Merging Participatory Action Research and System Dynamics as a Locus for Transformation in a Large Scale Hospital Setting
Keywords:
Participatory Action Research (PAR); System Dynamics (SD); Public Health
Abstract
In this paper, we report on the utility of merging Participatory Action Research (PAR) with System Dynamics (SD) as a locus for stimulating transformation in a large-scale hospital academic setting. This is significant because it provides points of cross fertilisation whereby the two frameworks act synergistically with each other to create high leverage interventions for change, which may otherwise not have been apparent. Coupled within a SD auspice, there was a synergistic blend of uncovering an overall ecological view of the public health care system. The PAR methodology is located within the epistemological realm of critical theory and constructivism, whereby facilitating positive social change is viewed to be the key outcome of such research. This outcome has been confirmed by the researchers prioritizing the necessity for a departure from the traditional expert-led health system, evolving into one which supports the empowerment of patients and health-care workers as a necessity. However, the implementation of the improvements has not been as straightforward as initially projected. Some of the challenges included the slow assimilation of proposed solutions for planned care and paucity of key engagement from upstream stakeholders. The value of this paper can potentially serve to encourage key stakeholders in public health care systems to consider viewing health care complexity through the lens of PAR and SD.
References
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Epstein, J. M., & Axtell, R. (1996). Growing artificial societies: Social science from the bottom up. Boston, MA: MIT Press.
Goessling, K. (2020). Youth participatory action research, trauma, and the arts: Designing youth spaces for equity and healing, International Journal of Qualitative Studies in Education, 33, 1.
Hilton, A., & Hilton, G. (2017). The impact of conducting practitioner research projects on teachers’ professional growth. Australian Journal of Teacher Education, 42(8). https://doi.org/10.14221/AJTE.2017V42N8.6.
Hirsch, G., & Homer, J. (2020). System dynamics applications to health care in the United States. In B. Dangerfield (Ed.), System dynamics. Encyclopedia of complexity and systems science series. New York, NY: Springer. https://doi.org/10.1007/978-1-4939-8790-0_270.
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Macdonald, C. (2012). Understanding participatory action research: A qualitative research methodology option. Canadian Journal of Action Research, 13, 34–50.
Marchildon, G. P. (2016). Legacy of the doctors’ strike and the Saskatoon Agreement. CMAJ: Canadian Medical Association Journal, 188(9), 676–677.
Marshall, D. A., Burgos-Liz, L., I Jzerman, M. J., Osgood, N. D., Padula, W. V., Higashi, M. K., …Crown, W. (2015). Applying dynamic simulation modeling methods in health care delivery research—The SIMULATE checklist: Report of the ISPOR simulation modeling emerging good practices task force. Value in Health, 18(1), 5–16. https://doi.org/10.1016/j.jval.2014.12.001
Määttä, H., Ruutu, S., & Toivonen, M. (2014). Revealing the complexities of health care renewal: A system dynamics approach. In Proceedings of the 5th International Conference on Applied Human Factors and Ergonomics AHFE 2014 (4th ed.).
McTaggart, R. (1991). Principles for participatory action research. Adult Education Quarterly, 41(3), 168–187.
Meadows, D. H. (2008). Thinking in systems: A primer. D. Wright (Ed.). White River Junction, VT: Chelsea Green Publishing.
Nakamura, I. (2014). A discussion of practitioner research: How are reflective practice, action research, and exploratory practice different? Retrieved from https://www.semanticscholar.org/paper/A-Discussion-of-Practitioner-Research-%3A-How-Are-and-Nakamura/1263aea49a3ac85560181b0f0ced5dcf0487c0c2.
Norton, L. S. (2009). Action research in teaching and learning. A practical guide to conducting pedagogical research in universities. London: Routledge.
Paley, J. (2007). Complex adaptive systems and nursing. Nursing Inquiry, 14, 233–242.
Randolph Jr, B. (2015). Changing steps: A reflexive journey in transition. The Journal of Global Health care Systems, 5(2).
Reid, I. (2002). Complexity science. Let them eat complexity: The emperor’s new toolkit. BMJ (Clinical research ed.), 324(7330), 171.
Rifkin, S. (2009). Lessons from community participation in health programmes: A review of the post Alma-Ata experience. International Health, 1(1), 31–36.
Rosala-Hallas, A., Bhangu, A., Blazeby, J., Bowman, L., Clarke, M., Lang, T., … Williamson, P. R. (2018). Global health trials methodological research agenda: Results from a priority setting exercise. Trials, 19, 48. https://doi.org/10.1186/s13063-018-2440-y.
Sales, A., Moliner, O., & Traver, J. (2020). Participatory action research: A case study on the school democratisation process. Research Papers in Education. https://doi.org/10.1080/02671522.2020.1767182.
Schoenenberger, L., Schmid, A., Tanase, R., Beck, M., & Schwaninger, M. (2021). Structural analysis of system dynamics models. Simulation Modelling Practice and Theory, 110, 10233. https://doi.org/10.1016/j.simpat.2021.102333.
Sterman, J. D. (2006). Learning from evidence in a complex world. American Journal of Public Health, 6, 505–514. https://doi.org/10.2105/ AJPH.2005.066043.
Sterman, J. D. (2018). System dynamics at sixty: The path forward. System Dynamics Review, 34(1–2), 5–47.
Stroh, D. P. (2015). Systems thinking for social change: A practical guide to solving complex problems, avoiding unintended consequences, and achieving lasting results. Chelsea Green Publishing.
Von Bertalanffy, L. (1972). The history and status of general systems. In J. Klir (Ed.), Trends in general systems theory. New York, NY: Wiley-Interscience.
Wimpenny, K., & Savin-Baden, M. (2013). Alienation, agency and authenticity: A synthesis of the literature on student engagement. Teaching in Higher Education, 18(3), 311–326. https://doi.org/10.1080/13562517.2012.725223.
Wolstenholme, E., & Mckelvie, D. (Eds.). (2019). Towards a dynamic theory of how hospitals cope in times of high demand. In The Dynamics of Care (pp. 171–187). Springer. https://doi.org/10.1007/978-3-030-21878-2_10
Wolstenholme, E., Monk, D., Mckelvie, D., & Arnold, S. (2007). Coping but not coping in health and social care: Masking the reality of running organisations beyond safe design capacity. System Dynamics Review, 23, 371–389.
Wolstenholme, E. (1999). A patient flow perspective of the U.K. health services: Exploring the case for new “intermediate care” initiatives. System Dynamics Review, 15(3), 253–271. https://doi.org/10.1002/(SICI)1099-1727(199923)15:3<253::AID-SDR172>3.
Wright, D. (2020). Imagining a more just world: Critical arts pedagogy and youth participatory action research. International Journal of Qualitative Studies in Education, 33(1), 32–49.
Zimmerman, L., Lounsbury, D. W., Rosen, C. S., Kimerling, R., Trafton, J. A., & Lindley, S. E. (2016). Participatory system dynamics modeling: Increasing stakeholder engagement and precision to improve implementation planning in systems. Administration and Policy in Mental Health, 43(6), 834–849.
Amissah, M., Gannon, T., & Monat, J. (2020). What is systems thinking? Expert perspectives from the WPI Systems Thinking Colloquium of 2 October 2019. Systems, 8(1), 6. https://doi.org/10.3390/systems8010006.
Andersson, N. (2018). Participatory research—A modernizing science for primary health care. Journal of General and Family Medicine, 19(5), 154–159.
Bala, B. K., Arshad, F. M., & Noh, K. M. (2017). System dynamics: modelling and simulation. Singapore: Springer.
Brailsford, S. C. (2008). System dynamics: What’s in it for health care simulation modelers. Winter Simulation Conference, 1(1968), 1478–1483.
Cabrera, D. (2021). Developing and validating a measurement of systems thinking: The systems thinking and metacognitive inventory (STMI). In Routledge Handbook of Systems Thinking. Routledge.
Carter, J. (2021). Developing a future pipeline of applied social researchers through experiential learning: The case of a data fellows programme. Statistical Journal of the IAOS, 37, 1–16.
Clancy, T. (2018). Systems thinking: Three system archetypes every manager should know. IEEE Engineering Management Review, 46, 32–41. https://doi.org/10.1109/EMR.2018.2844377.
Cusack, C., Cohen, B., Mignone, J., Chartier, M. J., & Lutfiyya, Z. (2018). Participatory action as a research method with public health nurses. Journal of Advanced Nursing, 74(7), 1544–1553. https://doi.org/10.1111/jan.13555.
Diaz, R., Behr, J., Kumar, S., & Britton, B. (2015). Modeling chronic disease patient flows diverted from emergency departments to patient-centered medical homes. IIE Transactions on Health care Systems Engineering, 5, 268–285.
Epstein, J. M., & Axtell, R. (1996). Growing artificial societies: Social science from the bottom up. Boston, MA: MIT Press.
Goessling, K. (2020). Youth participatory action research, trauma, and the arts: Designing youth spaces for equity and healing, International Journal of Qualitative Studies in Education, 33, 1.
Hilton, A., & Hilton, G. (2017). The impact of conducting practitioner research projects on teachers’ professional growth. Australian Journal of Teacher Education, 42(8). https://doi.org/10.14221/AJTE.2017V42N8.6.
Hirsch, G., & Homer, J. (2020). System dynamics applications to health care in the United States. In B. Dangerfield (Ed.), System dynamics. Encyclopedia of complexity and systems science series. New York, NY: Springer. https://doi.org/10.1007/978-1-4939-8790-0_270.
Kelly, P. J. (2005). Practical suggestions for community interventions using participatory action research. Public Health Nursing, 22(1), 65–73.
Kirshner, J., & Kamberelis, G. (Eds.). (2021). Participatory action research. In Decolonizing transcultural teacher education through participatory action research. https://doi.org/10.4324/9781003111573-5.
Kjellström, S., & Mitchell, A. (2019). Health and health care as the context for participatory action research. Action Research, 17(4), 419–428.
Kolb, D. (1984). Experiential learning. Englewood Cliffs, NJ: Prentice Hall.
Kwamie, A., Ha, S., & Ghaffar, A. (2021). Applied systems thinking: Unlocking theory, evidence and practice for health policy and systems research. Health Policy and Planning, czab062. https://doi.org/10.1093/heapol/czab062.
Lane, D. C., & Husemann, E. (2018). System dynamics mapping of acute patient flows. In M. Kunc (Ed.), System dynamics. OR essentials. London: Palgrave Macmillan. https://doi.org/10.1057/978-1-349-95257-1_13.
Leerapan, B., Teekasap, P., & Urwannachotima, N. (2021). System dynamics modelling of health workforce planning to address future challenges of Thailand’s Universal Health Coverage. Human Resources for Health, 19, 31. https://doi.org/10.1186/s12960-021-00572-5.
Loewenson, R., Laurell, A. C., Hogstedt, C., D’Ambruoso, L., & Shroff, Z. (2014). Participatory action research in health systems: A methods reader. TARSC, AHPSR, WHO, IDRC Canada, Equinet. Retrieved from. http://equinetafrica.org/sites/default/files/uploads/documents/PARMethods_Reader2014_for_web.pdf.
Lin, G., Palopoli, M., & Dadwal, V. (2020). From causal loop diagrams to system dynamics models in a data-rich ecosystem. In L. Celi, M. Majumder, P. Ordóñez, J. Osorio, K. Paik, & M. Somai (Eds.), Leveraging data science for global health (pp. 77–98). Springer. https://doi.org/10.1007/978-3-030-47994-7_6.
Maani, K. E., & Cavana, R.Y. (2006). Systems thinking, system dynamics: Managing change and complexity. New Zealand: Pearson Education.
Macdonald, C. (2012). Understanding participatory action research: A qualitative research methodology option. Canadian Journal of Action Research, 13, 34–50.
Marchildon, G. P. (2016). Legacy of the doctors’ strike and the Saskatoon Agreement. CMAJ: Canadian Medical Association Journal, 188(9), 676–677.
Marshall, D. A., Burgos-Liz, L., I Jzerman, M. J., Osgood, N. D., Padula, W. V., Higashi, M. K., …Crown, W. (2015). Applying dynamic simulation modeling methods in health care delivery research—The SIMULATE checklist: Report of the ISPOR simulation modeling emerging good practices task force. Value in Health, 18(1), 5–16. https://doi.org/10.1016/j.jval.2014.12.001
Määttä, H., Ruutu, S., & Toivonen, M. (2014). Revealing the complexities of health care renewal: A system dynamics approach. In Proceedings of the 5th International Conference on Applied Human Factors and Ergonomics AHFE 2014 (4th ed.).
McTaggart, R. (1991). Principles for participatory action research. Adult Education Quarterly, 41(3), 168–187.
Meadows, D. H. (2008). Thinking in systems: A primer. D. Wright (Ed.). White River Junction, VT: Chelsea Green Publishing.
Nakamura, I. (2014). A discussion of practitioner research: How are reflective practice, action research, and exploratory practice different? Retrieved from https://www.semanticscholar.org/paper/A-Discussion-of-Practitioner-Research-%3A-How-Are-and-Nakamura/1263aea49a3ac85560181b0f0ced5dcf0487c0c2.
Norton, L. S. (2009). Action research in teaching and learning. A practical guide to conducting pedagogical research in universities. London: Routledge.
Paley, J. (2007). Complex adaptive systems and nursing. Nursing Inquiry, 14, 233–242.
Randolph Jr, B. (2015). Changing steps: A reflexive journey in transition. The Journal of Global Health care Systems, 5(2).
Reid, I. (2002). Complexity science. Let them eat complexity: The emperor’s new toolkit. BMJ (Clinical research ed.), 324(7330), 171.
Rifkin, S. (2009). Lessons from community participation in health programmes: A review of the post Alma-Ata experience. International Health, 1(1), 31–36.
Rosala-Hallas, A., Bhangu, A., Blazeby, J., Bowman, L., Clarke, M., Lang, T., … Williamson, P. R. (2018). Global health trials methodological research agenda: Results from a priority setting exercise. Trials, 19, 48. https://doi.org/10.1186/s13063-018-2440-y.
Sales, A., Moliner, O., & Traver, J. (2020). Participatory action research: A case study on the school democratisation process. Research Papers in Education. https://doi.org/10.1080/02671522.2020.1767182.
Schoenenberger, L., Schmid, A., Tanase, R., Beck, M., & Schwaninger, M. (2021). Structural analysis of system dynamics models. Simulation Modelling Practice and Theory, 110, 10233. https://doi.org/10.1016/j.simpat.2021.102333.
Sterman, J. D. (2006). Learning from evidence in a complex world. American Journal of Public Health, 6, 505–514. https://doi.org/10.2105/ AJPH.2005.066043.
Sterman, J. D. (2018). System dynamics at sixty: The path forward. System Dynamics Review, 34(1–2), 5–47.
Stroh, D. P. (2015). Systems thinking for social change: A practical guide to solving complex problems, avoiding unintended consequences, and achieving lasting results. Chelsea Green Publishing.
Von Bertalanffy, L. (1972). The history and status of general systems. In J. Klir (Ed.), Trends in general systems theory. New York, NY: Wiley-Interscience.
Wimpenny, K., & Savin-Baden, M. (2013). Alienation, agency and authenticity: A synthesis of the literature on student engagement. Teaching in Higher Education, 18(3), 311–326. https://doi.org/10.1080/13562517.2012.725223.
Wolstenholme, E., & Mckelvie, D. (Eds.). (2019). Towards a dynamic theory of how hospitals cope in times of high demand. In The Dynamics of Care (pp. 171–187). Springer. https://doi.org/10.1007/978-3-030-21878-2_10
Wolstenholme, E., Monk, D., Mckelvie, D., & Arnold, S. (2007). Coping but not coping in health and social care: Masking the reality of running organisations beyond safe design capacity. System Dynamics Review, 23, 371–389.
Wolstenholme, E. (1999). A patient flow perspective of the U.K. health services: Exploring the case for new “intermediate care” initiatives. System Dynamics Review, 15(3), 253–271. https://doi.org/10.1002/(SICI)1099-1727(199923)15:3<253::AID-SDR172>3.
Wright, D. (2020). Imagining a more just world: Critical arts pedagogy and youth participatory action research. International Journal of Qualitative Studies in Education, 33(1), 32–49.
Zimmerman, L., Lounsbury, D. W., Rosen, C. S., Kimerling, R., Trafton, J. A., & Lindley, S. E. (2016). Participatory system dynamics modeling: Increasing stakeholder engagement and precision to improve implementation planning in systems. Administration and Policy in Mental Health, 43(6), 834–849.
Published
2023-06-09
How to Cite
Ansermeah, M. (2023). Merging Participatory Action Research and System Dynamics as a Locus for Transformation in a Large Scale Hospital Setting. International Journal of Social Science Research and Review, 6(5), 784-797. https://doi.org/10.47814/ijssrr.v6i6.1383
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