Assessment of health service systems: a case study of metamodelling to explore options for future health service provision

Within health services, debates about the future configuration of services often involve a variety of stakeholders. Operational research or systems models can be used to inform such debates. The paper introduces our notion of metamodelling as a process of modelling with the stakeholder(s), i.e. an interactive process for involving them in: (1) eliciting model structures and parameters for use in a particular situation, and (2) using some model(s) to explore a particular decision situation. This involves working with a combination of different forms of representation, selected according to the context and according to the preferences of the stakeholders. The paper presents a case study involving the use of a simulation model, specifically an attraction constrained spatial interaction model, to provide information to assist in the exploration of different options for the future provision of inpatient hospital facilities in a region of the UK.