A Systems Dynamics Model for Acute Care Patient Flows In New Zealand

1. A Systems Dynamics Model for Acute Care Patient Flows In New Zealand A 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 Project (SSEDNRP)

2. A Whole System Approach 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 system • Assess the impact of an intervention across the system before it is rolled out • Facilitate collaboration between different parts of the health sector VIEW WHOLE MODEL HOW IT WORKS

3. 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)

4. 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 EXAMPLE VIEW WHOLE MODEL

5. Example Left Click to see how hospital access block affects patient flow from ED Access Block Wards unable to take new patients In the ideal world, when a patient is ready to go to the ward from ED they go immediately, and patient flow is unimpeded WARD ED Patient Flow Patient Flow 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 HOW TO USE THE MODEL

6. Viewing the Model • The main model is a navigation page to explore each sub-model of the health system • Read the explanation of the model by clicking on in the main model. • Navigate back to the main model at any time by clicking on • In main model, click on any to view the part of the system you are interested in • To view the Key click • To view Abbreviations list click • Use the scroll of your mouse to enlarge the model for easy viewing. • To Submit feedback by email click on • Use of ‘Ctrl’ key + scroll of your mouse to enlarge the model may not work for some internet browsers. HOW IT WORKS HOW IT WORKS VIEW MAIN MODEL VIEW MAIN MODEL KEY ABBREVIATIONS SUBMIT FEEDBACK VIEW MAIN MODEL

7. Main Model Click a Blue Button to go to your area of interest HOW TO USE IT Other Hospital ED Intensive Care Short Stay Residential Care GP Main Ward Community Care Outpatients Electives HOW IT WORKS

8. Emergency Department Sub-Model Use ‘Ctrl’ key + scroll of your mouse to enlarge the model SUBMIT FEEDBACK KEY BACK TO MAIN MODEL

9. Short Stay Sub-Model Use ‘Ctrl’ key + scroll of your mouse to enlarge the model KEY SUBMIT FEEDBACK BACK TO MAIN MODEL

10. Intensive Care Sub-model Use ‘Ctrl’ key + scroll of your mouse to enlarge the model KEY SUBMIT FEEDBACK BACK TO MAIN MODEL

11. Ward Sub-model Use ‘Ctrl’ key + scroll of your mouse to enlarge the model KEY SUBMIT FEEDBACK BACK TO MAIN MODEL

12. Ward – General Surgery Use ‘Ctrl’ key + scroll of your mouse to enlarge the model KEY SUBMIT FEEDBACK BACK TO WARD MODEL BACK TO MAIN MODEL

13. Ward – Subspecialty Use ‘Ctrl’ key + scroll of your mouse to enlarge the model SUBMIT FEEDBACK KEY BACK TO WARD MODEL BACK TO MAIN MODEL

14. Ward – General Medicine Use ‘Ctrl’ key + scroll of your mouse to enlarge the model KEY SUBMIT FEEDBACK BACK TO WARD MODEL BACK TO MAIN MODEL

15. Primary Care Sub-modelUse ‘Ctrl’ key + scroll of your mouse to enlarge the model KEY SUBMIT FEEDBACK BACK TO MAIN MODEL

16. Outpatients Sub-modelUse ‘Ctrl’ key + scroll of your mouse to enlarge the model KEY SUBMIT FEEDBACK BACK TO MAIN MODEL

17. Electives Sub-modelUse ‘Ctrl’ key + scroll of your mouse to enlarge the model KEY SUBMIT FEEDBACK BACK TO MAIN MODEL

18. Long-term Residential Care Sub-modelUse ‘Ctrl’ key + scroll of your mouse to enlarge the model KEY SUBMIT FEEDBACK BACK TO MAIN MODEL

19. Community Care Sub-modelUse ‘Ctrl’ key + scroll of your mouse to enlarge the model KEY SUBMIT FEEDBACK BACK TO MAIN MODEL

20. Provide Feedback CLICK HERE TO PROVIDE FEEDBACK As 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

21. The Shorter Stays in ED National Research Project A 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 Stream One Stream Two Stream Three Stream Four Future policy and practice for long term health system sustainability RETURN TO HOME