When 'solutions of yesterday become problems of today': crisis-ridden decision making in a complex adaptive system (CAS)-the Additional Duty Hours Allowance in Ghana
When 'solutions of yesterday become problems of today': crisis-ridden decision making in a complex adaptive system (CAS)-the Additional Duty Hours Allowance in Ghana
复制标题
DOI：
10.1093/heapol/czs083
复制
发表时间：
2012-10-01
影响因子：
3.2
通讯作者：
Adam, Taghreed
中科院分区：
文献类型：
--
作者：
Agyepong, Irene Akua;Kodua, Augustina;Adam, Taghreed
卫生部门政策（决定）的执行有时因系统对政策本身的反应而失败。这可能会导致违反直觉的、意想不到的或比政策设计者预期的更温和的影响。卫生部门符合复杂适应系统的特征，复杂性是这一现象的核心。预测决策的积极和消极影响，了解多个参与者之间的利益，权力和相互作用，并规划政策决策的延迟和远端影响是有效的CAS决策的关键。不理解这些要素往往会导致一系列简化的方法干预或“修复”。这反过来又会引发一系列负面反馈循环，随着时间的推移使情况进一步复杂化。在本文中，我们使用的额外工作时间津贴（ADHA）在加纳的政策的案例研究来说明这些点。使用因果循环图，我们解开政策的预期和非预期影响，以及这些影响如何随着时间的推移而演变。总体目标是促进我们对复杂适应系统中决策的理解，并通过这一过程确定制定、更新和实施卫生政策的一些基本要素，这些要素有助于改善预期成果的实现，并最大限度地减少负面的意外影响。
Implementation of policies (decisions) in the health sector is sometimes defeated by the system's response to the policy itself. This can lead to counter-intuitive, unanticipated, or more modest effects than expected by those who designed the policy. The health sector fits the characteristics of complex adaptive systems (CAS) and complexity is at the heart of this phenomenon. Anticipating both positive and negative effects of policy decisions, understanding the interests, power and interaction between multiple actors; and planning for the delayed and distal impact of policy decisions are essential for effective decision making in CAS. Failure to appreciate these elements often leads to a series of reductionist approach interventions or 'fixes'. This in turn can initiate a series of negative feedback loops that further complicates the situation over time. In this paper we use a case study of the Additional Duty Hours Allowance (ADHA) policy in Ghana to illustrate these points. Using causal loop diagrams, we unpack the intended and unintended effects of the policy and how these effects evolved over time. The overall goal is to advance our understanding of decision making in complex adaptive systems; and through this process identify some essential elements in formulating, updating and implementing health policy that can help to improve attainment of desired outcomes and minimize negative unintended effects.