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System Dynamics Modelling and its Role in Policy Development and Implementation Within the New Zealand Health Sector
Abstract
In 1996 increasing public and professional concern about the length of waiting lists for health services within New Zealand led the Government to instigate significant policy changes. These changes required the health purchasing bodies (Regional Health Authorities) to replace waiting lists with booking systems for secondary services. $NZ130 million was allocated to assist the Regional Health Authorities in this implementation. There was however, little common understanding amongst health professionals - managers and clinicians - of how a booking system would work and whether the funds allocated would achieve the government targets. A System Dynamics model was developed to assist health professionals understand the key operational dynamics of a booking system and the implications for purchasing patterns and clinical behaviour. The first phase of the work, undertaken during 1996 and 1997, focused on educating health policy makers and purchasers about the dynamics of booking systems and the operational implications of various purchasing policies. The model highlighted a number of feedback loops within the structure of the booking system which severely limited the effect of increased expenditure. The results of this initial work was used to help refine government policy. Since early 1998 the authors have been involved in implementing booking systems throughout the country. As part of this work we are now modelling, in more detail, the booking system to assist in unravelling more specific operational issues which are arising during the implementation process. The model development process is incorporating the input from approximately 50 health professionals throughout New Zealand. The paper outlines the model building process, key findings and the role of both models in assisting health professionals close the gap between health policy and practice. It highlights the role that system dynamics modelling can play in educating
... Understanding the structure that these connections make enables people to develop much deeper insights into the nature of a system and how it behaves under given conditions. Within the health sector the approach has been widely used to explore such issues as wait lists (van Ackere and Smith, 1999), health policy (Rees and Malpass, 1999), antibiotic resistance (Homer et al, 2000), HIV/AIDS (Dangerfield, 2001), chronic care (Homer et al, 2004) and general medical practice (Liddell and Powell, 2004). Most recently the American Journal of Public Health has dedication a completed volume to the application of systems thinking to public health (America Journal of Public Health, March 2006). ...
This paper looks at the use of a System Dynamics model to support the development of a strategy to address diabetes in Manukau, a large multi-cultural city sitting on the southern border of New Zealand's largest city, Auckland. The paper describes the development of the model, from a simple, high-level conceptual framework to a computer simulation used to test a range of policy scenarios. As part of a major project undertaken by the Counties Manukau District Health Board, the model was developed with a team comprising clinicians across the spectrum from public health, through primary and secondary care. The model has been useful to inform thinking and develop a broader, system-wide understanding of diabetes and the strategies needed to address it.
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