High-fidelity whole-system patient flow modeling to assess health care transformation policies

Health systems are continuously seeking ways of transforming their capacities and processes to provide care in novel ways that are aligned with emerging best practices and patient choice while remaining responsive to fiscal pressures. These transformation policy options call for interventions across multiple sectors and patient cohorts, and expect benefits to be realized across the care system, driving policy analysts to take a whole-system point of view in their assessments. This paper presents a system dynamics simulation for the assessment of healthcare transformation policies involving alterations to patient pathways and service levels. The model takes a whole-system, strategic perspective, and is designed to evaluate the direction and magnitude of patient flow changes resulting from transformation policy implementations. The strategic simulation model is developed through a collaborative process with decision-makers across the health system. It has a simple model structure while providing detailed breakdown of cross-sector flows through the use of patient-level clinical and demographic data. A use case is presented for the assessment of the impact of Ontario's proposed stroke best practices. The results indicate significant patient flow gains from the implementation of this policy, which are contingent on significant investments in the community care sector.