Evidence map›Paper›PMID 37579386›Full record

ArticleInternational journal of health policy and management2023

Integrating System Dynamics and Action Research: Towards a Consideration of Normative Complexity Comment on "Insights Gained From a Re-analysis of Five Improvement Cases in Healthcare Integrating System Dynamics Into Action Research".

Rik Wehrens, Lieke Oldenhof, Marjolijn Heerings, Violet Petit-Steeghs, Sander van Haperen, Roland Bal, Trisha Greenhalgh

Open access · diamondAbstract readComment
In one paragraph

Article in International journal of health policy and management, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
2.6field-weighted citation impact, top 10% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed, 6 citations in OpenAlex.

  1. Working With Value Complexity in Healthcare.Qualitative health research · 2026
    Article
  2. Article
  3. Helping Healthcare to Help Itself: A Response to the Recent Commentaries.International journal of health policy and management · 2024
    Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

7 authors at 2 institutions in 2 countries.

Rik WehrensErasmus School of Health Policy & Management, Erasmus University, Rotterdam, The Netherlands.ORCID 0000-0002-6141-9863
Lieke OldenhofErasmus School of Health Policy & Management, Erasmus University, Rotterdam, The Netherlands.
Marjolijn HeeringsErasmus School of Health Policy & Management, Erasmus University, Rotterdam, The Netherlands.ORCID 0000-0002-8280-0305
Violet Petit-SteeghsErasmus School of Health Policy & Management, Erasmus University, Rotterdam, The Netherlands.ORCID 0000-0001-9002-6826
Sander van HaperenErasmus School of Health Policy & Management, Erasmus University, Rotterdam, The Netherlands.
Roland BalErasmus School of Health Policy & Management, Erasmus University, Rotterdam, The Netherlands.ORCID 0000-0001-7202-5053
Trisha GreenhalghUniversity of Oxford, Oxford, UK.ORCID 0000-0003-2369-8088
Erasmus University Rotterdam · NLUniversity of Oxford · GB

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Holmström and co-authors argue for the value of integrating system dynamics into action research to deal with increasing complexity in healthcare. We argue that despite merits, the authors overlook the key aspect of normative complexity, which refers to the existence of multiple, often conflicting values that actors in healthcare systems have to pragmatically develop responses to in their daily practices. We argue that a better theoretical and empirical understanding of the multiplicity of values and how actors deal with value conflicts in daily practices can enrich discussions about complexity in healthcare. We introduce the alternative methodology of 'value exnovation' for action researchers to broaden the scope of system-based thinking and action research in healthcare.

Indexed as

Delivery of Health CareHealth Services ResearchHumansResearch PersonnelAction ResearchComplexityMixed MethodsPragmatismSystem DynamicsValues

Identifiers

PMID37579386
PMCPMC10425676
OpenAlexW4380271321

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.