Talk:Health System Archetypes

From HPSIGWiki

Note to Eric: I am ambivalent about the hierarchy, whether it should start with the archetypes and enumerate the modes and settings in which care is delievered or follow the one I used above. They each have their merits. Starting with the archetypes naturally favors the integration of all modes and settings of care. Starting with the modes and settings of care makes it more relevant to a reader in a particular mode and/or setting. See Alternate Health System Archetypes Hierarchy.

Bill

[edit] Generic Structures/Behaviors

Eric, Bill as you can see I have restructured this area in the table of contents.

I'd probably put most of Bill's classes as Sections underneath the Service Delivery heading of the WHO HSP framework -geoff

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Geoff, does this mean you are going to do away with Health System Archetypes as a heading? :bill

No Bill. I was really trying out the Subject/headline box on the Talk page There is a section of the book about Generic Structures/Behaviors and Health System Archetypes is currently a (probably THE) major heading under this book section.

Looking at John Sterman's BD book he uses in Part II Two sections

Ch 7 Dynamics of Stocks and Flows

Ch 8 Closing the Loop Dynamics of Simple Structures

He then goes on in part III THE DYNAMICS OF GROWTH

Ch 9 S Shaped growth (which I use in my Health Systems Simulation Course)

Ch 10 Path Dependence and Positive Feedback

Also of relevance (in my mind) is Ch12 Coflows and Aging Chains

Ch15 Modeling Human Behavior

part V INSTABILITY AND OSCILLATION

Ch19 Labor Supply Chain

All of the above were things I thought should covered with specific health examples/case studies in this Section of the Book.

You and Eric are probably the best to decide what exactly is covered by Health System Archetypes...I was only trying to expand on the overall book Section Here

-geoff

[edit] Wellbeing

Jan 6.2006 Bill

At 35,000 feet I see health care as a subsystem of health. In the US for example, healthcare is seemingly thought of as THE determinant of health. There is little (common) awareness (or at least little interest) that the state of one's health is a determinant of the demand for healthcare services.

That is why Evans', et.al. model is appealing to me. Yes it does have its roots in the "Public Health, Epidemiology, Social and Economic Determinants of Health" context of which you speak. At the same time, if we are thinking systemically (and here I invoke Ackoff's admonition to solve problems in the largest system to which we have access), how can we separate the dynamics of health and healthcare?

That said, a bit of aggregation may be in oder, at least to get us started. I'd like to talk more about lumping these dimensions into a Social Context category.

I am interested in hearing Eric's thoughts.

Jan 7.2006 Eric

Thanks for starting this Bill. I like the causal map and I agree it is best to start at the highest level.

My thoughts are that what you have here is a good causal map but not an archetype.

To me an archetype tells a story which begins with one or two loops and then others come in after a delay and across boundaries. Usually loops cross boundaries so no individual or single group really has control over them.

My story here would be a limits to growth of well being. There is a basic reinforcing loop around response-prosperity-health wellbeing, supported by another linking propriety to well being via social environment. So in a unconstrained situation we would all prosper.

A number of balancing loops then cut in, some driven exogenously by genetic endowment (or maybe this is closed loop in the long term?) and some endogenously. For example individual response could lead to disease to health care and undermine prosperity.

Also prosperity leads to economic environment growth and then we are in the limits to growth world model.....

The main point here is to probe the purpose of the mapping? In the UK we are thinking a lot about well being and so my purpose would be to story tell how well being is created and lost. What is your purpose and what is your story in the map drawn? What was the story in Evans, et al?

Finally is your map drawn in Vensim. It would be good to be able to add to/subtract from it.

Jan 7.2006 Bill

Wonderful to hear from you., Points well made. To clarify one item, I never intended this to be an archetype but a meta model for the organization of archetypes.

I used MapSys to draw the model. It is available free from http://www.simtegra.com. A terrific tool that does very little very well.