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Exploring the drivers of unsustainable pressures in health and social care: A qualitative system dynamics approach

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  • Nguyen, Le Khanh Ngan
  • McCabe, Holly
  • Howick, Susan
  • Megiddo, Itamar
  • Sengupta, Soumen
  • Morton, Alec

Abstract

Health and social care systems face immense pressures that emerge from complex interdependencies between system components, transcending conventional explanations of demand-capacity mismatches. Although multiple theoretic perspectives (e.g., “complex adaptive systems”, “sociotechnical systems”) have been advocated as ways to capture and characterise the nature of that complexity, consolidating it into actionable insights for coordinated stakeholder efforts remains challenging, perpetuating implementation failure. This study introduces a novel application of qualitative system dynamics, using Causal Loop Diagrams (CLDs), to reveal the deeper structural patterns that drive persistent challenges and explain why policies have often fallen short.

Suggested Citation

  • Nguyen, Le Khanh Ngan & McCabe, Holly & Howick, Susan & Megiddo, Itamar & Sengupta, Soumen & Morton, Alec, 2025. "Exploring the drivers of unsustainable pressures in health and social care: A qualitative system dynamics approach," Social Science & Medicine, Elsevier, vol. 371(C).
  • Handle: RePEc:eee:socmed:v:371:y:2025:i:c:s0277953625002424
    DOI: 10.1016/j.socscimed.2025.117913
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    References listed on IDEAS

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    1. J Mingers, 2000. "The contribution of critical realism as an underpinning philosophy for OR/MS and systems," Journal of the Operational Research Society, Palgrave Macmillan;The OR Society, vol. 51(11), pages 1256-1270, November.
    2. Emily Ryan & Matthew Pepper & Albert Munoz, 2021. "Causal Loop Diagram Aggregation Towards Model Completeness," Systemic Practice and Action Research, Springer, vol. 34(1), pages 37-51, February.
    3. S C Brailsford & V A Lattimer & P Tarnaras & J C Turnbull, 2004. "Emergency and on-demand health care: modelling a large complex system," Journal of the Operational Research Society, Palgrave Macmillan;The OR Society, vol. 55(1), pages 34-42, January.
    4. Negar Darabi & Niyousha Hosseinichimeh, 2020. "System dynamics modeling in health and medicine: a systematic literature review," System Dynamics Review, System Dynamics Society, vol. 36(1), pages 29-73, January.
    5. D C Lane & C Monefeldt & J V Rosenhead, 2000. "Looking in the wrong place for healthcare improvements: A system dynamics study of an accident and emergency department," Journal of the Operational Research Society, Palgrave Macmillan;The OR Society, vol. 51(5), pages 518-531, May.
    6. Yearworth, Mike & White, Leroy, 2013. "The uses of qualitative data in multimethodology: Developing causal loop diagrams during the coding process," European Journal of Operational Research, Elsevier, vol. 231(1), pages 151-161.
    7. Lane, David C. & Munro, Eileen & Husemann, Elke, 2016. "Blending systems thinking approaches for organisational analysis: Reviewing child protection in England," European Journal of Operational Research, Elsevier, vol. 251(2), pages 613-623.
    8. Rashwan, Wael & Abo-Hamad, Waleed & Arisha, Amr, 2015. "A system dynamics view of the acute bed blockage problem in the Irish healthcare system," European Journal of Operational Research, Elsevier, vol. 247(1), pages 276-293.
    Full references (including those not matched with items on IDEAS)

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