Systems thinking methods: a worked example of supporting emergency medical services decision-makers to prioritize and contextually analyse potential interventions and their implementation
Abstract Background Systems thinking can be used as a participatory data collection and analysis tool to understand complex implementation contexts and their dynamics with interventions, and it can support the selection of tailored and effective implementation actions. A few previous studies have ap...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-06-01
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| Series: | Health Research Policy and Systems |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12961-023-00982-y |
| _version_ | 1797806412998377472 |
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| author | Cassandra Rehbock Thomas Krafft Anja Sommer Carijn Beumer Stefan K. Beckers Stefan Thate Jörn Kaminski Alexandra Ziemann |
| author_facet | Cassandra Rehbock Thomas Krafft Anja Sommer Carijn Beumer Stefan K. Beckers Stefan Thate Jörn Kaminski Alexandra Ziemann |
| author_sort | Cassandra Rehbock |
| collection | DOAJ |
| description | Abstract Background Systems thinking can be used as a participatory data collection and analysis tool to understand complex implementation contexts and their dynamics with interventions, and it can support the selection of tailored and effective implementation actions. A few previous studies have applied systems thinking methods, mainly causal loop diagrams, to prioritize interventions and to illustrate the respective implementation context. The present study aimed to explore how systems thinking methods can help decision-makers (1) understand locally specific causes and effects of a key issue and how they are interlinked, (2) identify the most relevant interventions and best fit in the system, and (3) prioritize potential interventions and contextually analyse the system and potential interventions. Methods A case study approach was adopted in a regional emergency medical services (EMS) system in Germany. We applied systems thinking methods following three steps: (1) a causal loop diagram (CLD) with causes and effects (variables) of the key issue “rising EMS demand” was developed together with local decision-makers; (2) targeted interventions addressing the key issue were determined, and impacts and delays were used to identify best intervention variables to determine the system’s best fit for implementation; (3) based on steps 1 and 2, interventions were prioritized and, based on a pathway analysis related to a sample intervention, contextually analysed. Results Thirty-seven variables were identified in the CLD. All of them, except for the key issue, relate to one of five interlinked subsystems. Five variables were identified as best fit for implementing three potential interventions. Based on predicted implementation difficulty and effect, as well as delays and best intervention variables, interventions were prioritized. The pathway analysis on the example of implementing a standardized structured triage tool highlighted certain contextual factors (e.g. relevant stakeholders, organizations), delays and related feedback loops (e.g. staff resource finiteness) that help decision-makers to tailor the implementation. Conclusions Systems thinking methods can be used by local decision-makers to understand their local implementation context and assess its influence and dynamic connections to the implementation of a particular intervention, allowing them to develop tailored implementation and monitoring strategies. |
| first_indexed | 2024-03-13T06:06:55Z |
| format | Article |
| id | doaj.art-04850d3a7f38468796acd057a32319fb |
| institution | Directory Open Access Journal |
| issn | 1478-4505 |
| language | English |
| last_indexed | 2024-03-13T06:06:55Z |
| publishDate | 2023-06-01 |
| publisher | BMC |
| record_format | Article |
| series | Health Research Policy and Systems |
| spelling | doaj.art-04850d3a7f38468796acd057a32319fb2023-06-11T11:28:46ZengBMCHealth Research Policy and Systems1478-45052023-06-0121111310.1186/s12961-023-00982-ySystems thinking methods: a worked example of supporting emergency medical services decision-makers to prioritize and contextually analyse potential interventions and their implementationCassandra Rehbock0Thomas Krafft1Anja Sommer2Carijn Beumer3Stefan K. Beckers4Stefan Thate5Jörn Kaminski6Alexandra Ziemann7Department of Health, Ethics and Society, Care And Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht UniversityDepartment of Health, Ethics and Society, Care And Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht UniversityDepartment of Health, Ethics and Society, Care And Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht UniversityDepartment of Health, Ethics and Society, Care And Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht UniversityAachen Institute for Rescue Management and Public Safety, University Hospital RWTH Aachen and City of AachenCity of Oldenburg - Fire DepartmentRettungsdienst Landkreis OldenburgDepartment of Health, Ethics and Society, Care And Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht UniversityAbstract Background Systems thinking can be used as a participatory data collection and analysis tool to understand complex implementation contexts and their dynamics with interventions, and it can support the selection of tailored and effective implementation actions. A few previous studies have applied systems thinking methods, mainly causal loop diagrams, to prioritize interventions and to illustrate the respective implementation context. The present study aimed to explore how systems thinking methods can help decision-makers (1) understand locally specific causes and effects of a key issue and how they are interlinked, (2) identify the most relevant interventions and best fit in the system, and (3) prioritize potential interventions and contextually analyse the system and potential interventions. Methods A case study approach was adopted in a regional emergency medical services (EMS) system in Germany. We applied systems thinking methods following three steps: (1) a causal loop diagram (CLD) with causes and effects (variables) of the key issue “rising EMS demand” was developed together with local decision-makers; (2) targeted interventions addressing the key issue were determined, and impacts and delays were used to identify best intervention variables to determine the system’s best fit for implementation; (3) based on steps 1 and 2, interventions were prioritized and, based on a pathway analysis related to a sample intervention, contextually analysed. Results Thirty-seven variables were identified in the CLD. All of them, except for the key issue, relate to one of five interlinked subsystems. Five variables were identified as best fit for implementing three potential interventions. Based on predicted implementation difficulty and effect, as well as delays and best intervention variables, interventions were prioritized. The pathway analysis on the example of implementing a standardized structured triage tool highlighted certain contextual factors (e.g. relevant stakeholders, organizations), delays and related feedback loops (e.g. staff resource finiteness) that help decision-makers to tailor the implementation. Conclusions Systems thinking methods can be used by local decision-makers to understand their local implementation context and assess its influence and dynamic connections to the implementation of a particular intervention, allowing them to develop tailored implementation and monitoring strategies.https://doi.org/10.1186/s12961-023-00982-yComplexityDecision supportImplementation |
| spellingShingle | Cassandra Rehbock Thomas Krafft Anja Sommer Carijn Beumer Stefan K. Beckers Stefan Thate Jörn Kaminski Alexandra Ziemann Systems thinking methods: a worked example of supporting emergency medical services decision-makers to prioritize and contextually analyse potential interventions and their implementation Health Research Policy and Systems Complexity Decision support Implementation |
| title | Systems thinking methods: a worked example of supporting emergency medical services decision-makers to prioritize and contextually analyse potential interventions and their implementation |
| title_full | Systems thinking methods: a worked example of supporting emergency medical services decision-makers to prioritize and contextually analyse potential interventions and their implementation |
| title_fullStr | Systems thinking methods: a worked example of supporting emergency medical services decision-makers to prioritize and contextually analyse potential interventions and their implementation |
| title_full_unstemmed | Systems thinking methods: a worked example of supporting emergency medical services decision-makers to prioritize and contextually analyse potential interventions and their implementation |
| title_short | Systems thinking methods: a worked example of supporting emergency medical services decision-makers to prioritize and contextually analyse potential interventions and their implementation |
| title_sort | systems thinking methods a worked example of supporting emergency medical services decision makers to prioritize and contextually analyse potential interventions and their implementation |
| topic | Complexity Decision support Implementation |
| url | https://doi.org/10.1186/s12961-023-00982-y |
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