Abstract for: Re-designing policy and process in health care service delivery: a system dynamics case study

The Veterans Administration faces growing dissatisfaction with the delivery of one of its key services, Compensation and Pension (C&P). This paper focuses on the system surrounding the administration of C&P exams, which determine the extent of a veteran’s service-related disability. Many VHA facilities nation-wide are experiencing increasing service delays, along with reductions in exam quality and patient satisfaction. A system dynamics model was developed to determine the relationships between operational policies, management decisions, and process outcomes, and calibrated with data from one New England-area VA hospital. Simulation of system performance under various demand scenarios reveal the extent of the implicit the trade-off between resource flexibility, clinic utilization rates and patient wait-times. These scenarios are used to develop strategic policies to improve resource allocation and increase timeliness under highly variable demand conditions. Furthermore, alternate staffing models were tested against historic demand patterns, providing quantitative evidence for system redesign.