: Journal of the Operational Research Society
      Publisher: Palgrave Macmillan
      Refereed: Yes
      ISSN: 0160-5682
      Depositing User: BC Dangerfield
      Date Deposited: 04 Oct 2011 12:55
      Last Modified: 03 Jul 2014 11:57
      URI: http://usir.salford.ac.uk/id/eprint/17830

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