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Looking in the Wrong Place for Healthcare Improvements: A System Dynamics Study of an Accident and Emergency Department

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Operational Research for Emergency Planning in Healthcare: Volume 2

Part of the book series: The OR Essentials series ((ORESS))

Abstract

Accident and Emergency (A&E) units provide a route for patients requiring urgent admission to acute hospitals. Public concern over long waiting times for admissions motivated this study, whose aim is to explore the factors which contribute to such delays. The paper discusses the formulation and calibration of a system dynamics model of the interaction of demand pattern, A&E resource deployment, other hospital processes and bed numbers; and the outputs of policy analysis runs of the model which vary a number of the key parameters. Two significant findings have policy implications. One is that while some delays to patients are unavoidable, reductions can be achieved by selective augmentation of resources within, and relating to, the A&E unit. The second is that reductions in bed numbers do not increase waiting times for emergency admissions, their effect instead being to increase sharply the number of cancellations of admissions for elective surgery. This suggests that basing A&E policy solely on any single criterion will merely succeed in transferring the effects of a resource deficit to a different patient group.

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References

  1. Audit Commission (1996). By Accident or Design: Improving A&E Services in England and Wales. HMSO: London.

    Google Scholar 

  2. Department of Health (1996). The Patient’s Charter. HMSO: London.

    Google Scholar 

  3. NHS Confederation Royal College of Physicians (1997). Tack ling NHS Emergency Admissions: Policy into practice. NHS Confederation: Birmingham.

    Google Scholar 

  4. Department of Health (1998). Outpatient and Ward Attenders, England: Financial year 1996–1997. HMSO: London.

    Google Scholar 

  5. Hadfield J, Yates D and Berry A (1994). The emergency department and the community: model for improved coopera tion. J Roy Soc Med 87: 663–665.

    Google Scholar 

  6. Lane DC (1994). System dynamics practice: a comment on a case study in community care using systems thinking. J Opl Res Soc 45: 361–363.

    Google Scholar 

  7. Audit Commission (1997). The Coming of Age: Improving care services for older people. Audit Commission Publications: Abingdon.

    Google Scholar 

  8. Dale J, Green J, Reeds F and (1995). Primary care in the accident and emergency department: 1. Prospective identification of patients. Brit Med J, 311: 423–426.

    Article  Google Scholar 

  9. Leydon GM, Lawrenson R, Meakin R and Roberts JA (1996). The Cost of Alternative Models Of Accident and Emergency Care: A systematic review. Report to North Thames Regional Health Authority: London.

    Google Scholar 

  10. Middleton EL and Whitney FW (1993). Primary care in the emergency room: a collaborative model. Nurs Connect 6: 29–40.

    Google Scholar 

  11. Davies R and Davies H (1994). Modelling patient flows and resource provision in health systems. Omega 22: 123–131.

    Article  Google Scholar 

  12. Paul R (1995). Outpatient clinics. OR Insight 8 (2): 24–27.

    Article  Google Scholar 

  13. O’Kane PC (1981). Simulation model of a diagnostic radiology department. Eur J Opl Res 6: 38–45.

    Article  Google Scholar 

  14. Riley J (1995). Visual interactive simulation of accident and emergency departments. In: Kastelein A, Vissers J, van Merode GG and Delesie L (eds). Proceedings of ORAHS 21 Managing Health Care Under Resource Constraints. Eindhoven Univer sity Press: Maastricht, pp 135–141.

    Google Scholar 

  15. Altinel IK and Ulas E (1996). Simulation modelling for emer gency bed require-ment planting. A Opl Res 67: 183–210.

    Article  Google Scholar 

  16. Romanin-Jacur G and Faechin P (1987). Optimal planning of a pediatric semi-intensive care unit via simulation. Eur J Opl Res 29: 192.

    Article  Google Scholar 

  17. Mejia A, Shirazi R, Beech R and Balmer D (1998). Planning midwifery ser-vices to deliver continuity of Care. J Opl Res Soc. 49: 33–41.

    Article  Google Scholar 

  18. Forrester JW (1961). Industrial Dynamics. MIT Press: Cambridge, MA.

    Google Scholar 

  19. Taylor KS and Lane DC (1998). Simulation applied to health services: opportunities for applying the system dynamics approach. J Health Services Res and Policy 3: 226–232.

    Google Scholar 

  20. Lane DC (1999). System Dynamics Modelling of Patient Flows Through Acute Hospitals. Report for the NHS Executive: London.

    Google Scholar 

  21. Richardson GP (1991). Feedback Thought in Social Science and Systems Theory. Univ. Pennsylvania: Philadelphia.

    Google Scholar 

  22. Richamond BM, Vescuso P and Peterson S (1990). iThink Software Manuals. High Performance Systems, 145 Lyme Road, Hanover, NH 03755, USA.: Hanover NH.

    Google Scholar 

  23. Lane DC (1992). Modelling As Learning: a consultancy methodology for enhancing learning in management teams. Eur J Opl Res 59: 64–84.

    Article  Google Scholar 

  24. Lane DC (1995). On a resurgence of management simulations and games. J Opl Res Soc 46: 604–625.

    Google Scholar 

  25. Lane DC (1997). From discussion to dialogue: A case study using an interactive system dynamics modelling a approach (De la discussion an dialogue: one étude de cas d’utilisation interactive de la dynamique des systémes). Revue des Sys de Décis 6: 251–281.

    Google Scholar 

  26. Richardson GP and Pugh AL (1981). Introduction to System Dynamics Modelling with DYNAMO (republished edition). Productivity: Cambridge, MA.

    Google Scholar 

  27. Lane DC and Smart C (1996). Reinterpreting generic structure: evolution, application and limitations of a concept. Sys Dyn Rev. 12: 87–120.

    Article  Google Scholar 

  28. Randers J (1980). Guidelines for model conceptualisation. In: Randers J (ed). Elements of the System Dynamics Method. MIT Press: Cambridge, MA, pp 117–139.

    Google Scholar 

  29. Goodman MR (1974). Study Notes in System Dynamics. MIT Press: Cambridge, MA.

    Google Scholar 

  30. Tomlinson B (1992). Report of the Inquiry into London’s Health Service, Medical Education and Research. HMSO: London.

    Google Scholar 

  31. Kings Fund Commission (1992). London Health Care 2010: Changing the Future of Services in the Capital King’s Fund: London.

    Google Scholar 

  32. Department of Health (1993). Making London Better HMSO: London.

    Google Scholar 

  33. Lane DC (1995). The Folding Star: a comparative reframing and extension of validity concepts in system dynamics. In: Shimadar T and Saeed K (eds). Proceedings of the 1995 International System Dynamics Conference: Volume Plenary Program. Gakushuin University and the International System Dynamics Society: Tokyo, pp. 111–130.

    Google Scholar 

  34. Forrester JW and Senge PM (1980). Tests for building confidence in system dynamics models. In: Lagasto AA, Forrester JW and Lyneis JM (eds). System Dynamics: TIMS Studies in the Management Science. North-Holland: Oxford, pp 209–228.

    Google Scholar 

  35. Monefeldt C and Lane DC (1997). A&E Model: Validation notes. LSE research Notes.

    Google Scholar 

  36. Lane DA and Monefeldt C (1999). Client involvement in simulation model building: hints and insights from a case study in a London hospital. LSE OR Department Working Paper Series LSE OR 99/32.

    Google Scholar 

  37. Sterman JD (1984). Appropriate summary statistics for evaluat ing the historical fit of system dynamics models. Dynamica 10: 51–66.

    Google Scholar 

  38. Mass NJ (1991). Diagnosing surprise model behavior: a tool for evolving behavioral and policy insights (1981). Sys Dyn Rev 7: 68–86.

    Article  Google Scholar 

  39. Lane DC, Monefeldt C and Rosenhead JV (1998). Looking in the wrong place for healthcare improvements: A system dynamics study of an accident and emergency department. LSE OR Department Working Paper Series LSEOR 98. 23.

    Google Scholar 

  40. Forrester JW (1970). Counterintuitive behaviour of social systems. In: Collected Papers of Jay W Forrester (1975 collection). Wright-Allen Press: Cambridge, MA pp 211–244.

    Google Scholar 

  41. Fry L (1960). Casualties and casuals. Lancet 1: 163–166.

    Article  Google Scholar 

  42. Royal College of Surgeons of England (1993). British Associa tion for Accident and Emergency Medicine Directory 1993. Royal College of Surgeons of England: London.

    Google Scholar 

  43. Kaplan RS and Norton DP (1992). The balanced scorecard— measures that drive performance. Harvard Bus Rev Jan/Feb: 71–79.

    Google Scholar 

  44. Ashby WR (1956). An Introduction to Cybernetics. Chapman & Hall: London.

    Book  Google Scholar 

  45. Homer JB (1985). Worker Burnout: A dynamic model with implications for prevention and control. Sys Dyn Rev 1: 42–62.

    Article  Google Scholar 

  46. Audit Commission (1992) Lying in Wait: The Use of Medical Beds in Acute Hospitals. HMSO: London.

    Google Scholar 

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Author information

Authors and Affiliations

  1. The London School of Economics and Political Science, University of London, UK

    D. C. Lane, C. Monefeldt & J. V. Rosenhead

Authors
  1. D. C. Lane
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  2. C. Monefeldt
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  3. J. V. Rosenhead
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Editor information

Editors and Affiliations

  1. University of Exeter Business School, UK

    Navonil Mustafee (Senior Lecturer in Operations Management) (Senior Lecturer in Operations Management)

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© 2016 Operational Research Society

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Lane, D.C., Monefeldt, C., Rosenhead, J.V. (2016). Looking in the Wrong Place for Healthcare Improvements: A System Dynamics Study of an Accident and Emergency Department. In: Mustafee, N. (eds) Operational Research for Emergency Planning in Healthcare: Volume 2. The OR Essentials series. Palgrave Macmillan, London. https://doi.org/10.1007/978-1-137-57328-5_6

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