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 For the Shorter Stays in Emergency Departments National Research Project (SSEDNRP)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 WHOLE MODEL VIEW EXAMPLE

5. Example ED WARD Access Block Patient Flow 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 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 Patient Flow HOW TO USE THE MODEL Left Click to see how hospital access block affects patient flow from ED

6. Viewing the Model HOW IT WORKS VIEW MAIN MODEL The main model is a navigation page to explore each sub-model of the health system 1)Read the explanation of the model by clicking on in the main model. 2)Navigate back to the main model at any time by clicking on 3)In main model, click on any to view the part of the system you are interested in 4)To view the Key click 5)To view Abbreviations list click 6)Use the scroll of your mouse to enlarge the model for easy viewing. 7)To Submit feedback by email click on 8)Use of Ctrl key + scroll of your mouse to enlarge the model may not work for some internet browsers. SUBMIT FEEDBACK KEY ABBREVIATIONS VIEW MAIN MODEL HOW IT WORKS

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

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

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

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

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

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

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

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

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

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

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

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

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

20. 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. Model Key A factor which is unknown or variable Flow with factors that can be manipulated/turned on/off Factors converting inputs to outputs Reservoirs of patient flow (both into and out of stocks) Parts of the health sector Sub-model within a part (represents different care models by speciality) Links between parts of the system Symbol Definition RETURN TO PREVIOUS PAGE VIEW MAIN MODEL

22. Abbreviations ALOS: Average Length of Stay ED: Emergency Department HDU: High Dependency Unit ICU: Intensive Care Unit GM: General Medicine GS: General Surgery LTRC: Long Term Residential Care OP: Outpatients OPH:Older Peoples Health OR: Operating Room SMO: Senior Medical Officer SS: Subspecialty SSU:Short Stay Unit RETURN TO PREVIOUS PAGE VIEW MAIN MODEL KEY

23. The Shorter Stays in ED National Research Project Stream One Stream Two Stream Three Stream Four 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 RETURN TO HOME