System Dynamic Modelling of Patient Flow and Transferral Problem in a Mixed Public-Private Healthcare System: A Case Study of Hong Kong SAR

Abstract

The current healthcare system in Hong Kong is experiencing pressure due to constrained resources, with dramatic increases in inpatient services queue lengths, dissatisfaction with the working environment, unacceptable workforce arrangements and high turnover rate of hospital staff. To maintain the robustness of the healthcare system and a sustainable inpatients flow, the Food and Health Bureau launched a public-private partnership programme to utilise the resources of the public and private hospitals. This research investigates the potential for extension of the programme and further enhancing the sustainability of the long-term inpatient services under a mixed public-private healthcare policy via system dynamic modelling. The findings show that an increase of human resources in public hospitals does not substantially improve inpatient flow rate performance. Further, the results from the system dynamic approach provide insights into the expansion of the service areas of the programme and suggest increasing the number of referrals to private hospitals.

This is a preview of subscription content, log in to check access.

References

  1. Ahsan K, Rahman S (2017). Green public procurement implementation challenges inAustralian public healthcare sector. Journal of Cleaner Production 152:181–197.

    Article  Google Scholar 

  2. Barlas Y (1994). Model validation in system dynamics. In Proceedings of the 1994 Iinternational System Dynamics Conference: 1–10. Sterling, Scotland.

    Google Scholar 

  3. Bastian N D, Munoz D, Ventura M. (2016). A mixedmethods research framework for healthcare process improvement. Journal of Pediatric Nursing 31(1):39–51.

    Article  Google Scholar 

  4. Brailsford S C (2008). System dynamics: What's in it for healthcare simulation modelers. In 2008 Winter Simulation Conference: 1478–1483, IEEE.

    Google Scholar 

  5. Caterina Cavicchi, Emidia Vagnoni (2017). Does intellectual capital promote the shift of healthcare organizations towards sustainable development? Evidence from Italy. Journal of Cleaner Production 153:275–286.

    Article  Google Scholar 

  6. Census & Statistics Department (2015). Hong Kong population projections 2015–2064. http://www.statistics.gov.hk/pub/B1120015062015XXXXB0100.pdf.

    Google Scholar 

  7. Census & Statistics Department (2016a). Gross domestic product. http://www.statistics.gov.hk/pub/B10300012016QQ01B0100.pdf.

    Google Scholar 

  8. Census & Statistics Department (2016b). Hong kong annual digest of statistics. http://www.statistics.gov.hk/pub/B10100032016AN16B0100.pdf.

    Google Scholar 

  9. Census & Statistics Department.(2016c). Population by age group and sex. https://www.censtatd.gov.hk/hkstat/sub/sp150.jsp?tableID=002&ID=0&productType=8.

    Google Scholar 

  10. Census & Statistics Department (2016d). Women and men in Hong Kong key statistics. http://www.statistics.gov.hk/pub/B11303032016AN16B0100.pdf..

    Google Scholar 

  11. Chaerul M, Tanaka M, Shekdar A V (2008). A system dynamics approach for hospitalwaste management. Waste Management 28(2):442–449.

    Article  Google Scholar 

  12. Cheng TC, Haisken-DeNew J P, Yong J (2015). Cream skimming and hospital transfers in a mixed public-private system. Social Science & Medicine 132:156–164.

    Article  Google Scholar 

  13. Chiarini A, Opoku A, Emidia V (2017). Public healthcare practices and criteria for a sustainable procurement: A comparative study between UK and Italy. Journal of Cleaner Production 162:391–399.

    Article  Google Scholar 

  14. Comendeiro-Maaløe M, Ridao-López M, Gorgemans S, Bernal-Delgado E (2019). Public-private partnerships in the spanish national health system: The reversion of the Alzira model. Health Policy 123(4):408–411.

    Article  Google Scholar 

  15. Coyle R G (1996). System Dynamics Modelling: A practical approach, Volume 1. CRC Press.

  16. Dangerfield B C (2016). System Dynamics Applications to European Healthcare Issues. Palgrave Macmillan UK, London.

    Google Scholar 

  17. Du LL, Li XZ, Zhao HJ, Ma W C, Jiang P (2018). System dynamic modeling of urban carbon emissions based on the regional national economy and social development plan: A case study of Shanghai city. Journal of Cleaner Production 172:1501–1513.

    Article  Google Scholar 

  18. Faezipour M, Ferreira S (2013). A system dynamics perspective of patient satisfaction in healthcare. Procedia Computer Science 16:148–156.

    Article  Google Scholar 

  19. Food & Health Bureau (2015). Report of the steering committee on review of hospital authority. http://www.fhb.gov.hk/en/committees/harsc/report.html.

    Google Scholar 

  20. Food & Health Bureau (2017). Health expenditure. http://www.fhb.gov.hk/statistics/en/statistics/health_expenditure.htm#table2.

    Google Scholar 

  21. Forrester JW (1961). Industrial Dynamics. MIT Press, Cambridge, Massachusetts.

    Google Scholar 

  22. Forrester JW (1969). Urban Dynamics. MIT Press, Cambridge, Massachusetts. Gonzalez- Busto B, Garcia R (1999). Waiting lists in Spanish public hospitals: A system dynamics approach. System Dynamics Review 15(3):201–224.

    Google Scholar 

  23. Guo QX, Wang E, Nie YY, Shen JY (2018). Profit or environment? A system dynamic model analysis of waste electrical and electronic equipment management system in China. Journal of Cleaner Production 194:34–42.

    Article  Google Scholar 

  24. Hejazi T H, Badri H, Yang K (2019). A reliability-based approach for performance optimization of service industries: An application to healthcare systems. European Journal of Operational Research 273(3):1016–1025.

    Article  Google Scholar 

  25. Hirsch G, Immediato C S (1999). Microworlds and generic structures as resources for integrating care and improving health. System Dynamics Review 15 (3):315–330.

    Article  Google Scholar 

  26. Homer J, Hirsch G, Minniti M, Pierson M (2004a). Models for collaboration: Howsystem dynamics helped a community organize cost-effective care for chronic illness. System Dynamics Review 20(3):199–222.

    Article  Google Scholar 

  27. Homer J, Jones A, Don Seville, Essien J, Bobby Milstein, Dara Murphy (2004). The CDC's diabetes systems modeling project: Developing a newtool for chronic disease prevention and control. In 22nd International Conference of the System Dynamics Society: 25–29.

    Google Scholar 

  28. Homer J B, Hirsch B G, Milstein B(2007). Chronic illness in a complex health economy: The perils and promises of downstream and upstream reforms. SystemDynamics Review 23 (2-3): 313–343.

    Google Scholar 

  29. Homer J B, Hirsch B G(2006). System dynamics modeling for public health: Background and opportunities. American Journal of Public Health 96(3):452–458.

    Article  Google Scholar 

  30. Hong Kong Government (2017). Health facts of Hong Kong. www.ha.org.hk/visitor/ha_visitor_index.asp?Content_ID=221223&Lang=ENG&Dimension=100&Parent_ID=214172&Ver=HTML.

    Google Scholar 

  31. Hospital Authority (2011). Hospital authority annual report 2010–2011. http://www.ha.org.hk/ho/corpcomm/Annual%20Report/2010-11_chi.pdf.

    Google Scholar 

  32. Hospital Authority (2013). Hospital authority statistical report 2011–2012. http://www.ha.org.hk/upload/publication_15/471.pdf.

    Google Scholar 

  33. Hospital Authority (2018a). Annual plan 2018–2019. www.ha.org.hk/haho/ho/ap/AP18-19Eng.pdf.

    Google Scholar 

  34. Hospital Authority (2018b). Waiting time for total joint replacement surgery. www.ha.org.hk/visitor/ha_visitor_index.asp?Content_ID=221223&Lang=ENG&Dimension=100&Parent_ID=214172&Ver=HTML.

    Google Scholar 

  35. Keung KL, Lee C, Ng KKH, Leung S S, Choy KL (2018). An empirical study on patients' acceptance and resistance towards electronic health record sharing system: Acase study of Hong Kong. International Journal of Knowledge and Systems Science(?KSS) 9(2):1–27.

    Article  Google Scholar 

  36. Lai H Y, Chen C H, Zheng P, Li P K (2020). Investigating the evolving context of an unstable approach in aviation from mental model disconnects with an agent-based model. Reliability Engineering & System Safety 193:106–657.

    Article  Google Scholar 

  37. Lane D C, Monefeldt C, Rosenhead J V (2016). Looking in the Wrong Place for Healthcare Improvements: A System Dynamics Study of an Accident and Emergency Department. Palgrave Macmillan UK, London.

    Google Scholar 

  38. Lee C K M, Keung K L, Ng K K H, Lai D C P (2018). Simulation-based multiple automated guided vehicles considering charging and collision-free requirements in automatic warehouse. In 2018 IEEE International Conference on Industrial Engineering and Engineering Management (IEEM): 1376–1380, IEEE.

    Google Scholar 

  39. Lee C K M, Ng K K H, Chan, K L Choy, W C Tai, L S Choi (2018a). A multi-group analysis of social media engagement and loyalty constructs between fullservice and low-cost carriers in hong kong. Journal of Air Transport Management 73:46–57.

    Article  Google Scholar 

  40. Lee C K M, K K H Ng, Kwong C K, Tay S T (2018b). A system dynamics model for evaluating foodwaste management in Hong Kong, China. Journal of Material Cycles and Waste Management.Doi:10.1007/s10163-018-0804-8.

    Google Scholar 

  41. Lee C K M, Ng K K H, Kwong C K, Tay S T (2019). A system dynamics model for evaluating foodwaste management in Hong Kong, China. Journal of Material Cycles and Waste Management 21(3):433–456.

    Article  Google Scholar 

  42. Lee C K M, Huo Y Z, Zhang S Z, Ng K KH (2020). Design of a smart manufacturing system with the application of multi-access edge computing and blockchain technology. IEEE Access. Doi:10.1109/ACCESS.2020.2972284.

    Google Scholar 

  43. Legislative Council (2012). Lcq1: Waiting time for public hospital services. http://www.info.gov.hk/gia/general/201202/08/P201202080335.htm.

    Google Scholar 

  44. Legislative Council (2015). Lcq15: Nursing manpower in public hospitals. http://www.info.gov.hk/gia/general/201510/28/P201510280704htm.

    Google Scholar 

  45. Leung G M, Wong I OL, Chan W S, Choi S, Lo S V (2005). The ecology of health care in Hong Kong. Social Science & Medicine 61(3):577–590.

    Article  Google Scholar 

  46. Julien Mercille (2019). The public-private mix in primary care development: The case of Ireland. International Journal of Health Services 49(3):412–430.

    Article  Google Scholar 

  47. Ng K K H, Lee C K M, Chan F T S, Qin Y C (2017). Robust aircraft sequencing and scheduling problem with arrival/departure delay using the min-max regret approach. Transportation Research Part E: Logistics and Transportation Review 106:115–136.

    Article  Google Scholar 

  48. Ng KKH, Lee CKM, Felix T S Chan, Yaqiong Lv (2018). Review on meta-heuristics approaches for airside operation research. Applied Soft Computing 66:104–133.

    Article  Google Scholar 

  49. Ng K K H, Lee C K M, Chan F T S, Chen C H, Qin Y C (2020). A two-stage robust optimisation for terminal traffic flow problem. Applied Soft Computing 89:106048.

    Article  Google Scholar 

  50. Nikolaou I, Evangelinos K, Filho W L (2015). A system dynamic approach for exploring the effects of climate change risks on firms' economic performance. Journal of Cleaner Production 103:499–506.

    Article  Google Scholar 

  51. Qudrat-Ullah H, Seong B S (2010). How to do structural validity of a system dynamics type simulation model: The case of an energy policy model. Energy Policy 38(5):2216–2224.

    Article  Google Scholar 

  52. Rashwan W, Abo-Hamad W, Arisha A (2015). A system dynamics viewof the acute bed blockage problem in the Irish healthcare system. European Journal of Operational Research 247(1):276–293.

    Article  Google Scholar 

  53. Ritchie-Dunham J L, Galván J F M (1999). Evaluating epidemic intervention policies with systems thinking: A case study of dengue fever in Mexico. System Dynamics Review 15(2):119.

    Article  Google Scholar 

  54. Royston G, Dost A, Townshend J, Turner H (1999). Using system dynamics to help develop and implement policies and programmes in health care in England. System Dynamics Review 15(3): 293.

    Article  Google Scholar 

  55. Sabounchi N S, Hovmand P S, Osgood N D, Dyck R F, Jungheim E S (2014). A novel system dynamics model of female obesity and fertility. American Journal of Public Health 104(7):1240–1246.

    Article  Google Scholar 

  56. Sahin O, Siems R S, Stewart R A, Porter M G (2016). Paradigm shift to enhanced water supply planning through augmented grids, scarcity pricing and adaptive factory water: A system dynamics approach. Environmental Modelling & Software 75:348–361.

    Article  Google Scholar 

  57. Amir S, Savage E (2014). Private and public patients in public hospitals in Australia. Health Policy 115(2):189–195.

    Google Scholar 

  58. Schaffernicht M, Groesser S N (2011). A comprehensive method for comparing mental models of dynamic sys LEE et al.: System Dynamic Modelling of Patient Flow and Transferral Problem in a Mixed Public-Private Healthcare System 19 tems. European Journal of Operational Research 210(1):57–67.

    Article  Google Scholar 

  59. Senge P M, Forrester J W (1980). Tests for building confidence in system dynamics models. System Dynamics, TIMS Studies in Management Sciences 14:209–228.

    Google Scholar 

  60. Smits M (2010). Impact of policy and process design on the performance of intake and treatment processes in mental health care: A system dynamics case study. Journal of the Operational Research Society 61(10):1437–1445.

    Article  Google Scholar 

  61. Swanson J D (2002). Business dynamics - Systems thinking and modeling for a complex world. Journal of the Operational Research Society 53(4):472–473.

    Article  Google Scholar 

  62. Tsui Y M, Fong B Y F (2018). Waiting time in public hospitals: case study of total joint replacement in HongKong. Public Administration and Policy.

    Google Scholar 

  63. Ackere A Van, Smith P C (1999). Towards a macro model of national health servicewaiting lists. System Dynamics Review 15(3):225.

    Article  Google Scholar 

  64. Olmen J Van, Criel B, Bhojani U, Marchal B, Van Belle S, Chenge MF, Hoerée T, Pirard Ma, Van Damme W, Kegels G (2012). The health system dynamics framework: The introduction of an analytical model for health system analysis and its application to two case-studies. Health, Culture and Society 2(1):1–21.

    Article  Google Scholar 

  65. Wickramasinghe N, Chalasani S, Boppana R V, Madni A M (2007). Healthcare system of systems. 2007). In IEEE International Conference on System of Systems Engineering: 1–6. IEEE.

    Google Scholar 

  66. Wolstenholme E (1999). A patient flow perspective of UK health services: exploring the case for new “intermediate care” initiatives. System Dynamics Review 15(3):253.

    Article  Google Scholar 

  67. Wolstenholme E, Monk D, McKelvie D, Arnold S (2007). Coping but not coping in health and social care: Masking the reality of running organisations beyond safe design capacity. System Dynamics Review 23(4):371–389.

    Article  Google Scholar 

  68. Xie T, Liu WB, Anderson B D, Liu XR, Gray G C (2017). A system dynamics approach to understanding the one health concept. PloS One 12(9):e0184430.

    Article  Google Scholar 

  69. Zebda A (2002). Using cost-benefit analysis for evaluating decision models in operational research. Journal of American Academy of Business 2(1):106–114.

    Google Scholar 

Download references

Acknowledgments

The authors would like to express their gratitude and appreciation to the anonymous reviewers and the editors for providing valuable comments for the continuing improvement of this article. The research was supported by the Hong Kong Polytechnic University, Hong Kong and Nanyang Technological University, Singapore. The authors would like to thank the Hong Kong Hospital Authority and the Hong Kong Census and Statistics Department for providing the relevant data in supporting the research. Our gratitude is also extended to the Research Committee and the Department of Industrial and Systems Engineering of the Hong Kong Polytechnic University for supporting this project (G-UA7X).

Author information

Affiliations

Authors

Corresponding author

Correspondence to Kam K.H. Ng.

Additional information

C.K.M. LEE is currently an associate professor in the Department of Industrial and Systems Engineering, The Hong Kong Polytechnic University, Hong Kong. She obtained her PhD and B. Eng. degree from The Hong Kong Polytechnic University. She was awarded Silver Award of 47th International Exhibition of Inventions of Geneva, Bronze Award of 16th China National Invention Exhibition Award in 2006 and Outstanding Professional Service and Innovation Award, The Hong Kong Polytechnic University in 2006. Dr. Lee has authored or co-authored more than 100 journal papers including IEEE Transactions on Industrial Informatics, International Journal of Production Economics, and Decision Support System. Her current research areas include logistics information management, Industry 4.0, Internet of things and data mining techniques.

W.C. TAI. is currently a project associate in Departmentof Industrial and Systems Engineering, The Hong Kong Polytechnic University, Hong Kong SAR, China. She received the B.Sc. Degree and M.Sc. in the same institute. Her research interests include system modelling, human centred design, data-driven engineering design and open innovation. Industry 4.0, Internet of things and data mining techniques.

Kam K.H. NG is currently a research fellow in School of Mechanical andAerospace Engineering,Nanyang Technological University, Singapore. He received the B.Sc. Degree and Ph.D. Degree in Department of Industrial and Systems Engineering, The Hong Kong Polytechnic University, Hong Kong SAR, China. His research interests are transportation engineering, intelligent transportation system, operations research, robust optimisation, optimisation methods and artificial intelligence.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Lee, C., Tai, W. & Ng, K.K. System Dynamic Modelling of Patient Flow and Transferral Problem in a Mixed Public-Private Healthcare System: A Case Study of Hong Kong SAR. J. Syst. Sci. Syst. Eng. (2020). https://doi.org/10.1007/s11518-019-5454-4

Download citation

Keywords

  • System dynamic models
  • scenario analysis
  • inpatient transferral
  • mixed public-private healthcare system