Department of Health staff wished to use systems modelling to discuss acute patient flows with groups of NHS staff. The aim was to assess the usefulness of system dynamics (SD) in a healthcare context and to elicit proposals concerning ways of improving patient experience. Since time restrictions excluded simulation modelling, a hybrid approach using stock/flow symbols from SD was created. Initial interviews and hospital site visits generated a series of stock/flow maps. A 'Conceptual Framework' was then created to introduce the mapping symbols and to generate a series of questions about different patient paths and what might speed or slow patient flows. These materials formed the centre of three workshops for NHS staff. The participants were able to propose ideas for improving patient flows and the elicited data was subsequently employed to create a finalized suite of maps of a general acute hospital. The maps and ideas were communicated back to the Department of Health and subsequently assisted the work of the Modernization Agency.

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Relating system dynamics to the broad systems movement, the key notion is that reinforcing loops deserve no less attention than balancing loops. Three specific propositions follow. First, since reinforcing loops arise in surprising places, investigations of complex systems must consider their possible existence and potential impact. Second, because the strength of reinforcing loops can be misinferred-we include an example from the field of servomechanisms-computer simulation can be essential. Be it project management, corporate growth or inventory oscillation, simulation helps to assess consequences of reinforcing loops and options for interventions. Third, in social systems the consequences of reinforcing loops are not inevitable. Examples concerning "globalization" illustrate how difficult it might be to challenge such assumptions. However, system dynamics and ideas from contemporary social theory help to show that even the most complex social systems are, in principle, subject to human influence. In conclusion, by employing these ideas, by attending to reinforcing as well as balancing loops, system dynamics work can improve the understanding of social systems and illuminate our choices when attempting to steer them. Copyright © 2008 John Wiley & Sons, Ltd.Syst. Dyn. Rev. 24, 37-61, (2008) We are very honoured and happy to receive the Jay Wright Forrester Award. We are grateful to the members of the award committee, and to Peter Milling for his generous introduction. We are also in debt to many other people who have helped us and we would like to thank at least some of them here.We should like to mention our teachers at the universities of Bristol, Bielefeld and Oxford. We should also like to thank colleagues at LSE and in the fields of problem structuring methods and system science. The very first contact either of us ever had with system dynamics was when David sat in a room by himself for a week with a Mac 512 k, a copy of STELLA and the manual. It was Barry Richmond's fine work that set him off on a new course. He was also lucky enough early on to meet people who were great examples and who encouraged his growing interest in system dynamics. John Sterman, together with David Kreutzer, ran the very first system dynamics course that David ever went to. John's enthusiasm was infectious then and he has been immensely supportive ever since. One of the first people David got to work with on actual projects was John Morecroft and from that experience he saw directly how system dynamics could be used to improve organizations. Some of the earliest advice about work on problem structuring methods came from George Richardson,

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This paper describes the collaborative process of building a simulation model in order to understand patient waiting times in an accident and emergency department. The purpose is to explore the issues that arise when involving clients, in this case health care professionals, in the process of model building. The study background and a detailed account of the modelling process are presented. The focus of the paper is on some general themes that can be discovered running through the process. These offer some tentative insights into client involvement in system dynamics modelling, in particular its application in health care. Given this study's first promising results, further collaborative studies are encouraged.