Systemic Leverage and Homogeneity: Assessing Multifaceted Amplifying Mechanism of Systemic Risk

Kim, Myeong Hyeon; Kim, Baeho

doi:10.2139/ssrn.2639015

Cited by 3 publications

(5 citation statements)

References 31 publications

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“…Figure 5 depicts two reinforcing loops (R1 and R2) that together resemble one of the eight archetypes of systems thinking, the “success to the successful” systems archetype [ 50 ]. It starts with the one-time investment improving the work environment (basic equipment and stock of medicine), which positively influences the motivation and performance of the health workers [ 49 , 51 , 52 ].…”

Section: Resultsmentioning

confidence: 99%

“…Figure 6 shows that this “success to successful” loop (R) may be hampered by two balancing feedback loops; the increased number of patients also increases the workload, which puts both the work environment (B1) and motivation (B2) under stress (KIs 11, 12, 14, 15) [ 52 ]. This combination of loops corresponds to the “growth and underinvestment” archetype in systems thinking [ 50 ].…”

Section: Resultsmentioning

confidence: 99%

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Combining Theory-Driven Evaluation and Causal Loop Diagramming for Opening the ‘Black Box’ of an Intervention in the Health Sector: A Case of Performance-Based Financing in Western Uganda

Renmans

Holvoet

Criel

2017

IJERPH

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Increased attention on “complexity” in health systems evaluation has resulted in many different methodological responses. Theory-driven evaluations and systems thinking are two such responses that aim for better understanding of the mechanisms underlying given outcomes. Here, we studied the implementation of a performance-based financing intervention by the Belgian Technical Cooperation in Western Uganda to illustrate a methodological strategy of combining these two approaches. We utilized a systems dynamics tool called causal loop diagramming (CLD) to generate hypotheses feeding into a theory-driven evaluation. Semi-structured interviews were conducted with 30 health workers from two districts (Kasese and Kyenjojo) and with 16 key informants. After CLD, we identified three relevant hypotheses: “success to the successful”, “growth and underinvestment”, and “supervision conundrum”. The first hypothesis leads to increasing improvements in performance, as better performance leads to more incentives, which in turn leads to better performance. The latter two hypotheses point to potential bottlenecks. Thus, the proposed methodological strategy was a useful tool for identifying hypotheses that can inform a theory-driven evaluation. The hypotheses are represented in a comprehensible way while highlighting the underlying assumptions, and are more easily falsifiable than hypotheses identified without using CLD.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Combining Theory-Driven Evaluation and Causal Loop Diagramming for Opening the ‘Black Box’ of an Intervention in the Health Sector: A Case of Performance-Based Financing in Western Uganda

Renmans

Holvoet

Criel

2017

IJERPH

View full text Add to dashboard Cite

show abstract

“…They provide templates to demonstrate different types of balancing and reinforcing feedback loops, which can be used by teams to come to a diagnosis about how a system is working, and particularly about how performance changes over time. Kim [ 24 ] …”

Section: Theories Methods and Toolsmentioning

confidence: 99%

“…Some tools are intended as means of facilitating groups of people to have a common understanding about an issue to prompt further inquiry and action. For example, “systems archetypes” help teams to understand generic patterns of interaction that can be applicable to their “story” [ 24 ]. Rather than use the pre-existing templates of systems archetypes, causal loop diagrams (CLD) are created without a template, and involve drawing out people’s understanding of how elements of a problem are related to each other [ 19 ].…”

Section: Theories Methods and Toolsmentioning

confidence: 99%

The application of systems thinking in health: why use systems thinking?

Peters

2014

Health Res Policy Sys

371

338

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This paper explores the question of what systems thinking adds to the field of global health. Observing that elements of systems thinking are already common in public health research, the article discusses which of the large body of theories, methods, and tools associated with systems thinking are more useful. The paper reviews the origins of systems thinking, describing a range of the theories, methods, and tools. A common thread is the idea that the behavior of systems is governed by common principles that can be discovered and expressed. They each address problems of complexity, which is a frequent challenge in global health. The different methods and tools are suited to different types of inquiry and involve both qualitative and quantitative techniques. The paper concludes by emphasizing that explicit models used in systems thinking provide new opportunities to understand and continuously test and revise our understanding of the nature of things, including how to intervene to improve people’s health.

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“…The CLDs are often complex, so a simpler version of CLDs called system archetypes was developed to understand the complex causal mechanism. System archetypes are simple templates of CLDs for understanding common problems or dilemmas in an organisation or system and in a way that generates insights for action [ 31 , 32 ]. The CLDs and archetypes were built using the Vensim software [ 33 ].…”

Section: Methodsmentioning

confidence: 99%

The role of tobacco and alcohol use in the interaction of social determinants of non-communicable diseases in Nepal: a systems perspective

et al. 2020

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Background Tobacco and alcohol use are major behavioural risks in developing countries like Nepal, which are contributing to a rapid increase in non-communicable diseases (NCDs). This causal relationship is further complicated by the multi-level social determinants such as socio-political context, socio-economic factors and health systems. The systems approach has potential to facilitate understanding of such complex causal mechanisms. The objective of this paper is to describe the role of tobacco and alcohol use in the interaction of social determinants of NCDs in Nepal. Method The study adopted a qualitative study design guided by the Systemic Intervention methodology. The study involved key informant interviews (n = 63) and focus group discussions (n = 12) at different levels (national, district and/or community) and was informed by the adapted Social Determinants of Health Framework. The data analysis involved case study-based thematic analysis using framework approach and development of causal loop diagrams. The study also involved three sense-making sessions with key stakeholders. Results Three key themes and causal loop diagrams emerged from the data analysis. Widespread availability of tobacco and alcohol products contributed to the use and addiction of tobacco and alcohol. Low focus on primary prevention by health systems and political influence of tobacco and alcohol industries were the major contributors to the problem. Gender and socio-economic status of families/communities were identified as key social determinants of tobacco and alcohol use. Conclusion Tobacco and alcohol use facilitated interaction of the social determinants of NCDs in the context of Nepal. Socio-economic status of families was both driver and outcome of tobacco and alcohol use. Health system actions to prevent NCDs were delayed mainly due to lack of system insights and commercial influence. A multi-sectoral response led by the health system is urgently needed.

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Systemic Leverage and Homogeneity: Assessing Multifaceted Amplifying Mechanism of Systemic Risk

Cited by 3 publications

References 31 publications

Combining Theory-Driven Evaluation and Causal Loop Diagramming for Opening the ‘Black Box’ of an Intervention in the Health Sector: A Case of Performance-Based Financing in Western Uganda

Combining Theory-Driven Evaluation and Causal Loop Diagramming for Opening the ‘Black Box’ of an Intervention in the Health Sector: A Case of Performance-Based Financing in Western Uganda

The application of systems thinking in health: why use systems thinking?

The role of tobacco and alcohol use in the interaction of social determinants of non-communicable diseases in Nepal: a systems perspective

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