Nonlinear dynamics in health care service delivery: An exploratory inquiry and simulation

Traditional bureaucratic administration faced with rapid and changing public demands has been challenged as outdated. The "new public management" movement argues that government institutions, challenged by fiscal burdens, has exerted strong budgetary pressures on administrators to engage more cost-effective procedures to achieve their mandated purposes. Many scholars suspect that traditional organizational theory and approaches can no longer accommodate the growing complexity of this institutional environment.; Governmental organizations are increasingly seen as complex systems. Public management literature has proposed new models to deal with these complexity issues. Recognizing these challenges, public organizations must examine their management orientations and practices and consider the addition of new techniques.; Especially relevant to these changes is found in the health care environment, a condition exacerbated by the continued aging of the U.S. population. The greater usage of medical services forces Medicare policymakers to implement cost strategy programs such as Medicare+Choice. Administrators currently serving this population must continue to plan and provide efficient clinic service systems. To assist health care administrators in this endeavor, planning tools and techniques must advance to improve the delivery of health services to its government-funded populations.; This thesis combines insights from dynamics, organizational, and management literatures to propose that system dynamics modeling can assist health care administrators in delivering medical services more efficiently to the Medicare population. Modeling Medicare primary care services by simulation and subsystem analysis indicates that health care administrators can: (1) achieve superior appointment process efficiencies and significant cost savings for clinics; (2) develop the ability to design initiatives, manage resources and communicate results to decision-makers; and (3) benefit from incorporating nonlinear tools and approaches in their analytical tasks in an effort to improve organizational performance.; A change in the understanding and performance of internal organizational work activities not only directly benefits medical organizations but indirectly enhances government-funded Medicare cost strategy programs. Public managers and their successful administration ultimately make the difference between the triumph or failure in the delivery of public policy services.