Health Care System Dynamics Insights

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Mark Heffernan and Geoff McDonnell have collected system dynamics insights over the past two decades. We believe that often more can be gained by ‘zooming out’ on a problem and expanding the boundary of analysis, focusing on interactions with the wider context rather than the internal details of a part of the system. These insights are progressively built up to show health care practitioners and researchers how structure determines behavior. The insights are then used to perform ‘in silico’ virtual experiments as a way to learn more rigorously about complex interventions in complex systems. We hope the use of relevant generic structures will help health care students, researchers and practitioners to become more familiar with the principles of health system dynamics. We also hope they gain insights into how structures constrain behavior and how actions can result in unintended consequences. We encourage the wider use of these tools and structures as a starter kit and a scaffold for building and sharing more complex models that combine theory and data sets among disciplines. This collection might be included in a range of self-directed or formal learning activities in systems science, management science, health policy, public health, health services, operations research or health systems design. The system dynamics approach offers a ‘top down’ computer simulation method for understanding and designing complex health systems. It has the advantage of an elegant aggregate view which shows the accumulations, feedbacks, delays and non-linear relationships that produce surprising results when intervening in health systems. Future collections will focus on combining other simulation methods, agent based individual behavioral and process centric discrete event approaches, to provide integration of ‘bottom up’ and ‘middle out’ and ‘top down’ views into useful multi-scale, multi-method models that produce effective action.



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