ArticleBMC health services research2021
Application of systems dynamics and group model building to identify barriers and facilitators to acute care delivery in a resource limited setting.
Article in BMC health services research, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers.
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Who cites it
13 citing papers in PubMed.
- Paediatric Critical Care Implementation in Lower-Resource Settings: Application of Community-Based Group Model Building.Research square · 2026Article
- Mechanism-informed transition from pediatric to adult care in sickle cell disease: a case study.BMC health services research · 2026Article
- Participatory system dynamics modeling: advancing equity through contextualized implementation science in global health.BMC global and public health · 2026Review
- From Coordination to Personalization: A Trust-Aware Simulation Framework for AI-Driven Personalized Decision Support in Emergency Departments.Journal of personalized medicine · 2025Article
- An implementation science framework to understand low coverage in mass dog rabies vaccination.PLoS neglected tropical diseases · 2025Article
- Residents' perceptions of urban densification and health - a systems dynamics approach.BMC public health · 2025Article
- Contextual Factors Affecting Continuity of Follow-Up Care After Hospital Discharge for Patients with Chronic Diseases in Sudan: A Qualitative Study with Causal Loop Diagram Insights.Health services insights · 2025Article
- Adopting a systems-thinking approach to optimise dietary and exercise referral practices for cancer survivors.Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer · 2024Article
- Utilizing Group Model Building to Identify Barriers and Facilitators of Hypertension Management in Primary Health Care, China.Risk management and healthcare policy · 2024Article
- Planning for healthcare services during the COVID-19 pandemic in the Southeast of England: a system dynamics modelling approach.BMJ open · 2023Article
- Conceptualising the value of simulation modelling for public engagement with policy: a critical literature review.Health research policy and systems · 2023Review
- Examining the effect of interventions in emergency care for older people using a system dynamics decision support tool.Age and ageing · 2023Article
- Parent-identified barriers to accessing exposure therapy: A qualitative study using process mapping.Frontiers in psychiatry · 2023Article
Corrections and comments
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Authors and funding
9 authors.
Funding
Abstract
backgroundGroup model building (GMB) is a method to facilitate shared understanding of structures and relationships that determine system behaviors. This project aimed to determine the feasibility of GMB in a resource-limited setting and to use GMB to describe key barriers and facilitators to effective acute care delivery at a tertiary care hospital in Malawi.
methodsOver 1 week, trained facilitators led three GMB sessions with two groups of healthcare providers to facilitate shared understanding of structures and relationships that determine system behaviors. One group aimed to identify factors that impact patient flow in the paediatric special care ward. The other aimed to identify factors impacting delivery of high-quality care in the paediatric accident and emergency room. Synthesized causal maps of factors influencing patient care were generated, revised, and qualitatively analyzed.
resultsCausal maps identified patient condition as the central modifier of acute care delivery. Severe illness and high volume of patients were identified as creating system strain in several domains: (1) physical space, (2) resource needs and utilization, (3) staff capabilities and (4) quality improvement. Stress in these domains results in worsening patient condition and perpetuating negative reinforcing feedback loops. Balancing factors inherent to the current system included (1) parental engagement, (2) provider resilience, (3) ease of communication and (4) patient death. Perceived strengths of the GMB process were representation of diverse stakeholder viewpoints and complex system synthesis in a visual causal pathway, the process inclusivity, development of shared understanding, new idea generation and momentum building. Challenges identified included time required for completion and potential for participant selection bias.
conclusionsGMB facilitated creation of a shared mental model, as a first step in optimizing acute care delivery in a paediatric facility in this resource-limited setting.
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