Using simulation modelling to test the impact of future demand for end-of-life care

Abstract

Health systems globally are exploring new models of care to address the increasing demand for palliative, hospice, and end-of-life care. Yet few tools exist at the population level to explore "what if" scenarios and test, in a "cost avoidance environment," the impact of these new care models on policy, workforce, technology, and funding. This article introduces the application of scenario-based "what if" thinking and discrete event simulation in strategic planning for a not-for-profit hospice organization. It will describe how a set of conceptual models was designed to frame discussions between strategic partners about the implications and alternatives in implementing a new, integrated service model for palliative and end-of-life care.

Predicting and testing a silo-free delivery system

“…To support this, we are proposing new tools to predict and test models of care and new ways of working. 11,[19][20][21] Simulating business systems and performance was difficult in the past, but modern methods and tools now make it practical and easy. Live, quantified business models, using scenario generation and population health simulation tools, enable organizations and groups to co-design and continuously monitor system performance.…”

“…Potential outcomes can be tested and changes made prior to project investment. 21,29,30 Although there is considerable variation in governance arrangements, powers, and leadership capacity, there are enough resources to improve healthcare for the population. 1,2,4,6,9…”

“…Pairing experts from disciplines not traditionally associated with health issues, such as computer science, mathematics, and engineering, with health researchers who have access to decades of population health data, could facilitate the development of innovative care models. 11,19,21,26,29,30 Rethinking tradition: Creating an effective approach to predicting the future Strategic planning and decision-making is becoming more complex. For example, provincial governments set policy and strategy for the health of their population and negotiate physician payment models and budgets 1 Currently, provincial strategies are distributed to local regions/health authorities to develop implementation plans within defined budgets.…”

“…new way of working, aimed at addressing the needs of various population groups and communities. 21 As depicted in the diagram, using an outcomes-based approach versus the traditional strategic planning approach enables system-wide participants to bridge the gap between needs and outcomes, aligning the system drivers with the strategic goals. Scenario validation and simulation tools allow for testing the "model solutions" and may lead to more effective, evidence-based decisions.…”

“…Scenario validation and simulation tools allow for testing the "model solutions" and may lead to more effective, evidence-based decisions. 19,21,[22][23][24][25][26][27] The successful application of simulation modelling outlined in this article, and the enthusiasm and engagement of key participants in several of our case studies, has strengthened the argument for using simulation modelling to test policy and system changes prior to implementation. As the complexity of health systems increases within an environment of constrained resources, so too does the need for evidencebased decision-making.…”