Too many improvement initiatives are designed to cure isolated symptoms of a broken system rather than looking at the whole. The result of this is that when improvements to the symptoms are implemented they invariably move the problem to another part of the system thereby simply moving the problem. Using a systems dynamics approach will mean that issues within the whole system are fully understood and the up and downstream impacts of changes are fully considered prior to changes being made. By using a simulation model changes can be tested to gain greater insight into their impact in a safe environment thereby reducing the likelihood of unintended consequences in the real world.
The model above is a simplistic stock and flow diagram representation of an Emergency Department. Having identified a problem that we are trying to solve and created a model of the system as it currently operates we can use the model to help us understand the impact of changes to the variables within the system. For example, if our problem is that we are struggling to meet the 4 hour A&E waiting time target we can use the model to help us understand which levers to pull that will make the greatest difference and more importantly the impact pulling those leavers will have on the system as a whole. For example if we were to reduce the average length of stay in one of the wards by 0.5 days what would that do to our discharge flow and more importantly what would that do downstream to help us achieve the 4 hour A&E target? Clearly a simple model like the one above is not sufficient to help understand many of the issues faced by hospitals and the wider Healthcare system, to do so would require a much broader and more complex model to be created. However the level of understanding that this would provide about which changes would have the greatest impact across the health economy (local, regional or national) would be of significant value in times of increasing demand and both financial human resource constraints.