Senciuc, Alexandru; (2024) A simulation-based framework for collective intelligence in strategic healthcare planning. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

Strategic health planning of Integrated Care Systems remains a significant challenge for the English NHS despite its prioritisation in the NHS constitution. The first contribution of this thesis is to identify three problem causes through literature surveys and semi-structured interviews. A culture of organisational silos leads to conflicting interests and a lack of mutual understanding. A rigid, linear planning process leads to protracted planning timescales and promotes short-termism. Moreover, inadequate tools and methodologies prevent healthcare collectives from working across organisational and discipline boundaries. To address these issues, the research proposes a simulation-based framework integrating clinical, workforce, infrastructure, economic and financial planning at system-wide scale. The framework is designed as a fast-paced, iterative process supported by a prototype complex systems simulation model. It is estimated that the collaborative environment generated by the framework would lead to new opportunities for collective action across discipline and organisational boundaries. In this regard, the research proposes an experimental methodology to measure the framework’s impact on group performance. The main experiment activity is called the Integrated Care Game. It is a facilitated serious game where participants must collaboratively plan a fictional Integrated Care System by operating with the simulation model. The aim is to balance improvements across four system aspects: patient outcomes, patient experience, resource utilisation, and financial affordability. The game aims to maximise the overall score without triggering a Game Over. The micro-level interactions within the group are analysed using a hybrid methodology to identify collective behaviour patterns. Preliminary results from three workshops have shown that the framework positively impacted the group’s collective intelligence, improving group performance over time. The iterative planning process produces a group reinforcement learning effect that stimulates participants to self-organise, focus on the common goal, and aggregate shared strategies.

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