Abstract for:Applying Strategy Modeling to a NICU Quality Improvement Program
Initial interviews (n=20) in a neonatal intensive care unit (NICU) based quality improvement (QI) effort have identified contextual facilitators and challenges believed to be impacting QI work in the NICU. Using operations data and interviews, we develop a system dynamics simulation model to study how contextual facilitators and challenges to unit-based QI interact over time. Our model simulates NICU patient care, QI work and contextual factors. Then, we used sensitivity and policy analyses to examine system behavior. We found that under the current policies, QI efforts increase the skill level of employees which results in a greater discrepancy between the skill level of experienced employees to new employees. Improved QI efforts would simultaneously result in both a drop in the NICU census as discharges and transfers out of the NICU increase due a reduction in variances and an increase in the census as deaths are prevented. The average length of stay in the NICU would also drop from just over 26 days to approximately 22 days. The number of variances is reduced but would plateau after a couple of years with diminishing returns from QI interventions.