The dynamics of local rules in hospital admission processes
journal contributionposted on 2017-06-08, 02:26 authored by Walker, Beverly, Haslett, Tim
This paper reports on research into admission practices at a hospital that provided sub acute extended care. A System Dynamics model of the patient flow through the hospital was built to show the impact of the local rules used by the medical registrar. Local rules are behaviours that are local, and often idiosyncratic, adaptations to the local environment. Such adaptations can have a significant impact on organisational performance. In the hospital, patients were admitted from two large acute hospitals and from the community sources, into two different streams of care a within the hospital. The process by which they were selected for admission set for up the dynamics of patient flows within the hospital. These dynamics involved the acuity of the patients and the demands they placed on the medical systems within the hospital. Hospital funding in Victoria is based on length of stay and occupancy rate. The types and acuity of patients being admitted had a profound influence of these funding bases. The local rules used by the medical registrar, in turn, had a profound influence on the types of patient being admitted. The System Dynamics model demonstrated the impact of these local rules. During the process of building the model, it became clear that neither the medical registrar, nor senior administrators within the centre understood the impact of the local rules.