Participatory System Dynamics Modeling: Increasing Stakeholder Engagement and Precision to Improve Implementation Planning in Systems

Implementation planning typically incorporates stakeholder input. Quality improvement efforts provide data-based feedback regarding progress. Participatory system dynamics modeling (PSD) triangulates stakeholder expertise, data and simulation of implementation plans prior to attempting change. Frontline staff in one VA outpatient mental health system used PSD to examine policy and procedural “mechanisms” they believe underlie local capacity to implement evidence-based psychotherapies (EBPs) for PTSD and depression. We piloted the PSD process, simulating implementation plans to improve EBP reach. Findings indicate PSD is a feasible, useful strategy for building stakeholder consensus, and may save time and effort as compared to trial-and-error EBP implementation planning.

[1]  C. B. Taylor,et al.  National dissemination of cognitive behavioral therapy for depression in the Department of Veterans Affairs health care system: therapist and patient-level outcomes. , 2012, Journal of consulting and clinical psychology.

[2]  Oded Susskind,et al.  The VA/DOD Clinical Practice Guideline for Management of Post-Traumatic Stress (update 2010): development and methodology. , 2012, Journal of rehabilitation research and development.

[3]  R. Rosenheck,et al.  Sources of the increasing number of Vietnam era veterans with a diagnosis of PTSD using VHA services. , 2014, Psychiatric services.

[4]  J. Forrester Industrial Dynamics , 1997 .

[5]  Candice Bowman,et al.  Role of "external facilitation" in implementation of research findings: a qualitative evaluation of facilitation experiences in the Veterans Health Administration , 2006, Implementation science : IS.

[6]  Simon Peck,et al.  Group Model Building: Facilitating Team Learning Using System Dynamics , 1996, J. Oper. Res. Soc..

[7]  Josef I. Ruzek,et al.  Implementation of evidence-based psychological treatments in the Veterans Health Administration. , 2012 .

[8]  Jo Rycroft Malone The PARIHS framework--a framework for guiding the implementation of evidence-based practice. , 2015 .

[9]  G. Aarons,et al.  The implementation leadership scale (ILS): development of a brief measure of unit level implementation leadership , 2014, Implementation Science.

[10]  John D. Sterman,et al.  System Dynamics: Systems Thinking and Modeling for a Complex World , 2002 .

[11]  W. Livingood,et al.  Opening a Window on Systems Science Research in Health Promotion and Public Health , 2013, Health education & behavior : the official publication of the Society for Public Health Education.

[12]  G. Aarons,et al.  Advancing a Conceptual Model of Evidence-Based Practice Implementation in Public Service Sectors , 2010, Administration and Policy in Mental Health and Mental Health Services Research.

[13]  Jennifer Duffy,et al.  Unpacking Prevention Capacity: An Intersection of Research-to-practice Models and Community-centered Models , 2008, American journal of community psychology.

[14]  Hazhir Rahmandad,et al.  Effects of feedback delay on learning , 2009 .

[15]  K. Chard,et al.  Dissemination and experience with cognitive processing therapy. , 2012, Journal of rehabilitation research and development.

[16]  C. Estabrooks,et al.  Ingredients for change: revisiting a conceptual framework , 2002, Quality & safety in health care.

[17]  John D. Sterman,et al.  Business dynamics : systems thinking and modelling for acomplex world , 2002 .

[18]  Jill Khadduri,et al.  The 2013 Annual Homelessness Assessment Report (AHAR) to Congress: Part 1, Point-in-Time Estimates of Homelessness , 2013 .

[19]  Donald D. McGeary,et al.  Burnout among psychiatrists in the Veterans Health Administration , 2015 .

[20]  S. Sansgiry,et al.  Changes in psychotherapy utilization among veterans with depression, anxiety, and PTSD. , 2014, Psychiatric services.

[21]  Kim Warren,et al.  Improving strategic management with the fundamental principles of system dynamics , 2005 .

[22]  VA/DOD Clinical Practice Guideline for the Management of Posttraumatic Stress Disorder and Acute Stress Disorder: Clinician Summary. , 2018, Focus.

[23]  Uwe Siebert,et al.  Modeling good research practices--overview: a report of the ISPOR-SMDM Modeling Good Research Practices Task Force--1. , 2012, Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research.

[24]  J. Sterman Learning from evidence in a complex world. , 2006, American journal of public health.

[25]  Kim Warren,et al.  Why has feedback systems thinking struggled to influence strategy and policy formulation? Suggestive evidence, explanations and solutions , 2004 .

[26]  Morsi Mansour,et al.  Scaling up proven public health interventions through a locally owned and sustained leadership development programme in rural Upper Egypt , 2010, Human resources for health.

[27]  Donella H. Meadows The Electronic Oracle: Computer Models and Social Decisions , 2007 .

[28]  George P. Richardson,et al.  Best practices in system dynamics modeling , 2013 .

[29]  K. Osatuke,et al.  Psychological Safety and Error Reporting Within Veterans Health Administration Hospitals , 2015, Journal of patient safety.

[30]  J. Sterman Learning in and about complex systems , 1994 .

[31]  H. Simon,et al.  Bounded Rationality and Organizational Learning , 1991 .

[32]  M. Metzler,et al.  The CDC ' s Diabetes Systems Modeling Project : Developing a New Tool for Chronic Disease Prevention and Control , 2004 .

[33]  J. Vest,et al.  A critical review of the research literature on Six Sigma, Lean and StuderGroup's Hardwiring Excellence in the United States: the need to demonstrate and communicate the effectiveness of transformation strategies in healthcare , 2009, Implementation science : IS.

[34]  Josianne Basque,et al.  Modeling for learning , 2010 .

[35]  Abraham Wandersman,et al.  A practical implementation science heuristic for organizational readiness: R = MC2. , 2015, Journal of community psychology.

[36]  Arie W Kruglanski,et al.  The multifinality constraints effect: how goal multiplicity narrows the means set to a focal end. , 2011, Journal of personality and social psychology.

[37]  Petra Wächter Thinking in systems – a primer , 2011 .

[38]  R. Rosenheck,et al.  A formative evaluation of two evidence-based psychotherapies for PTSD in VA residential treatment programs. , 2013, Journal of traumatic stress.

[39]  Dean Tjosvold,et al.  Book review : Group model building : facilitating team learning using system dynamics , 1998 .

[40]  Diana Wright,et al.  Thinking in systems: a primer , 2012 .

[41]  C. Rosen,et al.  Effectiveness of national implementation of prolonged exposure therapy in Veterans Affairs care. , 2013, JAMA psychiatry.

[42]  J. Lowery,et al.  Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science , 2009, Implementation science : IS.

[43]  David A. Chambers,et al.  The dynamic sustainability framework: addressing the paradox of sustainment amid ongoing change , 2013, Implementation Science.

[44]  Yasuomi Ouchi,et al.  Microglial activation in young adults with autism spectrum disorder. , 2013, JAMA psychiatry.

[45]  Ingrid M. Nembhard,et al.  Assessing the Evidence of Six Sigma and Lean in the Health Care Industry , 2010, Quality management in health care.

[46]  D. Periard,et al.  Predictors of Job Satisfaction and Turnover Intention in VHA Mental Health Employees: A Comparison Between Psychiatrists, Psychologists, Social Workers, and Mental Health Nurses , 2015 .

[47]  B. Weiner,et al.  Implementation Science a Theory of Organizational Readiness for Change , 2009 .

[48]  David A. Chambers,et al.  National Institutes of Health approaches to dissemination and implementation science: current and future directions. , 2012, American journal of public health.

[49]  Alex H. S. Harris,et al.  Measuring the quality of substance use disorder treatment: evaluating the validity of the Department of Veterans Affairs continuity of care performance measure. , 2009, Journal of substance abuse treatment.

[50]  D. Luke,et al.  Systems science methods in public health: dynamics, networks, and agents. , 2012, Annual review of public health.

[51]  Steffen Bayer,et al.  Business dynamics: Systems thinking and modeling for a complex world , 2004 .

[52]  B. Karlin,et al.  From the laboratory to the therapy room: National dissemination and implementation of evidence-based psychotherapies in the U.S. Department of Veterans Affairs Health Care System. , 2014, The American psychologist.

[53]  Brian Shiner,et al.  Implementation of evidence-based psychotherapies for posttraumatic stress disorder in VA specialty clinics. , 2014, Psychiatric services.

[54]  Peter S. Hovmand,et al.  Community Based System Dynamics , 2013 .

[55]  Leonard W. D'Avolio,et al.  Measuring Use of Evidence Based Psychotherapy for Posttraumatic Stress Disorder , 2013, Administration and Policy in Mental Health and Mental Health Services Research.

[56]  George P. Richardson,et al.  Introduction to System Dynamics Modeling with DYNAMO , 1981 .

[57]  Pamela Mazzocato,et al.  Lean thinking in healthcare: a realist review of the literature , 2010, Quality and Safety in Health Care.

[58]  William H. Glick,et al.  Fit, Equifinality, and Organizational Effectiveness: A Test of Two Configurational Theories , 1993 .

[59]  Han K. Kang,et al.  Are Iraq and Afghanistan veterans using mental health services? New data from a national random-sample survey. , 2013, Psychiatric services.

[60]  Peter M. Senge,et al.  Modeling For Learning Organizations , 1994 .

[61]  P. Senge The fifth discipline : the art and practice of the learning organization/ Peter M. Senge , 1991 .

[62]  Aaron R. Lyon,et al.  Modeling the Impact of School-Based Universal Depression Screening on Additional Service Capacity Needs: A System Dynamics Approach , 2016, Administration and Policy in Mental Health and Mental Health Services Research.

[63]  Elliot Bendoly,et al.  System Dynamics Understanding in Projects: Information Sharing, Psychological Safety, and Performance Effects , 2014 .

[64]  Jay W. Forrester,et al.  “The” model versus a modeling “process” , 1985 .

[65]  E. Rogers Diffusion of Innovations , 1962 .

[66]  E. Proctor,et al.  Writing implementation research grant proposals: ten key ingredients , 2012, Implementation Science.

[67]  Geoff McDonnell,et al.  A model linking clinical workforce skill mix planning to health and health care dynamics , 2010, Human resources for health.

[68]  P. Senge The fifth discipline : the art and practice of the learningorganization , 2006 .

[69]  David B Matchar,et al.  Strategic Planning to Reduce the Burden of Stroke Among Veterans: Using Simulation Modeling to Inform Decision Making , 2014, Stroke.

[70]  Enola K. Proctor,et al.  A Compilation of Strategies for Implementing Clinical Innovations in Health and Mental Health , 2012, Medical care research and review : MCRR.

[71]  Alicia C. Bunger,et al.  Outcomes for Implementation Research: Conceptual Distinctions, Measurement Challenges, and Research Agenda , 2010, Administration and Policy in Mental Health and Mental Health Services Research.