Examining Trade－Offs in Hospital Operations Using a Systems Approach in an Acute Care Setting

Examining Trade－Offs in Hospital Operations Using a Systems Approach in an Acute Care Setting

Hospitals are often faced with operational challenges that require them to make compromises and tough decisions among multiple competing needs. This is particularly true in acute care hospitals, where practitioners often operate under resource-constrained conditions and are required to fulfill multiple work requirements. To manage such trade-offs, it is important to understand both the operating system as a whole and the contextual factors that drive the behavior of discrete units within the system. This paper examines the nature of trade-offs scenarios and how they play out in complex hospital operations. An in-depth case study approach is used to examine the trade-off phenomenon in a focused-care service delivery context in an acute care hospital in Singapore； namely, a specialized clinical function designed to serve the needs of acute care elderly patients. Data for the case study was collected from hospital interviews, surveys, site observations, and document analysis over a three-month period in 2012. The study uses a system conceptualization involving causal loop diagrams in order to achieve a deeper understanding of the trade-off phenomenon identified from the case study. This study found that the act of balancing trade-offs is context-dependent and dynamic and that it evolves over time. Overall, this study provides a finer-grained view of the trade-offs phenomenon in hospital operations and reveals novel insights on the management of resource thresholds in acute care settings.