A Systems Thinking Model to Support Long-Term Bearability of the Healthcare System: The Case of the Province of Quebec

This paper describes the modeling efforts devoted by the Ministry of Health and Social Services of Québec, Canada (MSSS), to ensure the long-term bearability of their care system. To this end, it studies the relationships between four entities that self-regulate and interact to form the complex care-providing system: (1) universities; (2) hospitals and doctors; (3) the ministry; and (4) society. The first phase of this research focuses on modeling such relationships and relies on the system dynamics methodology to adequately capture the long-term dynamics of the system. The methodology encompasses three phases: (a) determination of the critical variables and parameters of each entity; (b) development of the causal diagram of each entity; and (c) integration of the individual causal diagrams to form the global system diagram. The final casual model illustrates and explains the relationships between all the entities and constitutes an excellent tool to support experts during discussions or focus groups where critical variables that positively or negatively affect the system can be evaluated. We intend to enrich this casual model in a further phase of the project, which will hopefully lead to a simulation and scenario analysis tool that can be used to support managers in their long-term decision-making process.