System Dynamics Modeling of Multi-level Coping Responses to Understand Resilience

描述(由申请人提供)：急诊科/医院拥挤是一个主要的公共卫生问题，导致各种健康状况的过程和结果衡量标准的退化，包括急性心脏护理、老年人护理、肺炎、疼痛管理、儿科护理和公共健康筛查。拥挤问题是复杂的社会行为的一个例子，这种复杂的社会行为是由系统的各个元素(患者、提供者、资源、政策、做法、健康状况和其他)相互作用而产生的。拥挤问题表现出了“政策阻力”：尽管20年来一直是一个令人担忧的问题，但它仍在继续恶化。更阴险的是，目前提出的许多解决方案可能会产生反馈，从而在恶性循环中加剧问题。由于其动态复杂性、延迟的反馈环路和社会行为组件，该问题似乎非常适合系统动力学方法。例如，了解拥挤的系统动力学将在以下方面有所帮助： *制定潜在过度拥挤危机的早期预警信号和应对措施 *确定杠杆点，以管理患者需求或组织应对能力的动态和意外变化 *确定要避免的潜在功能失调的干预措施，即可能提供短期缓解但最终使整体问题恶化的干预措施。 这个项目的总体目标是使用系统动力学模型来研究急诊科(ED)和医院拥挤的问题，以便发展理论，并为旨在缓解这一问题的部门、组织、地区和社会政策和干预措施提供信息。 一个由具有行为和社会科学以及计算建模和系统思维专业知识的科学家组成的跨学科研究团队将使用经历过严重拥挤问题的单一医疗组织作为模型开发的试验场。该团队将构建急诊室-医院拥挤问题的系统动力学模型，紧密植根于焦点急诊室中人们的个人和集体行为。这些模型将侧重于普通业务，即不是外部灾难情景。这些模型将研究拥挤的急救人员如何经历常规操作的扰动，这些扰动如何引发应对和恢复的多层次反应，以及弹性在系统行为中的作用。这些模型将用于探索和实验，以确定特征行为，评估潜在的干预措施，并确定支持弹性绩效的杠杆点和关键变量。该项目旨在利用系统动力学模型来开发理论，以帮助我们了解教育署如何在更广泛的医疗保健和紧急反应系统的背景下，适应不同的服务需求和这种适应行为的后果。因此，NIGMS最适合作为主要资助方，NIMH作为次要资助方。

DESCRIPTION (provided by applicant): ED / hospital crowding is a major public health problem that leads to degradation in both process and outcome measures across a wide range of health conditions, including acute cardiac care, care for the elderly, pneumonia, pain management, pediatric care, and public health screening. The crowding problem is an example of complex social behavior that emerges from the interaction of individual elements (patients, providers, resources, policies, practices, health conditions, and others) of the system. The crowding problem has exhibited "policy resistance": despite being a source of concern for 20 years, it continues worsen. Even more insidiously, many current proposed solutions may have feedbacks that exacerbate the problem in a vicious cycle. Because of its dynamic complexity, delayed feedback loops, and social- behavioral components, the problem seems ideally suited to a system dynamics approach. For example, a system dynamics understanding of crowding would be useful in the following ways: * Developing early warning signals of and responses to a potential overcrowding crisis * Identifying leverage points for managing dynamic and unexpected changes in patient demand or organizational capacity to respond * Identifying potentially dysfunctional interventions to be avoided, i.e., that might provide short term relief but ultimately make the overall problem worse. The broad, overall objective of this project is use system dynamics modeling to study the problem of emergency department (ED) and hospital crowding in order to develop theory and inform departmental, organizational, regional, and societal policies and interventions aimed at alleviating it. A trans-disciplinary research team comprising scientists with expertise in the behavioral and social sciences as well as in computational modeling and systems thinking will use a single healthcare organization that has experienced severe crowding problems as a test site for the model development. The team will construct system dynamic models of the ED - hospital crowding problem, tightly grounded in the individual and collective behavior of people in a focal ED. These models will focus on ordinary operations, i.e., not external disaster scenarios. The models will study the ways in which crowded EDs experience perturbations to routine operations, how these perturbations occasion multi-level responses to cope and recover, and the role of resilience in the behavior of the system. The models will be used for exploration and experimentation to identify characteristic behaviors, evaluate potential interventions, and identif leverage points and critical variables supporting resilient performance. The project aims to use the system dynamics models to develop theory to inform our understanding of how the ED, in the context of the broader healthcare and emergency response system, adapts to varying demands for service and the consequences of this adaptive behavior. It would thus be most suitable for NIGMS as primary funder, with the NIMH as secondary.