Healthcare workers' perspectives on participatory system dynamics modelling and simulation: designing safe and efficient hospital pharmacy dispensing systems together.

With increasingly complex safety-critical systems like healthcare being developed and managed, there is a need for a tool that permits decision-makers to better understand the complexity, test various strategies and guide effective changes. System Dynamics (SD) modelling is an effective approach that can aid strategic decision-making in healthcare systems but has been underutilised partly due to the challenge of engaging healthcare stakeholders in the modelling process. This paper, therefore, investigates the applicability of a participatory SD approach based on healthcare workers' perspectives on ease of use (usability) and usefulness (utility). The study developed an interactive simulation dashboard platform which facilitated participatory simulation for exploring various hospital pharmacy staffing level arrangements and their impacts on interruptions, fatigue, workload, rework, productivity and safety. The findings reveal that participatory SD approach can enhance team learning by converging on a shared mental model, aid decision-making and identifying trade-offs. The implications of these findings are discussed as well as experience and lessons learned on modelling facilitation. This paper reports the perspectives of healthcare workers, who were engaged with a participatory system dynamics modelling and simulation process for hospital pharmacy staffing level management. Evaluative feedback revealed that the participatory SD approach can be a valuable tool for participatory ergonomics by helping the participants gain a deeper understanding of the complex dynamic interactions between workload, rework, safety and efficiency. SD: system dynamics; ETTO: efficiency-thoroughness trade-off.