A Pragmatic and Systemic Approach to Advance Research in Health Policy and Management; Comment on “Insights Gained From a Re-analysis of Five Improvement Cases in Healthcare Integrating System Dynamics Into Action Research”

Document Type : Commentary


Department of Economics, University of Messina, Messina, Italy


“Healthcare is complex” - or similar sentences – is a statement that introduces a wide number of scientific articles dealing with health policy and management issues. We all agree that healthcare is complex, but most studies, although using this kind of sentence to introduce their background, do little to effectively deal with such complexity in their analyses. Holmström et al proposed a methodological approach to tackle healthcare complexity by integrating system dynamics (SD) into action research (AR). This commentary highlights three touch points that makes the combination of AR and SD feasible, namely the epistemological ground, the use of experimentation and the collaborative approach. The proposed approach addresses some of the key sources of the complexity characterizing healthcare settings.


  1. Mazzocchi F. Complexity, network theory, and the epistemological issue. Kybernetes. 2016;45(7):1158-1170. doi:10.1108/k-05-2015-0125
  2. Head BW, Alford J. Wicked problems: implications for public policy and management. Adm Soc. 2015;47(6):711-739. doi:10.1177/0095399713481601
  3. Holmström P, Björk-Eriksson T, Davidsen P, Bååthe F, Olsson C. Insights gained from a re-analysis of five improvement cases in healthcare integrating system dynamics into action research. Int J Health Policy Manag. 2022. doi:10.34172/ijhpm.2022.5693
  4. Lewin K. Action research and minority problems. J Soc Issues. 1946;2(4):34-46.
  5. Dumay JC. A critical reflective discourse of an interventionist research project. Qual Res Account Manag. 2010;7(1):46-70. doi:10.1108/11766091011034271
  6. Kesić S. Rethinking the pragmatic systems biology and systems-theoretical biology divide: toward a complexity-inspired epistemology of systems biomedicine. Med Hypotheses. 2019;131:109316. doi:10.1016/j.mehy.2019.109316
  7. Forrester J. Industrial Dynamics. MIT Press; 1958.
  8. Noto G, Cosenz F. Introducing a strategic perspective in lean thinking applications through system dynamics modelling: the dynamic value stream map. Bus Process Manag J. 2021;27(1):306-327. doi:10.1108/bpmj-03-2020-0104
  9. Homer JB, Hirsch GB. System dynamics modeling for public health: background and opportunities. Am J Public Health. 2006;96(3):452-458. doi:10.2105/ajph.2005.062059
  10. Saunders M, Lewis P, Thornhill A. Research Methods for Business Students. Pearson Education; 2009.
  11. Argyris C, Schön D. Organizational Learning II: Theory, Method and Practice. Reading, UK: Addison-Westley; 1996.
  12. Kunc M, Morecroft JDW, Brailsford S. Special issue on advances in system dynamics modelling from the perspective of other simulation methods. J Simul. 2018;12(2):87-89. doi:10.1080/17477778.2018.1469385
  13. Kesić S. Toward a more general understanding of Bohr’s complementarity: insights from modeling of ion channels. Acta Biotheor. 2021;69(4):723-744. doi:10.1007/s10441-021-09424-0
  14. Nuti S, Noto G, Vola F, Vainieri M. Let’s play the patients music: a new generation of performance measurement systems in healthcare. Manag Decis. 2018;56(10):2252-2272. doi:10.1108/md-09-2017-0907
  15. Vennix JAM, Andersen DF, Richardson GP, Rohrbaugh J. Model-building for group decision support: Issues and alternatives in knowledge elicitation. Eur J Oper Res. 1992;59(1):28-41. doi:1016/0377-2217(92)90005-t
  • Receive Date: 18 September 2022
  • Revise Date: 24 October 2022
  • Accept Date: 26 October 2022
  • First Publish Date: 30 October 2022