Transfer care system performance in relation to resource scarcity

Abstract

The Netherlands is experiencing a significant increase in its aging population. Multi morbidity and a rapidly growing shortage of healthcare personnel are putting pressure on the healthcare system, leading to capacity issues. The capacity problems of care have medical, safety, social, and economic consequences. Policy measures are needed to address these challenges and improve the transfer care system. Therefore, the research question is: On which factors should policy interventions by the Ministry of Health, Welfare, and Sport be aimed, to improve the performance of the Dutch transfer care system? This study uses qualitative System Dynamics (SD), a method that uses causal loop diagrams, to analyze the relationships between factors that influence the transfer care system performance, such as the demographic changes and workforce shortage. The goal is to find strategies and solutions for a sustainable healthcare system. A visual SD model is used to highlight the complexity of the transfer care system and to reveal inter dependencies, interactions, and feedback loops, aiming to understand system dynamics. A literature review, multiple interviews and case studies have revealed factors and interactions that are modeled in a causal loop diagram. This qualitative System Dynamics analysis revealed both unidirectional (+ or -) and different polarity (+/-) interactions/feedback loops between/among the indicators, which implicates that certain policy interventions (mentioned in Dutch policy notes and other publications) may not achieve the intended results. Based on the interactions found, the Ministry of Health, Welfare and Sport can start using a bundle of interventions aiming on reducing workload/number of admissions and simultaneously keeping availability of aftercare constant. Additionally, the Ministry can improve other indicators, when keeping workload constant. However, to determine how many additional interventions are needed to keep workload and availability aftercare constant and to determine the net total effect of interactions with different polarities, quantitative System Dynamics is needed. In addition, quantitative System Dynamics is needed to be able to prioritize policy interventions, because qualitative System Dynamics is not able to determine the net effect of feedback loops. However, this qualitative System Dynamics study provides a solid foundation with which researchers (and the Ministry of Health, Welfare and Sport) can proceed to construct a quantitative model.