For more information, including our policy and submission procedure, please contact the Repository Team at: usir@salford.ac.uk. Modelling the feedback effects of reconfiguring health services AbstractThe shift in the balance of health care, bringing services 'closer to home', is a well established trend, which has been motivated by the desire to improve the provision of services. However, these efforts may be undermined by the improvements in access stimulating demand. Existing analyses of this trend have been limited to isolated parts of the system with calls to control demand with stricter clinical guidelines or to meet demand with capacity increases. By failing to appreciate the underlying feedback mechanisms, these interventions may only have a limited effect. We demonstrate the contribution offered by system dynamics modelling by presenting a study of two cases of the shift in cardiac catheterisation services in the U.K. We hypothesise the effects of the shifts in services and produce model output that is not inconsistent with real world data. Our model encompasses several mechanisms by which demand is stimulated. We use the model to clarify the roles for stricter clinical guidelines and capacity increases, and to demonstrate the potential benefits of changing the goals that drive activity.

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A system dynamics model of HIV/AIDS epidemiology is employed to simulate the effects of triple combination antiretroviral therapy in the treatment of HIV/AIDS. The epidemic data on homosexual men in the UK (1981‐‐1998) have been used to fit the baseline model. The new combination therapies, which supplanted antiviral mono and dual therapy in 1996, are proving to be the most effective prophylaxis yet for halting viral replication in vivo, but many uncertainties still surround their use. A range of model‐generated scenarios are created as a means of considering these uncertainties. Possible futures for the HIV/AIDS epidemic are constructed. Copyright © 2001 John Wiley & Sons, Ltd.

PurposeConstruction sector competitiveness has been a subject of interest for many years.Research too often focuses on the means of overcoming the 'barriers to change' as if such barriers were static entities. There has been little attempt to understand the dynamic interrelationship between the differing factors which impinge upon construction sector competitiveness. The paper outlines the benefits of taking a systems approach to construction competitiveness research. Design/methodology/approachThe System Dynamics (SD) modelling methodology is described. This can provide practitioners with 'microworlds' within which they can explore the dynamic effects of different policy decisions. The data underpinning the use of SD was provided by interviews and case study research which allowed an understanding of the context within which practitioners operate. FindingsThe over-riding conclusion is that the system dynamics methodology has been shown to be capable of providing a means to assess the forces which shape the sustained competitiveness of construction firms. As such, it takes the assessment of strategic policy analysis in the construction sector onto a higher plane. The need to collect data and make retrospective assessments of competitiveness and strategic performance at the statistical level is not now the only modus operandi available Originality/value 2 Novel research methodology which points towards an alternative research agenda for construction competitiveness research. Within the scope of a single paper it is not possible to describe in detail the project, colloquially known as the 'Big Ideas', in its entirety. The purpose of the current paper is to focus on the contribution offered by the work package which focused on system dynamics. Initially, the broad background to the project is described followed by an overview of the adopted research methodology. The origins and nature of system 3 dynamics are then described prior to a detailed description of how competitiveness was modelled for a typical contracting firm. Particular emphasis is given to the development of a 'competitiveness index'. For details on other strands of research within the Big Ideas project see: Green et al (2008a), Green et al (2008b), Harty et al (2007), Goodier et al Keywords

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