Mixing methodologies to enhance the implementation of healthcare operational research

Healthcare Operational Research (OR) has had limited success in achieving sufficient level stakeholder acceptance to lead to implementation of results. This research study aimed at combining OR methodologies to achieve greater acceptance of results for organizational change. Patient flow delays in the Pediatric Intensive Care Unit (PICU) at Children's Hospital of Wisconsin were identified using case studies. Patient flow was modeled using hard OR (simulation) using case study findings, with active stakeholder participation, and enhanced with outcomes research. Outcomes research allowed achieving greater clinical relevance of OR findings. Results from hard OR, particularly for politically sensitive issues, were persuasive but inadequate to result in change. Soft OR (cognitive mapping) was used to identify new issues and enhance results. Consequently, the planned PICU expansion was deferred, and resources focused on improving staffing strategies identified independently from both hard and soft OR. These findings suggest that: 1) Outcomes research has a unique role to enhance results from healthcare OR. 2) After obtaining a holistic understanding of the system using hard and soft OR, stakeholders are willing to implement results from each independently, supporting the development of a common form of knowledge which is consistent with Mixed-Mode Modelling. 3) Hard OR, enhanced with outcomes research, with active stakeholder participation, and combined with soft OR, results in greater acceptance and sustained organizational change.