Abstract
Hospitals provide highly sophisticated services, but they are largely steered by means of simplistic management models, which do not match the complexities faced by these organizations. The design of management models in hospitals and public organizations at large shows a bend toward reductionism. The reductionism of these models is rooted in their short-termism, and in the myopia of their designers. The purpose of our contribution is to draft a path by which steering approaches can be developed, which are more effective in coping with organizational complexity than the short-termist, reductionist management models often in use. Using a generic model, we demonstrate that conventional approaches to steering entail unintended side effects leading to counterproductive system behaviors and to results inferior to those coming from no steering at all. We suggest how more sophisticated steering models can be designed to induce desirable modes of system behavior.
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Notes
- 1.
We define “efficiency” as the ratio between useful output and total input, or, more generally the ability of doing things well (“doing a task right”). In contrast, we define “effectiveness” as the degree to which a goal or desired condition is achieved (“doing the right task”, also: doing something useful).
- 2.
In the present context, we conceive of “interdisciplinary” as a way of interacting among professionals from different disciplines. The attribute “transdisciplinary” then refers to a way of virtuous collaboration across disciplines, enabled through a shared theoretical framework or code.
- 3.
“Autopoietic” (from Greek) stands for the properties of self-production and self-maintenance of a biological or social system.
- 4.
We used efficiency more in the context of the short term, and effectiveness rather in terms of the long view.
- 5.
To make generally correct the statement “X and Y move in the same [opposite] direction”, a more precise formulation is necessary: “If X increases, Y increases above [below] what it would have been” (Richardson 1997).
- 6.
It is necessary to employ a double precision version of the software being utilized (in this case VENSIM).
- 7.
A cut of 15% of the budget is assumed (see scenarios in the next section).
- 8.
- 9.
That applies, as well, to temporary budget cuts for 1 or 2 years, but there the headcount rebounds, with a notable delay, as the budget goes back to normal.
- 10.
References
Barlas, Y. (1996). Formal aspects of model validity and validation in system dynamics. System Dynamics Review, 12(3), 183–210.
Beer, S. (1979). Heart of enterprise. Chichester: Wiley.
Boos, F., & Mitterer, G. (2014). Einführung in das systemische Management. Heidelberg: Carl-Auer-Systeme Verlag.
Carton, R. B., & Hofer, C. W. (2006). Measuring organizational performance: Metrics for entrepreneurship and strategic management research. Cheltenham, UK: Edward Elgar.
Conant, R. C., & Ashby, W. R. (1981, originally published in 1970). Every good regulator of a system must be a model of that system. mechanisms of intelligence: Ross Ashby’s writings on cybernetics (pp. 205–214) (R. C. Conant, Ed.). Seaside, CA: Intersystems Publications.
Dangerfield, B. (2014). Systems thinking and system dynamics: A primer. In S. Brailsford, L. Churilov, & B. Dangerfield (Eds.), Discrete-event simulation and system dynamics for management decision making (pp. 26–51). Chichester: Wiley.
Forrester, J. W. (1961). Industrial dynamics. Cambridge, MA: MIT Press.
Forrester, J. W. (1968). Principles of systems. Waltham, MA: Pegasus Communications.
Forrester, J. W. (1971). Counterintuitive behavior of social systems. Technology Review, 73(3), 52–68.
Forrester, J. W., & Senge, P. M. (1980). Tests for building confidence in system dynamics models. In A. A. J. Legasto, J. W. Forrester, & J. M. Lyneis (Eds.), system dynamics (pp. 209–228). Amsterdam: North-Holland.
Gladen, W. (2014). Performance measurement controlling mit Kennzahlen. Wiesbaden: Springer Fachmedien Wiesbaden.
Grossmann, R., & Scala, K. (2002). Intelligentes Krankenhaus: Innovative Beispiele der Organisationsentwicklung. Wien/New York: Springer.
Harper, P. R. (2002). A framework for operational modelling of hospital resources. Health Care Management Science, 5, 165–173.
Kaplan, R. S., & Norton, D. P. (1996). Using the balanced scorecard as a strategic management system. Harvard Business Review, 74(1), 1–14.
Oliva, R. (2016). Structural dominance analysis of large and stochastic models. System Dynamics Review, 32(1), 26–51.
Pierce, J. L., Kostova, T., & Dirks, K. (2001). Toward a theory of psychological ownership in organizations. Academy of Management Review, 26, 298–310.
Richardson, G. (1997). Problems in causal loop diagrams revisited. System Dynamics Review, 13(3), 247–252.
Richardson, G. P. (2011). Reflections on the foundations of system dynamics. System Dynamics Review, 27(3), 219–243.
Schwaninger, M. (1994). Managementsysteme. Frankfurt, New York: Campus.
Schwaninger, M., & Grösser, S. (2011). System dynamics modeling: Validation for quality assurance. In R. A. Meyers (Ed.), Complex systems in finance and econometrics (Vol. 2, pp. 767–78). New York: Springer.
Schwaninger, M., & Klocker, J. (2017a). Holistic systems design: The oncology carinthia study. In C. García-Díaz & C. Olaya (Eds.), Social systems engineering. Chichester: Wiley.
Schwaninger, M., & Klocker, J. (2017b). Systemic development of health organizations: An integrative systems methodology. In H. Qudrat-Ullah & P. Tsasis (Eds.), Innovative health systems for the 21st century. New York: Springer.
Senge, P. M. (1990). The fifth discipline: The art and practice of the learning organization. New York: Currency Doubleday.
Sterman, J. D. (2000). Business dynamics. Systems thinking and modeling for a complex world. Boston, MA: Irwin/Mc Graw-Hill.
Sterman, J. D. (1984). Appropriate summary statistics for evaluating the historical fit of system dynamics models. Dynamica, 10(2), 51–66.
Theil, H. (1966). Applied Economic forecasting. Chicago: Rand McNally.
Van Dyne, L., & Pierce, J. L. (2004). Psychological ownership and feelings of possession: Three field studies predicting employee attitudes and organizational citizenship behavior. Journal of Organizational Behavior, 25, 439–459.
Vennix, J. A. M. (1996). Group model building: Facilitating team learning using system dynamics. Chichester: Wiley.
Wolstenholme, E. F. (2003). Towards the definition and use of a core set of archetypal structures in system dynamics. System Dynamics Review, 19(1), 7–26.
Zelman, W. N., Pink, G. H., & Matthias, C. B. (2003). Use of the balanced scorecard in health care. Journal of Health Care Finance, 29(4), 1–16.
Ziegler, A., Lange, S., & Bender, R. (2007). Überlebenszeitanalyse: Der Log-Rang Test. Deutsche Medizinische Wochenschrift, 132, e39–e41.
Acknowledgements
The authors wish to thank two anonymous reviewers for their insightful critiques. Special thanks go to Ms. Evgenia Ushakova for her valuable comments on our text and precious help in technical matters. The authors are also grateful to Dr. John Peck for his excellent review of the English.
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Appendix: Parameter Values
Appendix: Parameter Values
Parameter | Value in the original model | Unit | Source | Value in the calibrated model |
|---|---|---|---|---|
Normal Daily Budget | 6630 | Euro/day | ed | 6562 |
Initial Personnel | 51 | Person | hf | 51 |
Personnel Cost | 130 | Euro/(day*person) | hf | 130 |
Delay Hires | 60 | Day | ed | 58 |
Initial Experience | 16320 | Day*person | ed | 16,256 |
Normal Personnel Turnover | 0.0033 | 1/day | ed | 0.0033 |
Cost without Personnel Cost per Patient/Day | 500 | Euro/person/day | ed | 500 |
Maximal Flat Rate per Case | 3500 | Euro/person | ed | 3500 |
Treatment Capacity | 80 | Person | hf | 80 |
Delay Quality of Care | 30 | Day | ed | 35 |
Target Personnel per Patient under Treatment | 0.625 | Dimensionless | ed | 0.75 |
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Schwaninger, M., Klocker, J. (2018). Efficiency Versus Effectiveness in Hospitals: A Dynamic Simulation Approach. In: Borgonovi, E., Anessi-Pessina, E., Bianchi, C. (eds) Outcome-Based Performance Management in the Public Sector. System Dynamics for Performance Management, vol 2. Springer, Cham. https://doi.org/10.1007/978-3-319-57018-1_20
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