Abstract for: Tertiary Cath Lab Services: Endogeneity of Commissioning

This work was to support a regional health and social care commissioning service in understanding the supply and demand dynamics of cath lab services. The primary intent was to assist commissioning of services for the next 20+ years in light of demographic change. Two years of hospital activity data (pre-Covid and post-Covid) were utilised as a proxy for demand. This raised complications for forecasting because demand is endogenously generated within services; yet activity data was the only empirical baseline available to estimate future commissioning needs. The conclusions emphasize a need to focus on understand management processes which generate endogeneity of target production. Utilizing current activity data as a basis for forecasting was proven limited by the use of SD modelling. Adding balancing feedback to account for capacity constraints based on staffing and scheduling would enhance the modelling and the commissioner's understanding of not just what is 'demanded', but what is deliverable and this would assist the commissioner to see how their own measurements and metrics become an endogenously generated standard of perceived population health need. The endogeneity of activity is often not sufficiently attended in within organizations and can be revealed by system dynamics modelling.