1. 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 structure
2. Identify control issues
3. Dynamic implications of the model structure
4. 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_29oct1
3_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)