Computer Simulation Within Action Research: A Promising Combination for Improving Healthcare Delivery?

Action research (AR) is increasingly being used to study the improvement of healthcare delivery. Ensuring that all the stakeholders in the AR are willing to take action, however, can be difficult. Especially in healthcare contexts, action plans may challenge the autonomy of the healthcare professionals and the positions of the different stakeholder groups. Does the use of computer simulation techniques within the AR promote action taking by all the stakeholders? We performed an AR experiment with computer simulation in a university hospital's emergency department in the Netherlands. A simulation model was designed that replicated the actual healthcare delivery process in the study setting. Together with representatives from the medical and nursing staff and department management, we used the model to discuss improvement actions. The team designed an improvement scenario that fundamentally rearranged the task division between the physicians and the nurses. The promising projections in the simulation model motivated the team to try the scenario in reality. The implementation was successful, although it generated much concerns and discussion. The new task division successfully improved patient length of stay (LOS) in the ED. The results achieved by the single team turned out to have lasting effects on the other stakeholders in the ED. Our AR experiment with computer simulation promoted action taking by all the stakeholders. Computer simulation within AR is a promising combination for improving healthcare delivery