Gyuchan Thomas Jun

Health care process modelling: which method when?

OBJECTIVE The role of process modelling has been widely recognized for effective quality improvement. However, application in health care is somewhat limited since the health care community lacks knowledge about a broad range of methods and their applicability to health care. Therefore, the objectives of this paper are to present a summary description of a limited number of distinct modelling methods and evaluate how health care workers perceive them. METHODS Various process modelling methods from several different disciplines were reviewed and characterized. Case studies in three different health care scenarios were carried out to model those processes and evaluate how health care workers perceive the usability and utility of the process models. RESULTS Eight distinct modelling methods were identified and characterized by what the modelling elements in each explicitly represents. Flowcharts, which had been most extensively used by the participants, were most favoured in terms of their usability and utility. However, some alternative methods, although having been used by a much smaller number of participants, were considered to be helpful, specifically in understanding certain aspects of complex processes, e.g. communication diagrams for understanding interactions, swim lane activity diagrams for roles and responsibilities and state transition diagrams for a patient-centred perspective. DISCUSSION We believe that it is important to make the various process modelling methods more easily accessible to health care by providing clear guidelines or computer-based tool support for health care-specific process modelling. These supports can assist health care workers to apply initially unfamiliar, but eventually more effective modelling methods.

Development of modelling method selection tool for health services management: From problem structuring methods to modelling and simulation methods

BackgroundThere is an increasing recognition that modelling and simulation can assist in the process of designing health care policies, strategies and operations. However, the current use is limited and answers to questions such as what methods to use and when remain somewhat underdeveloped.AimThe aim of this study is to provide a mechanism for decision makers in health services planning and management to compare a broad range of modelling and simulation methods so that they can better select and use them or better commission relevant modelling and simulation work.MethodsThis paper proposes a modelling and simulation method comparison and selection tool developed from a comprehensive literature review, the research teams extensive expertise and inputs from potential users. Twenty-eight different methods were identified, characterised by their relevance to different application areas, project life cycle stages, types of output and levels of insight, and four input resources required (time, money, knowledge and data).ResultsThe characterisation is presented in matrix forms to allow quick comparison and selection. This paper also highlights significant knowledge gaps in the existing literature when assessing the applicability of particular approaches to health services management, where modelling and simulation skills are scarce let alone money and time.ConclusionsA modelling and simulation method comparison and selection tool is developed to assist with the selection of methods appropriate to supporting specific decision making processes. In particular it addresses the issue of which method is most appropriate to which specific health services management problem, what the user might expect to be obtained from the method, and what is required to use the method. In summary, we believe the tool adds value to the scarce existing literature on methods comparison and selection.

A rapid review method for extremely large corpora of literature: Applications to the domains of modelling, simulation, and management

While literature reviews with a large-scale scope are nowadays becoming a staple element of modern research practice, there are many challenges in taking on such an endeavour, yet little evidence of previous studies addressing these challenges exists. This paper introduces a practical and efficient review framework for extremely large corpora of literature, refined by five parallel implementations within a multi-disciplinary project aiming to map out the research and practice landscape of modelling, simulation, and management methods, spanning a variety of sectors of application where such methods have made a significant impact. Centred on searching and screening techniques along with the use of some emerging IT-assisted analytic and visualisation tools, the proposed framework consists of four key methodological elements to deal with the scale of the reviews, namely: (a) an incremental and iterative review structure, (b) a 3-stage screening phase including filtering, sampling and sifting, (c) use of visualisation tools, and (d) reference chasing (both forward and backward). Five parallel implementations of systematically conducted literature search and screening yielded a total initial search result of 146 087 papers, ultimately narrowed down to a final set of 1383 papers which was manageable within the limited time and other constraints of this research work.

Articulating current service development practices: a qualitative analysis of eleven mental health projects.

BackgroundThe utilisation of good design practices in the development of complex health services is essential to improving quality. Healthcare organisations, however, are often seriously out of step with modern design thinking and practice. As a starting point to encourage the uptake of good design practices, it is important to understand the context of their intended use. This study aims to do that by articulating current health service development practices.MethodsEleven service development projects carried out in a large mental health service were investigated through in-depth interviews with six operation managers. The critical decision method in conjunction with diagrammatic elicitation was used to capture descriptions of these projects. Stage-gate design models were then formed to visually articulate, classify and characterise different service development practices.ResultsProjects were grouped into three categories according to design process patterns: new service introduction and service integration; service improvement; service closure. Three common design stages: problem exploration, idea generation and solution evaluation - were then compared across the design process patterns. Consistent across projects were a top-down, policy-driven approach to exploration, underexploited idea generation and implementation-based evaluation.ConclusionsThis study provides insight into where and how good design practices can contribute to the improvement of current service development practices. Specifically, the following suggestions for future service development practices are made: genuine user needs analysis for exploration; divergent thinking and innovative culture for idea generation; and fail-safe evaluation prior to implementation. Better training for managers through partnership working with design experts and researchers could be beneficial.

What causes imbalance in complex service networks? Evidence from a public health service

Purpose Service networks are inherently complex as they comprise of many interrelated actors, often driven by divergent interests. This can result in imbalance, which refers to a situation where the interests of at least one actor in a network are not secured. Drawing on the “balanced centricity” perspective, the purpose of this paper is to explore the causes of imbalance in complex service networks. Design/methodology/approach Adopting a qualitative case-based approach, this paper examines a public health service network that experienced imbalance that was detrimental to the lives of its users: the Mid-Staffordshire National Health Service (NHS) Trust, UK. Drawing on service-dominant logic and stakeholder theory, case evidence provides insight into the origin and drivers of imbalance in complex public service networks. Findings The origin of imbalance stems from competing institutional logics of various actors (patients/public, employees, managers, regulatory bodies, etc.), but the degree to which these competing institutional logics lead to imbalance is moderated by accountability, communication, engagement, and responsiveness within the service network. Research limitations/implications By uncovering causes of imbalance in complex public service networks, this paper pinpoints important research avenues for developing the balanced centricity perspective. Practical implications The inherent existence of multiple parallel institutional arrangements makes networks imbalanced, but value creation can be achieved when the appropriate mechanisms are fostered to manage balance between divergent logics. Originality/value By examining imbalance as the underlying cause of network dysfunction, this research contributes to understanding of the dynamics in, and performance of, complex public service networks.

Model driven healthcare: disconnected practices

Over the past decades simulation has been recognized as a vital tool for solving problems within the healthcare sector, almost catching up with other areas. It is evident that healthcare systems are rapidly evolving into complex and dynamic environments whilst bearing a multitude of stakeholders. Simulation has originally emerged from military and manufacturing applications that mainly follow sequential processing with pre-specified targets. Such an approach is too rigid and irrelevant to the complexity and dynamism of healthcare systems, where lack of understanding is a common feature. This is mainly attributed to lack of understating of the life cycle of healthcare services. In this paper we attempt to define the life cycle of healthcare services and explore the use of modeling and simulation in supporting healthcare service development and management. We particularly explore a number of exemplars of how modeling was used to support earlier stages of the service life cycle.

A participatory systems approach to design for safer integrated medicine management

Abstract It is recognised that whole systems approaches are required in the design and development of complex health care services. Application of a systems approach benefits from the involvement of key stakeholders. However, participation in the context of community based health care is particularly challenging due to busy and geographically distributed stakeholders. This study used action research to investigate what processes and methods were needed to successfully employ a participatory systems approach. Three participatory workshops planned and facilitated by method experts were held with 30 representative stakeholders. Various methods were used with them and evaluated through an audit of workshop outputs and a qualitative questionnaire. Findings on the method application and participation are presented and methodological challenges are discussed with reference to further research. Practitioner Summary: This study provides practical insights on how to apply a participatory systems approach to complex health care service design. Various template-based methods for systems thinking and risk-based thinking were efficiently and effectively applied with stakeholders.

System Diagrams for Healthcare Incident Investigation: Ease of Understanding and Usefulness Perceived by Healthcare Workers

System diagrams for healthcare incident investigation: ease of understanding and usefulness perceived by healthcare workers [Abstract]

Safety I and Safety II for suicide prevention – Lessons from how things go wrong and how things go right in community-based mental health services [Abstract]

Prevention of patient suicide is a major challenge for mental health services. This study applied both safety I and safety II approaches to gain an understanding of the detection and response process for suicide prevention in community mental health care in order to compare/contrast outputs from each approach. For safety I, 41 suicide incident reports were analysed using a systemic analysis approach. For safety II, interviews with 20 community-based mental health practitioners and managers were conducted asking their know-hows to successful suicide risk detection and response. The five key issues found from the Safety I approach were: (i) an inherent weakness in the interactions between patient and clinician with the presence of uncertainty in the risk detection; (ii) Poor patients’ engagement with services; (iii) Reliance on patients self-presenting in crisis and declining the offered support options; (iv) Delay in treating new patients; (v) Coordination, communication and process issues. On the other hand, the safety II approach revealed a complex decision-making process with the presence of uncertainty and trade-offs between patient clinical need, patient desire, legal and procedural obligations, and resource considerations. It also revealed a strong theme on the importance of peer-support. The results of this study indicate that safety II approach provides valuable insights into how to strengthen the system performance without challenging systemic issues, while system I approach identifies systemic issues and raise questions how to address them. These findings suggest the potential benefit of applying both approaches to quality and safety improvement in healthcare.

Design as a Provocation to Support Discussion About Euthanasia: The Plug

Dementia affects 47 million people worldwide [1]. It is a collection or consequence of many illnesses with symptoms including deterioration in memory, thinking and behaviour; it is a terminal disease. The fear of dementia may lead people to signing an Advance Euthanasia Directive (AED). AEDs are rarely adhered to because the dementia symptoms conflict with the due care criteria; a person requesting euthanasia must be able to confirm the request at time of death and must be undergoing hopeless suffering. Once dementia has progressed, the euthanasia ‘wish’ can no longer be confirmed, and assessing suffering in a person with dementia is hard. This creates difficulties for physicians supporting patient wishes. Speculative Design is described as a way to prototype other realities [2]. This paper describes a Speculative Design to explore patient autonomy for end-of-life decisions in dementia. A short video was developed to imagine the AED as an implant that would trigger a swift and painless death, once the conditions described in the AED were reached. Data were collected at the DementiaLab conference in Dortmund, Germany, September 2017. The workshop was attended by 15 participants of varying ages and backgrounds. The results found that the Speculative Design had potential to aid discussion between stakeholders, without each party needing to be a specialist. It sparked debate, but with a caveat about the importance of boundaries for awareness of the wider context and sensitivity to inherent bias.