Erasmus School of Health Policy & Management, Erasmus University, Rotterdam, The Netherlands.
University of Oxford, Oxford, UK.
Int J Health Policy Manag. 2023;12:7582. doi: 10.34172/ijhpm.2023.7582. Epub 2023 May 21.
Holmström and co-authors argue for the value of integrating system dynamics into action research to deal with increasing complexity in healthcare. We argue that despite merits, the authors overlook the key aspect of normative complexity, which refers to the existence of multiple, often conflicting values that actors in healthcare systems have to pragmatically develop responses to in their daily practices. We argue that a better theoretical and empirical understanding of the multiplicity of values and how actors deal with value conflicts in daily practices can enrich discussions about complexity in healthcare. We introduce the alternative methodology of 'value exnovation' for action researchers to broaden the scope of system-based thinking and action research in healthcare.
霍尔姆斯特伦等人认为，将系统动力学纳入行动研究对于应对医疗保健领域日益增加的复杂性具有重要价值。我们认为，尽管有其优点，但作者忽视了规范性复杂性的关键方面，规范性复杂性是指在医疗保健系统中，行动者必须在实践中应对的多种、往往相互冲突的价值观的存在。我们认为，更好地理解价值观的多样性以及行动者如何在日常实践中应对价值冲突，可以丰富对医疗保健复杂性的讨论。我们引入了“价值创新”这一替代方法，供行动研究者使用，以拓宽基于系统的思维和医疗保健行动研究的范围。
