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RESEARCH PRODUCT

Using Group Model Building and System Dynamics Modeling in Health Care Quality Assessment

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Introduction & Research Aim Drawing from previous research on performance management, arguing that measurement systems in the public sector sometimes lead to harmful outcomes (Bianchi, 2010, 2015; Bivona & Montemaggiore, 2010), the purpose of this study is to assess the long-term dynamic impact of “ESY-net” (i.e. the Greek public hospitals' national performance measurement system) on the quality of healthcare services. Methods As hospital quality is a quite broad and abstract concept, perceived differently by different stakeholders, we will take a systemic view (Meadows, 2008; Sterman, 1994) and use Group Model Building (GMB) (De Gooyert, 2016, 2018; De Gooyert, Honingh, & Van Genugten, 2019; Richardson & Andersen, 1995; Vennix, 1996;) and System Dynamics Modelling (Forrester, 1961; Richardson & Pugh, 1981; Sterman, 1989, 2000) to facilitate our perspective. Following Scott, Cavana & Cameron’s (2015) suggestion, we will use a comparative, multiple-case-study approach, combining primary qualitative data from preliminary semi-structured interviews, and GMB sessions with secondary qualitative and quantitative data from literature reviews and from official, open-access, online text-documents (i.e minutes of hospital council’s meetings, official statistic records, statements of performance targets and quality objectives) gathered from the Greek ministry of Health, the Greek Statistic centre, the web-based repository of ESY-net and the hospital websites. Four quality managers of public hospitals will be interviewed (gatekeepers) and snowball sampling will then be used to select 20 participants for the GMB sessions. GMB sessions will be organised in cooperation with the gatekeepers in their hospitals, including at least one person from all main key-stakeholder categories identified (managers, doctors, nurses, health workers, patients). Qualitative data from the literature (critically reviewed) and the online documents (narratively analysed with open and axial codes) will be used to derive a preliminary causal loop diagram (CLD) of hospital quality to be used during the preliminary interviews with the quality experts. Data from interviews will be used to refine this preliminary model and derive the “concept model”, used as a starting point of all GMB sessions. VENSIM and STELLA modeling software will be used. Expected Results Each session will produce a different CLD model as a final product. We will comparatively analyse all CLD models to create one "divergent" and one "convergent" version of the healthcare quality CLD, the latter of which will be converted into a quantified Stock-and-Flow model (SFD). Quantitative data (mainly statistical) will be drawn from the online documents and the literature in order to be used in the model formulation and analysis. The GMB and System Dynamics approach will provide us with a systemic perspective of the mechanisms that lead to quality services in the public healthcare sector. Our CLD and SFD models will not only make a theoretical contribution to the literature of public governance and healthcare quality, but also be used for insight and practical suggestions to hospital managers and health workers. Limitations & Future Research Future research would enable the validation of our findings through triangulation, e.g. by repeating the GMB sessions with larger participant groups from other countries.