The Challenges Facing Health and Social Care and the Relevance of Dynamic Models

  • Eric WolstenholmeEmail author
  • Douglas McKelvie


This Chapter outlines the challenges facing health and social care in many countries and the approach and scope of the methods used by the authors to address these issues. The background to and appropriateness of system dynamics models is discussed along with the current state of health and social care worldwide, with a focus on problems which habitually reoccur despite best efforts to contain them.


  1. Appleby, J., Galea, A., & Murray, M. (2014). The NHS productivity challenge—Experience from the front line. London, UK: The King’s Fund.Google Scholar
  2. Beer, S. (1989). The viable system model: Its provenance, development, methodology and pathology. In R. Espejo & R. Harnden (Eds.), The viable system model—Interpretations and applications of Stafford Beer’s VSM (pp. 11–37). Chichester, UK p: Wiley.Google Scholar
  3. Campbell, D. (2017). Guardian newspaper. Retrieved February 22, 2017.Google Scholar
  4. Campbell, D. (2018). Guardian newspaper. Retrieved December 6, 2018.Google Scholar
  5. Campbell, D. (2019). Guardian newspaper. Retrieved December 18, 2019.Google Scholar
  6. Churchman, C. W. (1967). Wicked Problems Management Science 14(4).
  7. Checkland, P. B. (1981). Systems thinking, systems practice. Wiley, Chichester, UK, 330 pp. ISBN 0 471 27911 0 (republished 1999 in paperback, with a 30‐year retrospective).Google Scholar
  8. Checkland, P. B., & Scholes, J. (1990/1999). Soft systems methodology in action. Wiley: Chicester.Google Scholar
  9. Dangerfield, B. C. (1999). System dynamics applications to European health care issues. Journal of the Operational Research Society 50(4), 345–353.CrossRefGoogle Scholar
  10. Dangerfield, B. C., Roberts, C. A., & Fang, Y. (2001). Model-based scenarios for the epidemiology of HIV/AIDS: The consequences of highly active antiretroviral therapy. System Dynamics Review, 17(2), 119–150.Google Scholar
  11. Dynamics Series, Pegasus Communications Cambridge MA.Google Scholar
  12. Flood, R. L., & Jackson, M. C. (1991). Critical systems thinking. Wiley: Chichester.Google Scholar
  13. Ford, A. (2009). Modeling the environment. Washington, DC: Island Press.Google Scholar
  14. Forrester, J. W. (1961). Industrial dynamics Cambridge, MA: The MIT Press. Waltham, MA: Reprinted by Pegasus Communications.Google Scholar
  15. Forrester, J. W. (1969). Urban dynamics. Cambridge, MA: The MIT Press. Reprinted by Pegasus Communications, Waltham, MA.Google Scholar
  16. Health Foundation. (2016). Acute hospital productivity, Health Foundation analysis of acute hospital productivity from 2009/10–2014/15.Google Scholar
  17. Healthwatch UK. (2017). What happens when people leave hospital and other care settings? Hospital and other care settings? Findings from the Healthwatch network October 2017.Google Scholar
  18. Hirsch, G., Homer, J. (2016). System dynamics applications to health care in the United States. In R. Meyers (Ed.) Encyclopaedia of complexity and system science. Springer: Berlin, Germany. ISBN 978-0-387-75888-6.Google Scholar
  19. Hirsch, G., Homer, J., Wile, K., Trogdon, J. G., & Orenstein, D. (2014). Using simulation to compare 4 categories of intervention for reducing cardiovascular disease risks. American Journal of Public Health, 104(7), 1187–1195.CrossRefGoogle Scholar
  20. Hirsch, G., Homer, J., & Tomoaia-Cotisel, A. (Eds.). System dynamics applications to Health and Health Care (15 previously published articles with new introduction and extended bibliography). Virtual Issue of System Dynamics Review. Retrieved January 2015, from
  21. Homer, J., Ritchie-Dunham, J., Rabbino, H., Puente, L., Jorgensen, J., & Hendricks, K. (2000). Toward a dynamic theory of antibiotic resistance. System Dynamics Review, 16(4), 287–319.CrossRefGoogle Scholar
  22. Homer, J., & Hirsch, G. (2006). System dynamics modeling for public health: Background and opportunities. American Journal of Public Health, 96(3), 452–458.CrossRefGoogle Scholar
  23. Homer, J., Hirsch, G., & Milstein, B. (2007). Chronic illness in a complex health economy: The perils and promises of downstream and upstream reforms. System Dynamics Review, 23(2/3), 313–343.CrossRefGoogle Scholar
  24. Homer, J. B. (2012). Models that matter. Barrytown, New York: Grapeseed Press.Google Scholar
  25. Homer, J., Milstein, B., Hirsch, G. B., & Fisher, E. S. (2016). Combined regional investments could substantially enhance health system performance and be financially affordable. Health Affairs, 35(8), 1435–1443.CrossRefGoogle Scholar
  26. Homer, J. B. (2017). More models that matter. Barrytown, New York: Grapeseed Press.Google Scholar
  27. Ham, C. (2018). Making sense of integrated care systems, integrated care partnerships and accountable care organisations in the NHS in England.
  28. Jones, A., Homer, J., Murphy, D., Essien, J., Milstein, B., & Seville, D. (2006). Understanding diabetes population dynamics through simulation modeling and experimentation. American Journal of Public Health, 96(3), 488–494.CrossRefGoogle Scholar
  29. Karakusevic, S. (2016). Understanding patient flow in hospitals. Nuffield Trust.Google Scholar
  30. Lacy, P. (2018). The whole system partnership.
  31. Lane, D. C., Monefeldt, C., & Rosenhead, J. V. (2000). Looking in the wrong place for healthcare improvements: A system dynamics study of an A&E department. Journal of the Operational Research Society, 51(5), 518–531.CrossRefGoogle Scholar
  32. Lane, D. C., & Jackson, M. C. (1995). Only connect! An annotated bibliography reflecting the breadth and diversity of systems thinking. Systems Research, 12(3), 217–228.CrossRefGoogle Scholar
  33. Maani, K. E., & Cavana, R. Y. (2007). Systems thinking, system dynamics: Understanding change and complexity. Prentice Hall: Aukland.Google Scholar
  34. Maybin, J., & Klein, R. (2012). ‘Thinking about rationing’. King’s Fund.Google Scholar
  35. McKelvie, D. (2018).
  36. Meadows, D. H., Meadows, D. L., Randers, J., & Behrens, W., III. (1972). The limits to growth; a report for the club of Rome’s project on the predicament of mankind. New York: Universe Books.CrossRefGoogle Scholar
  37. Meadows, D. H., Randers, J., & Meadows, D. L. (2004). The limits to growth: The 30-year update. Vermont USA: Chelsea Green Publishing Company.Google Scholar
  38. Milstein, B., Homer, J., Briss, P., Burton, D., & Pechacek, T. (2011). Why behavioral and environmental interventions are needed to improve health at lower cost. Health Affairs, 30(5). Scholar
  39. Milstein, B., Homer, J., & Hirsch, G. (2010). Analyzing national health reform strategies with a dynamic simulation model. American Journal of Public Health, 100(5), 811–819.CrossRefGoogle Scholar
  40. Morecroft, J. D. W. (2007). Strategic modeling and business dynamics: A feedback systems approach. In J. D. W. Morecroft, & J. D. Sterman (Eds.) (1994) Modeling for learning organizations system. Wiley: Chichester.Google Scholar
  41. NHS England. (2017). Next steps on the NHS five year forward view.
  42. Nuffield Trust. (2018). The history of NHS reform. Scholar
  43. Rajeev, S., & Campbell, D. (2018). Guardian UK report of interview with national audit office comptroller. Amyas Morse.Google Scholar
  44. Rawnsley, A. (2018). Guardian newspaper comment. Retrieved from June 24, 2018.Google Scholar
  45. Richardson, G. P. (1999). Feedback thought in social science and systems theory Philadelphia: University of Pennsylvania Press. Waltham, MA: Pegasus Communications.Google Scholar
  46. Richardson, G. P. (Ed.). (1996). Modelling for management: Simulation in support of systems thinking. International library of management. Aldershot, UK: Dartmouth Publishing Company.Google Scholar
  47. Richardson, G. P., & Pugh, A. L., III. (1981). Introduction to system dynamics modeling with DYNAMO. MA Reprinted by Pegasus Communications, Waltham, MA: The MIT Press Cambridge.Google Scholar
  48. Rutherford, P. A., Provost, L. P., Kotagal, U. R., Luther, K., & Anderson, A. (2017). Achieving hospital-wide patient flow. IHI White Paper. Cambridge, Massachusetts: Institute for Healthcare Improvement.
  49. Stoye, G. (2018). What does the NHS funding announcement mean for health spending in England. Institute of Fiscal Studies Observation, Economic and Social research Council, London.Google Scholar
  50. Senge, P. M. (1990). The fifth discipline: The art and practice of the learning organization. New York: Doubleday/Currency.Google Scholar
  51. Sherwood, D. (2002). Seeing the forest for the trees: A manager’s guide to applying systems thinking. London: Nicholas Brearley.Google Scholar
  52. Sterman, J. D. (2000). Business dynamics: Systems thinking and modelling for a complex world. Boston: Irwin McGraw-Hill.Google Scholar
  53. Stroth, P. L. (2015). Systems thinking for social change. White River Junction, Vermont, USA: Chelsea Green Publishing.Google Scholar
  54. Todd, D. (2018).
  55. Vennix, J. A. M. (1996). Group model building: Facilitating team learning using system dynamics. Chichester: Wiley.Google Scholar
  56. Warren, K. (2008). Strategic management dynamics. Chichester: Wiley.Google Scholar
  57. Wolstenholme, E. F. (1990). System enquiry: A system dynamics approach. John Wiley & Sons, Ltd.: Chichester.Google Scholar
  58. Wolstenholme, E. F., (1993). A case study in community care using systems thinking. Journal of the Operational Research Society, 44(9), 925–934.CrossRefGoogle Scholar
  59. Wolstenholme, E. F. (1996). A patient flow perspective of UK health services. System Dynamics Review, 15(3), 253–273.CrossRefGoogle Scholar
  60. Wolstenholme, E. F. (2003). Towards the definition and use of a core set of archetypal structures in system dynamics. System Dynamics Review, 19(1), 7–26.CrossRefGoogle Scholar
  61. Wolstenholme, E. F. (2008). Influencing and interpreting health and social care policy in the UK. In H. Qudrat-Ullah, M. J. Spector, & P. I. Davidsen (Eds.), Complex decision making: Theory and practice (pp. 155–185). Springer, US (with Monk D and McKelvie D).Google Scholar
  62. Wolstenholme, E. (2015). Health care in the United Kingdom and Europe, system dynamics applications to. In R. Meyers (Ed.), Encyclopaedia of complexity and systems science. Heidelberg: Springer, Berlin.Google Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Symmetric ScenariosEdinburghUK
  2. 2.Symmetric ScenariosEdinburghUK

Personalised recommendations