Department of Clinical Radiation Sciences, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
Regional Cancer Centre West, Gothenburg, Sweden.
Int J Health Policy Manag. 2022 Dec 6;11(11):2707-2718. doi: 10.34172/ijhpm.2022.5693. Epub 2022 Feb 26.
Healthcare is complex with multi-professional staff and a variety of patient care pathways. Time pressure and minimal margins for errors, as well as tension between hierarchical power and the power of the professions, make it challenging to implement new policies or procedures. This paper explores five improvement cases in healthcare integrating system dynamics (SD) into action research (AR), aiming to identify methodological aspects of how this integration supported multi-professional groups to discover workable solutions to work-related challenges.
This re-analysis was conducted by a multi-disciplinary research group using an iterative abductive approach applying qualitative analysis to structure and understand the empirical material. Frameworks for consultancy assignments/client projects were used to identify case project stages (workflow steps) and socio-analytical questions were used to bridge between the AR and SD perspectives.
All studied cases began with an extensive AR-inspired inventory of problems/objectives and ended with an SD-facilitated experimental phase where mutually agreed solutions were tested . Time was primarily divided between facilitated group discussions during meetings and modelling work between meetings. Work principles ensured that the voice of each participant was heard, inspired engagement, interaction, and exploratory mutual learning activities. There was an overall pattern of two major divergent and convergent phases, as each group moved towards a mutually developed point of reference for their problem/objective and solution, a case-specific multi-professional knowledge repository.
By integrating SD into AR, more favourable outcomes for the client organization may be achieved than when applying either approach in isolation. We found that SD provided a platform that facilitated experiential learning in the AR process. The identified results were calibrated to local needs and circumstances, and compared to traditional top-down implementation for change processes, improved the likelihood of sustained actualisation.
医疗保健是一个复杂的系统，涉及多专业人员和多种患者护理路径。时间压力和最小的错误空间，以及等级权力和专业权力之间的紧张关系，使得实施新政策或程序具有挑战性。本文探讨了将系统动力学（SD）融入行动研究（AR）的五个医疗保健改进案例，旨在确定这种整合如何支持多专业团队发现可行的解决方案，以应对与工作相关的挑战的方法学方面。
一个多学科研究小组使用迭代归纳方法对这 5 个案例进行了重新分析，该方法使用定性分析来构建和理解经验材料。顾问任务/客户项目框架用于识别案例项目阶段（工作流程步骤），社会分析问题用于在 AR 和 SD 视角之间架起桥梁。
所有研究案例都从广泛的 AR 启发式问题/目标清单开始，以 SD 促进的实验阶段结束，在该阶段，共同商定的解决方案得到了测试。时间主要分为会议期间的小组讨论和会议之间的建模工作。工作原则确保了每个参与者的声音都被听到，激发了参与、互动和探索性的相互学习活动。总体上存在两个主要的发散和收敛阶段的模式，因为每个团队都朝着他们的问题/目标和解决方案的共同发展的参考点前进，形成了特定于案例的多专业知识库。
通过将 SD 融入 AR，客户组织可能会获得比单独应用任何方法更好的结果。我们发现，SD 提供了一个平台，在 AR 过程中促进了体验式学习。确定的结果根据当地的需求和情况进行了校准，并与传统的自上而下的变革过程进行了比较，提高了持续实现的可能性。
