Participatory System Dynamics Modeling: Increasing Stakeholder Engagement and Precision to Improve Implementation Planning in Systems

Abstract

Implementation planning typically incorporates stakeholder input. Quality improvement efforts provide data-based feedback regarding progress. Participatory system dynamics modeling (PSD) triangulates stakeholder expertise, data and simulation of implementation plans prior to attempting change. Frontline staff in one VA outpatient mental health system used PSD to examine policy and procedural "mechanisms" they believe underlie local capacity to implement evidence-based psychotherapies (EBPs) for PTSD and depression. We piloted the PSD process, simulating implementation plans to improve EBP reach. Findings indicate PSD is a feasible, useful strategy for building stakeholder consensus, and may save time and effort as compared to trial-and-error EBP implementation planning.

Keywords: Evidence-based practices; Implementation science; Mental health; Participatory stakeholder engagement; System dynamics.

Conflict of interest statement

Conflict of Interest All the authors declare that they have no conflict of interest.

Figures

Fig. 1

Quality improvement: significant increase in EBP scheduling without explaining variability or gap between scheduling and completion

Fig. 2

System dynamics modeling: stock and flow diagram (intakes) and Electronic health record parameters (psychotherapy)

Fig. 3

Implementation scenario simulations: stakeholder hypotheses for improving evidence-based psychotherapy reach. Note The simulated output presented in this figure is synthetic data comparing the plausible future number of EBP sessions scheduled and completed over 1 year under the status quo or “base case” of current implementation, as compared to one of two alternative implementation plans: 60-min intakes and PTSD Streamline. Specialty care (SC) includes the Women’s Program and PTSD program. Behavioral Health Integration Program (BHIP) is generalist mental health care. Not shown: New Patient Referrals to Evidence-based Psychotherapy