System Dynamics Approach to Model Risk in Complex Healthcare Settings : Time Constraints , Production Pressures and Compliance with Safety Controls

Risk is an inherent part of healthcare, particularly in large referral centers, where some of the most complex cases are managed. While risk cannot be eliminated from the clinical activities, it is believed that some practices involving unnecessary risk can be mitigated without impacting overall performance. Our ability to identify these vulnerable practices, and develop durable preventative or mitigating strategies, however, is hampered by outdated models of risk and an inadequate approach to the analysis of risk. In an effort to develop more realistic models of risk in complex healthcare settings, we applied a system dynamics framework to model how features of the environment (e.g., time pressures, resource shortages, etc.) and human attributes (e.g., risk tolerance, confidence in existing safety policies, etc.) combine to influence safety. The models have enabled us to study, through simulation, the complex interactions between production pressures, historical experience with adverse outcomes, inherent risk tolerance/propensity, confidence in and compliance with safety controls. We present here the modeling strategy and the results of a series of simulation experiments studying these phenomena.