Should doctors use their judgment? How a system dynamics model elicited knowledge in neonatal care services.

Neonatal services, which provide care to babies born with medical complications, are under financial pressures in the United Kingdom (UK). The services are heavily regulated affecting efficiency. One possible solution is to reduce the length of stay (LoS) of babies and allow a degree of doctors' clinical judgment to make decisions. The aim of this paper is to determine the impact of using clinical judgment on neonatal services performance. To achieve this aim, an system dynamics (SD) model was built and validated in a UK neonatal unit. The model was used initially to evaluate the impact of LoS reduction on performance as clinical judgment policies were rejected by participants. The counterintuitive results led to a behavioural change and participants accepted clinical judgment policies which the results indicated should lead to considerable performance improvement. Results' implications and SD's modelling ability to foster learning and alter participants' perceptions and behaviour are discussed. [ABSTRACT FROM AUTHOR]