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The purpose of this paper is to demonstrate through practical application how a system dynamics (SD) patient flow model of an emergency department (ED) can show which levers effectively reduce backlogs to improve access to care. Overcrowded EDs are struggling to meet demand and access targets. In 2016 and 2017, in the UK and Australia, respectively, 15% and 28% of arrivals waited longer than the targeted 4‐hr treatment time. Historically, simulation models that have informed access to emergency care have ignored the wider systems impacts. There is a growing awareness of the value of systems analysis tools for informing interventions and policy. In this study, we constructed a pilot system dynamics patient flow model, where the scope was the ambulatory and ambulance patient arrivals, the ED processes for acute and fast‐track pathways, pathology and radiology services, the ED short‐stay unit, and the Medical Assessment Planning Inpatient Unit. Patients queued to access constrained ED resources (doctors and beds) and diagnostic services (pathology and X‐ray). The model was tested on actual data from five separate historical periods spanning 3 years. The resultant daily pattern of peaks and troughs in patient flow and system delays accurately replicated patterns in actual patient flows, resource use, and the location of delays. "What if" scenario analysis (b) simulated how access would have looked in the sample weeks with different intervention strategies, (b) simulated system limits on the basis of current resources, (c) accurately identified levers that historically have been most effective at minimizing ambulance ramping, and (d) identified when additional staffing would fail to improve flow. [ABSTRACT FROM AUTHOR]

The Reserve Bank of Australia is the sole issuer and redeemer of Australian banknotes, but between issuance and destruction there is little information about where banknotes go or what they are used for. We estimate the whereabouts and uses of Australian banknotes, and find that 15–35 per cent are used to facilitate legitimate transactions, 4–7 per cent are used for transactions in the shadow economy, while the remainder are non‐transactional. The vast majority of non‐transactional banknotes are likely to be hoarded, and we estimate that 5–10 per cent of outstanding banknotes are lost or collected. [ABSTRACT FROM AUTHOR]

Traditional and current approaches to modelling the impacts of health care interventions have focused on detail complexity and been ceteris paribus dependent and thereby ignored the wider system impacts. In this study, we have demonstrated that system dynamics (SD) offers theoretical and practical advantages over conventional methodologies and the qualitative assessment tools that have informed the business of emergency care. We translate the key findings of qualitative research, existing literature reviews and studies of the use of simulation and economic evaluation models into a value proposition for using SD tools. We conclude that there is growing evidence of a strong value proposition for the use of SD tools to investigate interventions targeting improved emergency care access. SD models can incorporate dynamic and organizational complexity and fill a gap beyond the microscope of the conventional methodologies informing health care. This potential to strengthen health care systems warrants further investigation. [ABSTRACT FROM AUTHOR]