Analysing “the Workings” of Health Systems as Complex Adaptive Systems
Looking backwards asking: which of its structures and behaviours allowed its current state to emerge (the what and why questions)
Looking forward asking: changes to which of its structures and behaviours may most likely shape dynamics that achieve a future desired outcome (the how questions)
Health atlases that describe the distribution of various health services like the location of hospitals, community practices, specialist medical and allied services, etc. in a geographic area
Geospatial distribution maps superimpose a variety of different data onto a map and visually highlight their linkages. For example, researchers have found a strong relationship between socioeconomic characteristics, the distribution of fast food outlets, and obesity rates across different suburbs
Creating geospatial maps for different time periods can show progress in combating particular issues of concern like the improvements in the battle against sleeping sickness in the Democratic Republic of the Congo
Looking forward takes account of the fact that the system as a whole, rather than its discrete entities, produce the behaviours and outcomes one observes and desires. Looking forward is the realm of modelling. A model is a “simplified version of reality”, it contains those “agreed upon” variables regarded as “responsible to cause” the behaviours and outcomes of the system.
Modelling in the first instance is a learning tool—it allows all involved in model building to gain a deep insight into the system’s structure and function. In the second instance it is a decision-making tool—it invites the exploration of “what-if” scenarios to help find the “best possible” approach to solving a problem. Modelling provides decision makers a “safe space” to explore the long-term effects of potential solutions on the system’s behaviours and outcomes.
However, modelling is not a panacea; as Rittel emphasised, every solution to a wicked problem is a “one shot solution”; modelling helps decision makers to “give it the best shot possible”.
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