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More Detailed Overview of Health Care Infrastructure in Relation to Population and Other Infrastructures
Source publication
Health care systems are complex entities that are difficult enough to operate under normal circumstances. Catastrophes such as natural disasters or terrorist acts can have severe impacts on health care systems by overloading them with casualties. At the same time, these catastrophes can greatly reduce health systems' capacity for dealing with this...
Contexts in source publication
Context 1
... of health care workers, for example, can keep the health care system from functioning effectively and from restoring those workers and others to working status. Figure 2 goes into more detail about some of these relationships, but still at an overview level. It indicates that the population structure is replicated several times to segment the population into such categories as the working population (divided into health care and emergency services and all other infrastructures), non-working 18-65, under 18, and over 65. Figure 2 also suggests that certain strategies for mitigation and prevention (e.g., vaccinating a population early in an outbreak of a contagious disease) can reduce disability and requirements for health care. ...
Context 2
... of health care workers, for example, can keep the health care system from functioning effectively and from restoring those workers and others to working status. Figure 2 goes into more detail about some of these relationships, but still at an overview level. It indicates that the population structure is replicated several times to segment the population into such categories as the working population (divided into health care and emergency services and all other infrastructures), non-working 18-65, under 18, and over 65. Figure 2 also suggests that certain strategies for mitigation and prevention (e.g., vaccinating a population early in an outbreak of a contagious disease) can reduce disability and requirements for health care. It indicates that, in addition to the segment of the population that becomes sick as the result of an event, there will be many others who may have been exposed. ...
Context 3
... Washington University, 2002) These include advance credentialling of volunteers with some health care experience (e.g., retired nurses). Figure 2 showed an aggregate view of how an area's population might be represented. Figure 3 goes into more detail in depicting a module that is replicated multiple times to represent different segments of the population. ...
Context 4
... suggested in Figure 2, the model contains a detailed structure for capturing the flow of people who become sick or injured as a result of an event. Figure 4 shows part of this structure related to patients coming to Emergency Rooms in hospitals, either on their own or via ambulances operated by various emergency services. ...
Citations
... 53 ,Manley and Hardy (2005) 30 , Yu Wang et al. (2012) 54 . Measuring the proportion of patients who voluntarily leave the ED because of the delay in receiving a medical evaluation (the so-called "walkouts") is proposed by the General Accounting Office (GAO), in a report published in 2003. ...
Objectives
Hospitals are expected to operate at a high-performance level even under exceptional conditions of peak demand and resource disruptions. This understanding is not mature yet, and there are wide areas of possible improvement. In particular, the fast mobilization and reconfiguration of resources frequently result into the severe disruption of elective activities, worsening the quality of care. More resilient resource allocation strategies, ie, which adapt to the dynamics of the prevailing circumstance, are needed to maximize the effectiveness of health-care delivery. In this study, a simulation approach was adopted to assess and compare different hospital’s adaptive resource allocation strategies in responding to a mass casualty incident (MCI).
Methods
A specific set of performance metrics was developed to take into consideration multiple objectives and priorities and holistically assess the effectiveness of health-care delivery when coping with an MCI event. Discrete event simulation (DES) and system dynamics (SD) were used to model the key hospital processes and the MCI plan.
Results
In the daytime scenario, during the recovery phase of the emergency, a gradual disengagement of resources from the emergency department (ED) to restart ordinary activities in operating rooms and wards, returned the best performance. In the night scenario, the absorption capacity of the ED was evaluated by identifying the current bottleneck and assessment of the benefit of different resource mobilization strategies.
Conclusions
The present study offers a robust approach, effective strategies, and new insights to design more resilient plans to cope with MCIs. Future research is needed to widen the scope of the analysis and take into consideration additional resilience capacities, such as operational coordination mechanisms, among multiple hospitals in the same geographic area.
... Some of the problems addressed were disease management in diabetics Q5 (Homer et al, 2004a, b;Jones et al, 2006), HIV/AIDS (Roberts and Dangerfield, 1990;Dangerfield et al, 2001), tobacco Q6 (Roberts et al, 1982;Lane et al, 2000;Tengs et al, 2001). Other issues modelled were related to modelling patient flows (Wolstenholme, 1996(Wolstenholme, , 1999Hirsch, 2004;McDonnell et al, 2004), performance assessment (Hoard et al, 2005) and public health emergencies (Hirsch andImmediato, 1998, 1999), and high-level policymaking in human resources planning in health care (Birch et al, 2007;Murphy et al, 2009). Some scholars have concentrated on public health planning and healthcare reform (Homer and Milstein, 2004;Homer and Hirsch, 2006;Milstein, 2008). ...
... Some of the problems addressed were disease management in diabetics Q5 (Homer et al, 2004a, b;Jones et al, 2006), HIV/AIDS (Roberts and Dangerfield, 1990;Dangerfield et al, 2001), tobacco Q6 (Roberts et al, 1982;Lane et al, 2000;Tengs et al, 2001). Other issues modelled were related to modelling patient flows (Wolstenholme, 1996(Wolstenholme, , 1999Hirsch, 2004;McDonnell et al, 2004), performance assessment (Hoard et al, 2005) and public health emergencies (Hirsch andImmediato, 1998, 1999), and high-level policymaking in human resources planning in health care (Birch et al, 2007;Murphy et al, 2009). Some scholars have concentrated on public health planning and healthcare reform (Homer and Milstein, 2004;Homer and Hirsch, 2006;Milstein, 2008). ...
A modelling project involved system dynamics simulation of chronic cardiac disease in Bulgaria, examining the dynamic behaviour of a cardiac drug molecule in the market. The system dynamics model was calibrated using market data sourced from the Bulgarian National Health Care Fund, the Bulgarian Generic Pharmaceutical Association and a market research firm. The main results of the study showed that the timing of access to market was a critical driver in reducing prices and providing wider, as well as more affordable, access for patients to medicinal therapy. Our findings indicate that healthcare authorities may obtain savings while, at the same time, they may provide conditions for more patients to be treated depending on the timing of access to market of new generic drugs.
... To complement and enhance this hazard and vulnerability assessment, this study adapted and implemented a system dynamics model originally developed by Gary Hirsch, which will support emergency health care planning for Puerto Rico. The model is based on one originally developed by Hirsch in 2003 Hirsch in -2004 for the Sandia National Labs under contract to the U.S. Department of Homeland Security (Hirsch, 2004). That model had been designed to be generic and broadly applicable to a range of geographic areas and types of incidents including hurricanes. ...
... To complement and enhance this hazard and vulnerability assessment, this study adapted and implemented a system dynamics model originally developed by Gary Hirsch, which will support emergency health care planning for Puerto Rico. The model is based on one originally developed by Hirsch in 2003 Hirsch in -2004 for the Sandia National Labs under contract to the U.S. Department of Homeland Security (Hirsch, 2004). That model had been designed to be generic and broadly applicable to a range of geographic areas and types of incidents including hurricanes. ...
The Puerto Rico Emergency Preparedness Model simulates the impacts of major events such as hurricanes on the demand for health care and capacity of the health care system. The model enables its users to simulate events with different characteristics and try out different forms of mitigation for reducing the health care consequences of those events. Development of the model began with an earlier model. That model was expanded by representing the populations and health care delivery resources of Puerto Rico’s seven geographic regions. Other data on Puerto Rico’s population, its health status, and health care were also inserted into the model. Particular attention was paid to simulating hurricanes and influenza pandemics. The project culminated with a training session and production of a Users’ Manual to support the model’s ongoing use.
... system of the expected emergency plan. Associated infrastructures and population care requirements (regular basic and particular care) are intentionally and interdependently connected in the system [8,9]. Expected requirements are influential in instructing guidelines for resources underlying sector five in decision making. ...
Efficient and effective energy management are a prominent factor in the new global economy. The implementation of a Nuclear Power Program (NPP) in Malaysia is under examination for appraisal. Nonetheless, the safety issue has become pivotal in the light of public concern. This research is a feasibility study on the NPP in order to address the perception on risk issues by investigating highlighted safety issues in sustaining community resilience and confidence. In fact, this study is going to develop initial enhancement of the expected safety recommendations in favor of reducing public safety fears. The validation of this study is using suitable conceptual framework and expertise acceptance in sustaining the assurance of the system. Meanwhile, the verification of this study is by evaluating the research simulation system development and analysis to comply with the proposed framework. The focus of this paper is to initially validating the framework by examining requirements for Malaysia radiation and nuclear (RN) contingency plan such as emergencies, incidents or disasters, originating from radiological and nuclear resources. The prospective emergency plan requirements determined by Work System Theory (WST) modeling. The research case study analyzed according to explanatory structural analysis that depicted as proposed network diagram and work system snapshot. The development of these snapshots can help to enhance the proposed emergency plan simulation modeling in order to achieve certain preparedness regarding nuclear safety environment in Malaysia, far better than the use of manuals or conventional table top emergency drills.
... Some of the problems addressed were disease management in diabetics Q5 (Homer et al, 2004a, b;Jones et al, 2006), HIV/AIDS (Roberts and Dangerfield, 1990;Dangerfield et al, 2001), tobacco Q6 (Roberts et al, 1982;Lane et al, 2000;Tengs et al, 2001). Other issues modelled were related to modelling patient flows (Wolstenholme, 1996(Wolstenholme, , 1999Hirsch, 2004;McDonnell et al, 2004), performance assessment (Hoard et al, 2005) and public health emergencies (Hirsch andImmediato, 1998, 1999), and high-level policymaking in human resources planning in health care (Birch et al, 2007;Murphy et al, 2009). Some scholars have concentrated on public health planning and healthcare reform (Homer and Milstein, 2004;Homer and Hirsch, 2006;Milstein, 2008). ...
... Some of the problems addressed were disease management in diabetics Q5 (Homer et al, 2004a, b;Jones et al, 2006), HIV/AIDS (Roberts and Dangerfield, 1990;Dangerfield et al, 2001), tobacco Q6 (Roberts et al, 1982;Lane et al, 2000;Tengs et al, 2001). Other issues modelled were related to modelling patient flows (Wolstenholme, 1996(Wolstenholme, , 1999Hirsch, 2004;McDonnell et al, 2004), performance assessment (Hoard et al, 2005) and public health emergencies (Hirsch andImmediato, 1998, 1999), and high-level policymaking in human resources planning in health care (Birch et al, 2007;Murphy et al, 2009). Some scholars have concentrated on public health planning and healthcare reform (Homer and Milstein, 2004;Homer and Hirsch, 2006;Milstein, 2008). ...
A modelling project involved system dynamics simulation of chronic cardiac disease in Bulgaria, examining the dynamic behaviour of a cardiac drug molecule in the market. The system dynamics model was calibrated using market data sourced from the Bulgarian National Health Care Fund, the Bulgarian Generic Pharmaceutical Association and a market research firm. The main results of the study showed that the timing of access to market was a critical driver in reducing prices and providing wider, as well as more affordable, access for patients to medicinal therapy. Our findings indicate that healthcare authorities may obtain savings while, at the same time, they may provide conditions for more patients to be treated depending on the timing of access to market of new generic drugs.
... Some scenarios of the physical failures of some units where modeled using agent based modeling (Sansavini et al., 2008). In the context of health infrastructure it has been tested by assuming some known interactions as graphs and modeling some requirements for scenarios measuring the flow speed (Hirsch, 2004). Keil et al., 2007). ...
... Initially, proposing five sectors which are interrelated within the dotted line depicted. This finding is improvising from Rosyton et al. and Hirsch studies [25, 26]. This research scope is emphasizing two phases of largescale RN event. ...
Malaysia is in advancement towards the establishment of effective and efficient energy mix plan within its Nuclear Power Programme (NPP) resulting from current governance acceptance and support. Prior precautions have been inculcated in order to comprehend nuclear energy accountability in striving high income economic growth and energy security. This paper is attempting to prescribe nuclear safety recommendations encompassing radiation and nuclear (RN) event recovery phase within integrated disaster operations management (DOM) activities from Soft System Methodology (SSM) perspective by using Simulation Modelling. Possibly, this method is introduced in order to recommend triage categories for vulnerable population groups which are commonly at-risks during RN emergencies, incidents and disasters. Therefore, this paper will proposed some factors of triage categories which may affect these groups whereby representing an initial system map. It is concluded that prioritized suggestions given could possibly ascertain the characteristics of other interventions involved in order to achieve a sustainable and secure nuclear safety in the future.
... This research case uses a system-dynamics (SD) model to examine the market introduction in India of a PDV against hepatitis B as a substitute for the traditional vaccine technology. The literature on SD provides examples for looking at issues associated with the adoption and diffusion of new products (Maier, 1998;Milling, 2002), the introduction of medical technology (Homer, 1987), and health care policy (Hirsch, 2004;McDonnell, 2004). ...
Plant-derived vaccines may soon displace conventional vaccines. Assuming there are no major technological barriers undermining the feasibility of this innovative technology, it is worthwhile to generate quantitative models of regulatory burden of producing and diffusing plant-derived vaccines in industrialized and developing countries. A dynamic simulation model of technology diffusion, and the data to populate it, has been generated for studying regulatory barriers in the diffusion of plant derived vaccines. The role of regulatory burden is evaluated for a variety of scenarios in which plant-derived vaccines are produced and diffused. This model relates the innovative and conventional vaccine technologies and the effects of the impact of the uptake of the innovative technology on mortality and morbidity. This case study demonstrates how dynamic simulation models can be used to assess the long-term potential impact of novel technologies in terms of a variety of socio-economic indicators.
... The model focuses on contagious disease as a specific threat, following an earlier effort that examined the effects of an array of threats on a community's population and health care system. (See for example Hirsch, 2004) ...
Modeling contagious diseases has taken on greater importance over the past several years as diseases such as SARS and avian influenza have raised concern about worldwide pandemics. Most models developed to consider projected outbreaks have been specific to a single disease. This paper describes a generic System Dynamics contagious disease model and its application to human-to-human transmission of a mutant version of avian influenza. The model offers the option of calculating rates of new infections over time based either on a fixed "reproductive number" that is traditional in contagious disease models or on contact rates for different sub-populations and likelihood of transmission per contact. The paper reports on results with various types of interventions. These results suggest the potential importance of contact tracing, limited quarantine, and targeted vaccination strategies as methods for controlling outbreaks, especially when vaccine supplies may initially be limited and the efficacy of anti-viral drugs uncertain.
... This case research uses a system dynamics (SD) model which purpose is to examine the market introduction of a PDV vaccine in India against hepatitis B, as a substitute for the traditional vaccine technology. The literature in SD has a long tradition of looking at issues associated with new products adoption and diffusion (Maier, 1998;Milling, 2002), and even some related to the introduction of medical technology (Homer, 1987), and with health care policy (Hirsch, 2004;McDonnell, 2004). ...
The possible diffusion of plant-derived vaccine (PDV) biotechnology in developing countries offers an interesting potential substitute to existing more expensive vaccine technology currently available on the market. This paper is concerned with the potential impact that the introduction of such a technology could have on the incidence of hepatitis B cases on India's population overtime. The objective of the paper is to look at the hypothetical issues of a PDV diffusion using a system dynamics (SD) model. Some illustrative results are presented to show the interaction between infection rates, mortality rates, and vaccination rates. In spite of promising features, such as much lower production costs, institutional hurdles to a widespread diffusion of the technology still need to be overcome.
