Development and use of a decision support tool for cooperation between emergency departments and out-of-hours cooperatives of general practitioners

MOTIVATION: Cooperation between emergency departments (ED) of hospitals and out-of-hours cooperatives of general practitioners (GP-OOH) for delivering urgent health care is highly debated in recent years. Although there are several cooperation initiatives throughout the Netherlands, there is a lack of evidence about outcomes. Traditional research designs are not capable of dealing with the complexity and (local) context related to cooperation of organizations. Therefore, it is unknown how to organize cooperation and division of tasks and responsibilities to ensure optimal outcomes. STUDY GOAL: The goal of this study is to develop and use a decision support tool ('management cockpit') to give health care providers and management insight in the effects of variants of cooperation on performance of the local urgent health care system. Simulation of best practices, alternative forms of organization and sensitivity analysis will provide a common knowledge basis for health care providers, management and researchers. METHOD: System Dynamics Modeling and Simulation. This method helps to build a realistic simulation model of complex organizational processes and coordination and to use this model to simulate decisions to change the processes and coordination. Model building and simulation are done interactively with managers and professionals in 8 phases. Phase 1: creating causal maps. In three regions, a graphical representation ('causal map') of the current urgent health care processes of ED and GP-OOH will be made by the researchers, interacting with a group of health care providers and management of both organizations; Phase 2: translation of the causal map (by the researchers) into a quantitative simulation model including a user-friendly 'management cockpit'; Phase 3: comparison of basic scenarios and identification of performance indicators; Phase 4: defining alternative options (new ideas, best practices, what if); Phase 5: building and computation of alternative models including sensitivity analysis; Phase 6: presentation and discussion of alternative models; Phase 7: interactive simulation by healthcare providers and managers using the 'management cockpit'; Phase 8: reporting and making the 'management cockpit' accessible via internet for other health care organizations. INNOVATION. The innovation in this project lies in 1) developing a decision support tool for a health care area where traditional research methods fail; and 2) interactive knowledge exchange between health care providers, management and researchers. TIMELINE: Preparation and causal maps (phase 1): 3 months; Building simulation models, alternatives and management cockpit (phases 2, 3): 4 months; Interactive simulation (phases 4, 5, 6, 7): 2 months; Reporting and internet-accessibility (phase 8): 3 months. Total project duration: 12 months.