Participatory system dynamics modeling: Identifying, understanding and modifying drivers of implementation outcomes

Lindsey Zimmerman, Ph.D.
National Center for PTSD

ABSTRACT:
Evidence-based practices (EBPs) may be adopted by providers, prioritized by leadership and supported by health system infrastructure, yet still not reach an adequate proportion of patients. In these systems, local staff expertise and operations data can be synthesized in a participatory system dynamics (PSD) model. PSD capitalizes on health record data, stakeholder expertise and simulation to optimize implementation. PSD modeling simulation empowers stakeholders, enabling them see the potential yield of implementation plans prior to implementation by zooming in on the entire EBP care continuum: referral to EBP, scheduling EBPs, staffing for EBPs, patient initiation of EBPs, completing a therapeutic dose of an EBP and patient benefit from an EBP. PSD models evaluate stakeholders' theories of clinic operation, testing explanatory mechanisms (i.e., local policies and procedures) by which EBP reach could be improved. In this way, the PSD process increases staff general capacity for quality improvement, while the PSD modeling tool identifies strategies most likely to improve implementation outcomes given local EBP-specific capacities and constraints.