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Emergency department crowding in Singapore: insights from a systems thinking approach

Emergency department crowding in Singapore: insights from a systems thinking approach
Emergency department crowding in Singapore: insights from a systems thinking approach
Objectives: Emergency Department crowding is a serious and international health care problem that seems to be resistant to most well intended but often reductionist policy approaches. In this study, we examine Emergency Department crowding in Singapore from a systems thinking perspective using causal loop diagramming to visualize the systemic structure underlying this complex phenomenon. Furthermore, we evaluate the relative impact of three different policies in reducing Emergency Department crowding in Singapore: introduction of geriatric emergency medicine, expansion of emergency medicine training, and implementation of enhanced primary care.

Methods: The construction of the qualitative causal loop diagram is based on consultations with Emergency Department experts, direct observation, and a thorough literature review. For the purpose of policy analysis, a novel approach, the path analysis, is applied.

Results: The path analysis revealed that both the introduction of geriatric emergency medicine and the expansion of emergency medicine training may be associated with undesirable consequences contributing to Emergency Department crowding. In contrast, enhancing primary care was found to be germane in reducing Emergency Department crowding; in addition, it has apparently no negative side effects, considering the boundary of the model created.

Conclusion: Causal loop diagramming was a powerful tool for eliciting the systemic structure of Emergency Department crowding in Singapore. Additionally, the developed model was valuable in testing different policy options.
2050-3121
1-10
Schoenenberger, Lukas K.
fa7905ca-61d6-42d1-9440-ee5cf9cc4a2a
Bayer, Steffen
28979328-d6fa-4eb7-b6de-9ef97f8e8e97
Ansah, John P.
b75fc1e9-200f-4333-95d0-75c8af42fe35
Matchar, David B.
d93302f6-c585-4c64-a58d-c6d63264f928
Mohanavalli, Rajagopal L.
fc245f3c-994c-4fa6-b3e8-6e0c9ee2d2b2
Lam, Sean S.W.
b03081e1-e179-41fe-89aa-cf631284ed0a
Ong, Marcus E.H.
78d1dd4e-7b2e-4437-aeb0-880892d9b83f
Schoenenberger, Lukas K.
fa7905ca-61d6-42d1-9440-ee5cf9cc4a2a
Bayer, Steffen
28979328-d6fa-4eb7-b6de-9ef97f8e8e97
Ansah, John P.
b75fc1e9-200f-4333-95d0-75c8af42fe35
Matchar, David B.
d93302f6-c585-4c64-a58d-c6d63264f928
Mohanavalli, Rajagopal L.
fc245f3c-994c-4fa6-b3e8-6e0c9ee2d2b2
Lam, Sean S.W.
b03081e1-e179-41fe-89aa-cf631284ed0a
Ong, Marcus E.H.
78d1dd4e-7b2e-4437-aeb0-880892d9b83f

Schoenenberger, Lukas K., Bayer, Steffen, Ansah, John P., Matchar, David B., Mohanavalli, Rajagopal L., Lam, Sean S.W. and Ong, Marcus E.H. (2016) Emergency department crowding in Singapore: insights from a systems thinking approach. Sage Open Medicine, 4, 1-10. (doi:10.1177/2050312116671953).

Record type: Article

Abstract

Objectives: Emergency Department crowding is a serious and international health care problem that seems to be resistant to most well intended but often reductionist policy approaches. In this study, we examine Emergency Department crowding in Singapore from a systems thinking perspective using causal loop diagramming to visualize the systemic structure underlying this complex phenomenon. Furthermore, we evaluate the relative impact of three different policies in reducing Emergency Department crowding in Singapore: introduction of geriatric emergency medicine, expansion of emergency medicine training, and implementation of enhanced primary care.

Methods: The construction of the qualitative causal loop diagram is based on consultations with Emergency Department experts, direct observation, and a thorough literature review. For the purpose of policy analysis, a novel approach, the path analysis, is applied.

Results: The path analysis revealed that both the introduction of geriatric emergency medicine and the expansion of emergency medicine training may be associated with undesirable consequences contributing to Emergency Department crowding. In contrast, enhancing primary care was found to be germane in reducing Emergency Department crowding; in addition, it has apparently no negative side effects, considering the boundary of the model created.

Conclusion: Causal loop diagramming was a powerful tool for eliciting the systemic structure of Emergency Department crowding in Singapore. Additionally, the developed model was valuable in testing different policy options.

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2050312116671953 - Version of Record
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More information

Accepted/In Press date: 22 August 2016
e-pub ahead of print date: 4 October 2016
Published date: 25 November 2016
Additional Information: doi: 10.1177/2050312116671953
Organisations: Decision Analytics & Risk

Identifiers

Local EPrints ID: 411001
URI: https://eprints.soton.ac.uk/id/eprint/411001
ISSN: 2050-3121
PURE UUID: 2cda2050-ad97-41a5-a109-b6c531f37c2a

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Date deposited: 13 Jun 2017 16:31
Last modified: 13 Mar 2019 19:47

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