a dynamic simulation of Nordic ecosystems in healthcare and social services - implementing networked management and digitized infrastructure

Modelling distributed health care - Dynamic simulation of ecosystems in healthcare and social services Inland Hospital Trust (IHT) is one of the largest health entities in Norway, with 8500 employees covering an area equal to Denmark in size. A new hospital in Mjøsbrua will be built in 2027, where it will be part of a larger distributed health and care delivery system. IHT has submitted a HELSEVEL application to support IHT's transition towards a safe and resource-efficient networked delivery system - beginning with modeling Inland's entire current system. A unique multi-disciplinary consortium is established to support both health professionals and politicians before, during, and after the opening of the new hospital. The goal with the entire system's holistic model is to explore optimal multi-organizational designs that minimize re-admissions, enable safe and rapid discharges, and deliver health and care services close to the receiver's homes. The consortium's actors, the Norwegian University of Science and Technology (NTNU), Affecto (now part of Consultants to Government and Industries (CGI)), IHT, and Sel municipality combine technical expertise with practice-oriented experience in health and care delivery systems. The pre-project showed that Sel municipality contains the necessary infrastructure to design a feasible pilot, with Lillehammer hospital at the center. The Sel pilot will initially validate a model that optimizes resource utilization and allocation, with Lillehammer as the central hospital. The pilot will then be expanded to the county level, where Mjøsbua will be the central hospital. A distributed health and care delivery system requires studying resource allocation and consumption, specifically 1) What resources currently exist in the municipal and county levels? 2) What are the current consumption patterns? 3) How can resources be re-organized to safely, rapidly, and efficiently discharging patients, and delivering distributed care as close to the patient?s home as possible? Current literature gave limited knowledge into designing a project that models an entire system's infrastructure capacity and resource utilization. One explanation can be limited data access, since very few uniform data systems exist outside of Scandinavia. Another explanation can be conflicts over medical data, especially data that was altered using data collection and analysis platforms owned by private companies. In the consortium's Swedish network, a joint-project between a Swedish county council and Affecto (now part of CGI) was discovered, where a health care system was modeled, but without including the municipalities. The consortium wanted a collaboration to compare management practices in two different health care delivery systems (Norway and Sweden). A re-organizational process at the time, unfortunately, prevented a collaboration. The question was whether a computer platform used in the Sweden-Affecto project could help achieve the consortium's goals, objectives, and aims. Given the urgent need of a unique Norwegian platform, we had to proceed without a collaboration with researchers from outside of Scandinavia. An innovative research project has proved to be a multi-organizational effort with variable resource availability, dynamic decision-making, compared to a conventional project within an organization, and known resource availability. This is a potential source of frictions. Early legal and economic expertise involvement, and a careful discussion to reach a common ground prior to the main project can prevent such frictions. To conclude, a digital platform to enable a model of an entire Scandinavian health and care delivery network is urgently needed to address a rapidly ageing population and escalating healthcare costs. Designing and deploying this platform gives opportunities to identify needs at the patient level, and resource gaps at the system level. It can contribute to multi-disciplinary solutions towards increasingly complex global health problems in the coming decades.

The Inland Hospital Trust is one of the largest health entities in Noway with 8500 employees covering an area equal to Denmark in size. The current hospital structure is undergoing a change and during the next decade a new hospital will be built at a site not yet decided. In this process we need to consider the hospital as a part of a larger health and care system where formal care is provided by public and private services and informal care is provided by families and friends at no cost to the person receiving the care. To fully understand the complexity in such systems we will ask questions like (1) what are the right resources to be used where and when? (2) What functions need to be deployed for the general conditions to be met so that the purpose can be achieved? (3) What form (processes, procedures and systems) need to be performed that embody the functions? (4) How do we design a health system that can hold and develop these procedures, processes and systems? As a first step to ask this type of questions we will compare Norwegian and Swedish health systems that differs where Norway have a centralized command-and-control systems to steer the demand and supply of health care service where Sweden have less gate keeping and ample user choice of providers. Next step is to discuss the possibility to introduce network management of care supported by technology and asses this in a small Inland municipal in a rural area for the future use of Virtual Reality (VR) to interact in a distributed care model. This will in-turn lead to a larger project where the main project will simulate the complete Inland where we simulate the consequences of management techniques, localization and the use of technology in a dynamic model. The aim of a full project is minimized re-admissions, safe and rapid discharges, healthcare and social services as close to the patients home as possible and distributed real-time support in connection to advanced health care interventions.