A computer simulation can elicit field experts' knowledge to implement health coaching in Brussels

Chiêm, Jean-Christophe [UCL] Van Durme, Thérèse [UCL] Speybroeck, Niko [UCL] Macq, Jean [UCL]

Background Increasing chronic disease prevalence and demographic transition raise dreadful challenges in healthcare services organization, at global level. Conventional methodologies are ill-suited to represent the complex interactions between the patients and the diverse care providers. While eliciting field stakeholders knowledge could reinforce coping skills and promote realistic policies, a lack of formalization may render this experience anecdotal. The design of a computer simulation can provide such a formalism. The LMN-B (Local Multidisciplinary Network) is a healthcare support structure in Brussels. They initiated the design of an innovative « health coaching » aiming at reinforcing chronic patients’ autonomy. However, the conceptualisation of this initiative in terms of activities could not be resolved via conventional meetings. Method We performed a study during 7 workshops over a 4 months period, gathering 10 healthcare experts ; 2 field researchers and 1 programmer facilitated these meetings to build a computer simulation and discuss simulated evolutions of chronic patients prevalence. The modeling exercice animated the discussion with experts regarding their representation of the health coaching and its future implications. Results The formalism of the model and simulated scenarios permitted to 1) define the state of the target patients as a transition between autonomy and full coordination 2) discuss activities to regain autonomy or prepare the coordination 3) clarify the organization of the associated healthcare providers and the possible tasks repartition in terms of care and coordination 4) clarify the role of the LMN-B in a decentralized and fragmented Brussels health system. Discussion The discussion supported by the computer simulation enabled the experts to articulate the complex dynamic mechanisms induced by the health coaching. The model provided a natural but formal vocabulary to debate ambiguous points of agreement and disagreement. A shared view of the health coaching could be created, enlightened by a time perspective, field experience and multiple scenarios. Hence, experts’ elicitation supported by computer simulation can usefully inform future policies to promote and implement complex health interventions, at local and country level.