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Making Sense of System Boundaries: Critical Realism and Healthcare Policy Design

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Transitions and Boundaries in the Coordination and Reform of Health Services

Part of the book series: Organizational Behaviour in Healthcare ((OBHC))

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Abstract

Healthcare systems and organizations are increasingly recognized as complex adaptive systems (CAS) formed of agents whose interactions within a context produce outcomes. However, if complexity science helps us describe what happens within a system, we are still left with questions as to why they happen. Malone proposes critical realism as a theoretical framework to explain causality in systems. This framework allows to identify and explain generative mechanisms which determine outcomes and shape systems. Malone illustrates the benefits of the approach through an illustrative case study that seeks to explain the dynamics of healthcare policy design in France. Critical realism allows Malone to hypothesize a “Boundary control” mechanism that is instrumental in explaining the dynamics of the French policy advisory system.

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Authors and Affiliations

  1. École Nationale d’Administration Publique (ENAP), Quebec City, QC, Canada

    Antoine Malone

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  1. Antoine Malone
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Correspondence to Antoine Malone .

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Editors and Affiliations

  1. Institute of Health Sciences Education, McGill University, Montréal, QC, Canada

    Peter Nugus

  2. Department of Family Medicine, McGill University, Montréal, QC, Canada

    Charo Rodriguez

  3. School of Public Health, University of Montreal, Montréal, QC, Canada

    Jean-Louis Denis

  4. Department of Human Resource Management, HEC Montréal, Montréal, QC, Canada

    Denis Chênevert

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Malone, A. (2020). Making Sense of System Boundaries: Critical Realism and Healthcare Policy Design. In: Nugus, P., Rodriguez, C., Denis, JL., Chênevert, D. (eds) Transitions and Boundaries in the Coordination and Reform of Health Services. Organizational Behaviour in Healthcare. Palgrave Macmillan, Cham. https://doi.org/10.1007/978-3-030-26684-4_5

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