Applying Qualitative System Dynamics to Enhance Performance Measurement for a Sustainable Health System in British Columbia

William Yang | Graduate Student | School of Health Information Science | University of Victoria

• Sustainability in a health system context is often referred to as the ability to meet the needs of future generations without compromising the needs of current generations (Faezipour et al., 2013).

• Sustainable Health and Health Care is the appropriate balance between the cultural, social, and economic environments designed to meet the health and health care needs of individuals and the population (from health promotion and disease prevention to restoring health and supporting end of life) and that leads to optimal health and health care outcomes without compromising the outcomes and ability of future generations to meet their own health and health care needs (Prada et al., 2014).

• System Performance Measurement offers policymakers a major opportunity to secure health system improvement and accountability. A vital requirement of any performance measurement system is to formulate a robust conceptual framework within which performance measures can be developed. Definitions of performance measures can then fit into the framework (Smith et al., 2010).

• BC Health System Strategy, released in February 2014, emphasized the successful implementation of a three-year plan requires a clear performance management accountability framework built on public reporting (BC Ministry of Health, 2014).

• System Dynamics is a qualitative description and exploration of complex systems for analyzing system processes, information, boundaries and strategies, which facilitates quantitative simulation modeling and analysis for the design of system structure and control (Wolstenholme, 1990). This methodology can be used to support policy analysis and design (System Dynamics Society, 2013).

• The Qualitative System Dynamics methodology contains two phases (Wolstenholme, 1985). The first phase is to describe the system and understand the problem so that an initial interpretation of the system can be constructed into a mental model, which is often referred to as influence or causal loop diagram. The second phase involves the qualitative analysis of derived diagrams, which contains the following four steps:

1. Static analysis of the model structure2. Identify control issues3. Dynamic implications of the model structure4. Identify factors likely to lead to improved system performance

Qualitative System Dynamics

Health System Sustainability

System Performance Measurement

• Despite the recent stagnation in the growth of health spending among the 34 OECD (Organization for Economic Co-operation and Development) countries, health expenditure continues to consume a large portion of national budgets in the developed world (OECD, 2013).

• Effective health system management is required to control the growth of health expenditure, regulate distributions of the health budget, and maintain a sustainable health system for consumers and taxpayers.

Introduction

• BC Ministry of Health. (2013, June). 2012/13 Annual Service Plan Report. Retrieved from: http://www.bcbudget.gov.bc.ca/Annual_Reports/2012_2013/pdf/ministry/hlth.pdf

• BC Ministry of Health. (2014, February). Setting Priorities for the B.C. Health System. Retrieved from: http://www.health.gov.bc.ca/library/publications/year/2014/Setting-priorities-BC-Health-Feb14.pdf

• BC Patient Safety & Quality Council. (2012, September). BC Health Quality Matrix. Retrieved from: http://bcpsqc.ca/documents/2012/09/BCPSQC-Matrix_FEB20.pdf

• Canadian Institute for Health Information. (2013, October). Health spending in Canada 2013. Retrieved from: http://www.cihi.ca/cihi-ext-portal/internet/en/document/spending+and+health+workforce/spending/release_29oct13_infogra1pg

• Faezipour, M. & Ferreira, S. (2013, March 19). A system dynamics perspective of patient satisfaction in healthcare. Conference on System Engineering Research (CSER’13). 148-156.

• Organisation for Economic Co-operation and Development. (2013). Health spending continues to stagnate, says OECD. Retrieved from: http://www.oecd.org/els/health-systems/health-spending-continues-to-stagnate-says-oecd.htm

• Prada, G., Grimes, K. & Sklokin L. (2014, July). Defining Health and Health Care Sustainability. Canadian Alliance for Sustainable Health Care. The Conference Board of Canada. Retrieved from: http://www.conferenceboard.ca/e-library/abstract.aspx?did=6269

• Smith, P.C., Mossialos, E., Papanicolas, I., & Leatherman, S. (2010). Performance Measurement for Health System Improvement. Experiences, Challenges and Prospects. UK: Cambridge University Press.

• System Dynamics Society. (2013). The Field of System Dynamics. Retrieved from: http://www.systemdynamics.org/what-is-s/#approach

• Wolstenholme, E.F. (1985). A Methodology for Qualitative System Dynamics. System Dynamics Conference. Retrieved from: http://www.systemdynamics.org/conferences/1985/proceed/wolst1049.pdf

• Wolstenholme, E.F. (1990). Systems Enquiry: A System Dynamics Approach. John Wiley & Sons, Chichester, UK.

Reference

Infographic on Health Spending in Canada in 2013 (CIHI, 2013)Skyrocketing Increase of Health Budget in BC (BC Ministry of Health, 2013)

BC Health Quality Matrix Published by the BC Patient Safety & Quality Council (BCPSQC, 2013)

Causal loop diagram of the Conceptual Framework for the BC Performance Measurement System (Work in Progress)