Computer Simulation Within Action Research: A Promising Combination for Improving Healthcare Delivery?

Abstract

Action research (AR) is increasingly being used to study the improvement of healthcare delivery. Ensuring that all the stakeholders in the AR are willing to take action, however, can be difficult. Especially in healthcare contexts, action plans may challenge the autonomy of the healthcare professionals and the positions of the different stakeholder groups. Does the use of computer simulation techniques within the AR promote action taking by all the stakeholders? We performed an AR experiment with computer simulation in a university hospital's emergency department in the Netherlands. A simulation model was designed that replicated the actual healthcare delivery process in the study setting. Together with representatives from the medical and nursing staff and department management, we used the model to discuss improvement actions. The team designed an improvement scenario that fundamentally rearranged the task division between the physicians and the nurses. The promising projections in the simulation model motivated the team to try the scenario in reality. The implementation was successful, although it generated much concerns and discussion. The new task division successfully improved patient length of stay (LOS) in the ED. The results achieved by the single team turned out to have lasting effects on the other stakeholders in the ED. Our AR experiment with computer simulation promoted action taking by all the stakeholders. Computer simulation within AR is a promising combination for improving healthcare delivery.

Trialability, observability and risk reduction accelerating individual innovation adoption decisions

“…To address problems associated with population growth and aging and increasing incidence of chronic disease, some health services have adopted innovative approaches from other fields, including operations management and computer simulation (Clague et al, 1997;Hashimoto and Bell, 1996;Rosmulder et al, 2011). Despite the apparent value of these approaches, no research to date examines the induced diffusion of process innovations from manufacturing to health services settings.…”

“…However, to date little research has examined the factors influencing the diffusion of process innovations from manufacturing to health services settings, or the use of computer simulation to encourage the adoption of process change. The intentional use of animated computer simulation as a tool to accelerate or induce the DoIs from manufacturing to health settings is a new field (Rosmulder et al, 2011). This paper describes and analyses the use of animated computer simulation in facilitating clinicians' adoption decisions when encountering Lean Systems Thinking for the first time.…”

Engaging Healthcare Staff and Stakeholders in Healthcare Simulation Modeling to Better Translate Research Into Health Impact: A Systematic Review

“…Some studies provided descriptions about how they facilitated this input, which ranged from structured and active methods where stakeholders were asked specific questions (31) or engaged in purposeful storytelling exercises (32), to unstructured and passive methods where stakeholders provided feedback about or annotated an existing model (30,40). More structured methods of facilitation were used in early stages when studies were engaging stakeholders in designing the model from scratch (24,31,32,36,37,44,53), and more passive methods were used when stakeholders were engaged at a later stage and a draft model had already been designed (16,30,35,38,40,48). Further details about the Modes of Engagement & Facilitation are found in Appendix C.…”

Insights Gained From a Re-analysis of Five Improvement Cases in Healthcare Integrating System Dynamics Into Action Research

“…Little has, however, been reported about experiences from integrating any simulation method into an AR process. [27][28][29] Here we analyse five improvement cases in healthcare where SD was integrated into AR processes to support multi-professional groups in finding solutions to workrelated challenges. The aim of our study was to explore how this particular integration adapted to each case over time and to identify related work patterns and principles which can provide methodological guidance for practitioners and improve chances of actualisation in the client organization.…”