Evaluating the operational function of intermediate care using a multimethodology of soft systems methodology and discrete event simulation modelling

This thesis is about evaluating the operational function of Intermediate Care, a health and social care system for older people, by undertaking an action research project using a multimethodology of both “soft” and “hard” Operational Research. The Department of Health has invested heavily in the development of intermediate Care systems and their services and their evaluation is worthwhile and important. A group of local stakeholders commissioned in 1999 the University of Kent to evaluate Intermediate Care for the Shepway locality in East Kent. The commissioning project was named ICON and the work described herein is allied to the ICON project.

The multimethodology used for this project is Soft Systems Methodology and Discrete Event Simulation Modelling. The Soft Systems Methodology (SSM) approach was to use primary task root definitions to understand and examine the Operational Function of Intermediate Care (IC) in Shepway. The actions resulting from SSM included to extract Service Entry Eligibility Criteria and confirmed the need to undertake a simulation study to examine the services resource utilisation and the services compliance to these criteria. For the Simulation Study four models have been built, one for each of the “hard core” IC Services and a “whole system” model that examines the decision making mechanism of allocating patients to services in the system.

The contribution of this research is multidimensional. The primary contribution is the understanding and the evaluation of the operational function of Shepway IC. The project has contributed a multimethodology that can potentially be adapted to evaluate other IC systems and their services. Other dimensions are learning about applying each of these methods to the system of interest and learning about the combination of these two methods that are traditionally associated with different paradigms.