Systems thinking methods: a worked example of supporting emergency medical services decision-makers to prioritize and contextually analyse potential interventions and their implementation

Health Research Policy and Systems, vol. 21, pp. 42

Abstract

BACKGROUND: Systems thinking can be used as a participatory data collection and analysis tool to understand complex implementation contexts and their dynamics with interventions, and it can support the selection of tailored and effective implementation actions. A few previous studies have applied systems thinking methods, mainly causal loop diagrams, to prioritize interventions and to illustrate the respective implementation context. The present study aimed to explore how systems thinking methods can help decision-makers (1) understand locally specific causes and effects of a key issue and how they are interlinked, (2) identify the most relevant interventions and best fit in the system, and (3) prioritize potential interventions and contextually analyse the system and potential interventions. METHODS: A case study approach was adopted in a regional emergency medical services (EMS) system in Germany. We applied systems thinking methods following three steps: (1) a causal loop diagram (CLD) with causes and effects (variables) of the key issue "rising EMS demand" was developed together with local decision-makers; (2) targeted interventions addressing the key issue were determined, and impacts and delays were used to identify best intervention variables to determine the system's best fit for implementation; (3) based on steps 1 and 2, interventions were prioritized and, based on a pathway analysis related to a sample intervention, contextually analysed. RESULTS: Thirty-seven variables were identified in the CLD. All of them, except for the key issue, relate to one of five interlinked subsystems. Five variables were identified as best fit for implementing three potential interventions. Based on predicted implementation difficulty and effect, as well as delays and best intervention variables, interventions were prioritized. The pathway analysis on the example of implementing a standardized structured triage tool highlighted certain contextual factors (e.g. relevant stakeholders, organizations), delays and related feedback loops (e.g. staff resource finiteness) that help decision-makers to tailor the implementation. CONCLUSIONS: Systems thinking methods can be used by local decision-makers to understand their local implementation context and assess its influence and dynamic connections to the implementation of a particular intervention, allowing them to develop tailored implementation and monitoring strategies.

Authors 8

1. Cassandra Rehbock Aachen Aachen Institute for Rescue Management & Public Safety

   Maastricht University · Universitätsklinikum Aachen · Care and Public Health Research Institute · RWTH Aachen University

   Affiliation as printed

   Aachen Institute for Rescue Management and Public Safety, University Hospital RWTH Aachen and City of Aachen, 52068, Aachen, Germany

   Department of Health, Ethics and Society, Care And Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, 6229 ER, The Netherlands

   Aachen Institute for Rescue Management and Public Safety, University Hospital RWTH Aachen and City of Aachen, Aachen, Germany

   Department of Health, Ethics and Society, Care And Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands

2. Thomas Krafft corresponding

   Maastricht University · Care and Public Health Research Institute

   Affiliation as printed

   Department of Health, Ethics and Society, Care And Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, 6229 ER, The Netherlands. thomas.krafft@maastrichtuniversity.nl

   Department of Health, Ethics and Society, Care And Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands

3. Anja Sommer Aachen Aachen Institute for Rescue Management & Public Safety

   Maastricht University · Universitätsklinikum Aachen · Care and Public Health Research Institute · RWTH Aachen University

   Affiliation as printed

   Aachen Institute for Rescue Management and Public Safety, University Hospital RWTH Aachen and City of Aachen, 52068, Aachen, Germany

   Department of Health, Ethics and Society, Care And Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, 6229 ER, The Netherlands

   Aachen Institute for Rescue Management and Public Safety, University Hospital RWTH Aachen and City of Aachen, Aachen, Germany

   Department of Health, Ethics and Society, Care And Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands

4. Carijn Beumer

   Maastricht University · Care and Public Health Research Institute

   Affiliation as printed

   Department of Health, Ethics and Society, Care And Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, 6229 ER, The Netherlands

   Department of Health, Ethics and Society, Care And Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands

5. Stefan Kurt Beckers Aachen Aachen Institute for Rescue Management & Public Safety

   Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   Aachen Institute for Rescue Management and Public Safety, University Hospital RWTH Aachen and City of Aachen, 52068, Aachen, Germany

   Aachen Institute for Rescue Management and Public Safety, University Hospital RWTH Aachen and City of Aachen, Aachen, Germany

6. Stefan Thate Aachen

   Carl von Ossietzky Universität Oldenburg · Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   City of Oldenburg - Fire Department, 26127, Oldenburg, Germany

   Oldenburg Research Network Emergency and Intensive Care Medicine (OFNI), Carl Von Ossietzky University, 26129, Oldenburg, Germany

   University Institute of Medical Informatics, University Hospital RWTH Aachen, 52057, Aachen, Germany

   City of Oldenburg - Fire Department, Oldenburg, Germany

   Oldenburg Research Network Emergency and Intensive Care Medicine (OFNI), Carl Von Ossietzky University, Oldenburg, Germany

   University Institute of Medical Informatics, University Hospital RWTH Aachen, Aachen, Germany

7. Jörn Kaminski
   Affiliation as printed

   Rettungsdienst Landkreis Oldenburg, 27793, Wildeshausen, Germany

   Rettungsdienst Landkreis Oldenburg, Wildeshausen, Germany

8. Alexandra Ziemann

   Maastricht University · Care and Public Health Research Institute · University of Bath

   Affiliation as printed

   Department of Health, Ethics and Society, Care And Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, 6229 ER, The Netherlands

   Department of Social and Policy Sciences, University of Bath, Bath, BA2 7AY, United Kingdom

   Department of Health, Ethics and Society, Care And Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands

   Department of Social and Policy Sciences, University of Bath, Bath, United Kingdom