Finding capacity in the NSW statewide PICU System—collaborative MVP simulation development in a complex stakeholder environment

Managing bed capacity and patient flow in paediatric intensive care units poses ongoing challenges, particularly in large and geographically dispersed health systems. In New South Wales, Australia, three Paediatric Intensive Care Units serve as key nodes within a statewide network of more than 400 hospitals, collectively receiving critically ill children with diverse clinical needs. To address growing concerns about capacity constraints and uneven demand across these units, a collaborative study was undertaken to explore strategies for system-wide improvement. Simulation is well-suited to this kind of problem. However, modelling such a complex system while capturing the perspectives of many stakeholders remains challenging. Ultimately, a hybrid discrete-event and agent-based method was developed. This model captured both detailed bed-occupancy dynamics within each unit and the inter-hospital transfer rules that match patient diagnoses to clinical capabilities. Ensuring ongoing engagement with clinicians and hospital managers proved integral to defining structure, validating outputs and iteratively identifying feasible policy interventions such that a useful decision-making tool emerged. In addition to informing capacity-management decisions, the project also strengthened local simulation expertise. The article discusses the value of an incremental (Minimum Viable Product) development approach for managing and delivering highly complex healthcare-simulation studies. The approach deliberately revisited CM assumptions as the model became more detailed and disciplined the team to deliver the most valuable model achievable within the available time, data, and resourcing constraints.