Visualisation of a complex healthcare system: mapping vascular and trauma surgery services in Ghana

Background: Providing comprehensive vascular and trauma care requires a functional surgical system, but these can often be complex. To better understand this system complexity, we aimed to develop multiple visualisation techniques, combining qualitative and quantitative data, using vascular and trauma surgery services in Korle Bu Teaching Hospital, Ghana, as a case study. Methods: Data collection was undertaken through a mixed methods approach. Qualitative data was generated from workshops on vascular and trauma care, and quantitative data was derived from observational data on trauma laparotomy patients collected as part of a larger multi-centre study. Visualisation tools were used to represent the varying aspects of the data obtained, each refined through an iterative process with local healthcare professionals. Results: Five separate data visualisations were generated: Directed Acyclic Graphs, Swimlane Diagrams, Data Flow Diagrams, Parallel Coordinate Maps, and Sankey Diagrams.These were chosen to illustrate key areas of clinical interest. Conclusions: The use of multiple visualisation techniques based on mixed data allows for the complexity of a healthcare system to be appreciated. Such visualisations can support a range of further research and improvement efforts to strengthen healthcare systems and improve patient outcomes, even in lower resource settings. A complex system cannot be visualised in one map and the use of multiple visualisations can provide a more comprehensive understanding of a healthcare system.