Revealing the Complexities of Health Care Renewal: A System Dynamics Approach

Health care systems are under significant development pressure due to the ageing of population and the problems of public financing. As an answer, a new model of chronic care, and integrated care programs based on it, has been applied in several countries. These renewals have a systemic focus: they aim at simultaneously developing organizations, technologies, services, and partner relationships. Empowerment of citizens and multidisciplinary collaboration among professionals play central roles in them. This paper examines the challenge of combining the system view with the multiple operational improvements that are needed at the practical level when the chronic care model is implemented. Using an empirical case from Finland and the method of system dynamics modeling, we show that established routines are not easy to break down even though the organization is committed to change, set clear goals and concretized their content. Paying attention to the complex causal relations and feedback s typical of human systems is necessary in order engthen each other. Recognizing the most crucial points that foster either “a vicious or a virtuous circle” in care processes, and analyzing them in terms of influential factors, supports the raising of awareness and facilitates changes.