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This paper discusses the strategies required to develop system dynamics capabilities in hospital environments and to use simulation analysis to help hospital organizations address important operational problems. The system dynamics perspective has the ability to create improvements in strategic management, both in overcoming single-issue challenges and in spurring continuous process improvement (Sterman, 2000). Prior system dynamics work has often addressed systematic health care challenges from a disease perspective, such as oral health (Hirsch et al., 1975); cardiovascular disease (Hirsch & Myers,1975; Luginbuhl et al., 1981); diabetes (Homer et al., 2004; Jones et al., 2006); obesity (Homer et al., 2006); smoking (Tengs et al., 2001); and chronic illnesses more generally (Hirsch & Immediato, 1999; Homer et al., 2007) This work, however, contributes to a growing body of literature that focuses on how structures and decisions embedded within hospital organizations subvert efforts to change and improve the performance of health care delivery, such as ward management (Akiyama et al., 2009); patient flow (Wolstenholme, 1999); and safe design capacity (Wolstenholme et al., 2007).
Of particular importance are the dynamics relating to the emergence of new Health Information Systems (HIS) that have the potential to revolutionize hospital practice and management, improve patient safety, and create vast new rich new datasets. Many excellent HIS systems, however, go unused or under-utilized because HIS implementation is met with resistance by staff and managers. For example, Dr. Steven Cantrill, a practicing emergency medical doctor, describes the challenge as thus: “health-care providers (especially physicians) have little tolerance for systems that serve as impediments to getting their work done, often regardless of what positives might accrue from using such a system.” (Cantrill, 2010) Further, if HIS are implemented, unanticipated behavioral decisions resulting from HIS implementation can create counterintuitive outcomes that actually subvert overall hospital efficiency. Implementations resulting in unintended negative “side-effects” include computerized prescriber order entry (Zhan et al., 2006), electronic health records (Sidorov, 2006), bar code technology (Poon, 2006), and overall HIT systems (Ash et al., 2003; Wears & Berg, 2005; Kohn, 2000). Finally, once developed, there are often significant barriers to utilize HIS data-sets to help hospitals implement changes and manage operations (Goodman et al., 2011).