Abstract for:From Scriptapedia to hexagons, engaging stakeholders in model building to develop a healthcare quality improvement program

We report our early experiences with Participatory System Dynamics (PSD) in one Veterans Health Administration (VA) outpatient mental health system. Our aim was to empower frontline clinic leadership and staff by eliciting their concepts and expertise in designing system dynamics models of local capacity for evidence-based practice (EBP) in mental health service delivery. Over an 18 month period, we applied a variety of group modeling building tools and materials to engage frontline staff and other key stakeholders. Through biweekly staff meetings facilitated by a core modeling team, participating staff engaged cycles of reflective dialogue about the barriers and facilitators to improved reach of evidence-based psychotherapy for post-traumatic stress disorder (PTSD) and depression. Demonstration models and wire frames (hexagonal clustering) effectively promoted enthusiasm for systems thinking and identified central feedback structures that would inform subsequent system dynamics modeling to evaluate two EBP implementation plans that VA mental health stakeholders believed would improve reach of EBPs for PTSD and depression. Our early experience with PSD generated key insights about how to design ‘Modeling to Learn,’ namely the need for multiple, small models and reliable, local data; and the utility of adapting prior, seminal service delivery modeling to our quality improvement program.