scholarly journals Policy options for surgical mentoring: Lessons from Zambia based on stakeholder consultation and systems science

PLoS ONE ◽  
2021 ◽  
Vol 16 (9) ◽  
pp. e0257597
Author(s):  
Henk Broekhuizen ◽  
Martilord Ifeanyichi ◽  
Mweene Cheelo ◽  
Grace Drury ◽  
Chiara Pittalis ◽  
...  
Keyword(s):  
Model Building ◽  
District Hospital ◽  
District Level ◽  
Systems Science ◽  
Group Model ◽  
Policy Options ◽  
Surgical Performance ◽  
Stakeholder Consultation ◽  
Provincial Level ◽  
Surgical Teams

Background Supervision by surgical specialists is beneficial because they can impart skills to district hospital-level surgical teams. The SURG-Africa project in Zambia comprises a mentoring trial in selected districts, involving two provincial-level mentoring teams. The aim of this paper is to explore policy options for embedding such surgical mentoring in existing policy structures through a participatory modeling approach. Methods Four group model building workshops were held, two each in district and central hospitals. Participants worked in a variety of institutions and had clinical and/or administrative backgrounds. Two independent reviewers compared the causal loop diagrams (CLDs) that resulted from these workshops in a pairwise fashion to construct an integrated CLD. Graph theory was used to analyze the integrated CLD, and dynamic system behavior was explored using the Method to Analyse Relations between Variables using Enriched Loops (MARVEL) method. Results The establishment of a provincial mentoring faculty, in collaboration with key stakeholders, would be a necessary step to coordinate and sustain surgical mentoring and to monitor district-level surgical performance. Quarterly surgical mentoring reviews at the provincial level are recommended to evaluate and, if needed, adapt mentoring. District hospital administrators need to closely monitor mentee motivation. Conclusions Surgical mentoring can play a key role in scaling up district-level surgery but its implementation is complex and requires designated provincial level coordination and regular contact with relevant stakeholders.

Engaging Stakeholders in Mapping and Modeling Complex Systems Structure to Inform Population Health Research and Action

2020 ◽  
pp. 119-134
Author(s):  
Kristen Hassmiller Lich ◽  
Jill Kuhlberg
Keyword(s):  
System Dynamics ◽  
Population Health ◽  
Model Building ◽  
Community Based Participatory Research ◽  
Boundary Objects ◽  
Systems Science ◽  
Group Model ◽  
System Maps ◽  
Learning And Collaboration ◽  
System Mapping

Systems science methods are designed to study “wholes” and to support decision-making in the context of complexity. While these methods are powerful in the hands of researchers, they can be transformative when used collaboratively with the stakeholders impacted by and capable of impacting a population health phenomena. This chapter introduces group model building (GMB), developed by practitioners of system dynamics seeking to meaningfully engage system stakeholders in all stages of model building and use. The authors describe the general approach, its alignment with community-based participatory research, and the role system dynamics artifacts and other system maps serve as “boundary objects” to facilitate co-learning and collaboration among individuals with diverse experiences, world views, disciplinary backgrounds, and/or organizational affiliations. The chapter introduces emerging examples of GMB processes, adapted for use with other systems science modeling methods, as well as other examples of collaborative system mapping that can accentuate the GMB toolbox and generate additional boundary objects

scholarly journals Using Group Model Building to Capture the Complex Dynamics of Scaling Up District-Level Surgery in Arusha Region, Tanzania

2020 ◽  
Author(s):  
Henk Broekhuizen ◽  
Monic Lansu ◽  
Jakub Gajewski ◽  
Chiara Pittalis ◽  
Martilord Ifeanyichi ◽  
...  
Keyword(s):  
Model Building ◽  
Complex Dynamics ◽  
Scale Up ◽  
Nominal Group Technique ◽  
Scaling Up ◽  
Feedback Loops ◽  
District Level ◽  
Nominal Group ◽  
Group Model ◽  
Arusha Region

Background: Scaling up surgery at district hospitals (DHs) is the critical challenge if the Tanzanian national Surgical, Obstetric, and Anesthesia Plan (NSOAP) objectives are to be achieved. Our study aims to address this challenge by taking a dynamic view of surgical scale-up at the district level using a participatory research approach. Methods: A group model building (GMB) workshop was held with 18 professionals from three hospitals in the Arusha region. They built a graphical representation of the local system of surgical services delivery through a facilitated discussion that employed the nominal group technique. This resulted in a causal loop diagram (CLD) from which the participants identified the requirements for scaling-up surgery and the stakeholders who could satisfy these. After the GMB sessions, we identified clusters of related variables using inductive thematic analysis and the main feedback loops driving the model. Results: The CLD consists of 57 variables. These include the 48 variables that were obtained through the nominal group technique and those that participants added later. We identified 6 themes: patient benefits, financing of surgery, cost sharing, staff motivation, communication, and effects on referral hospital. There are 5 self-reinforcing feedback loops: training, learning, meeting demand, revenues, and willingness to work in a good hospital. There are four self-correcting feedback loops or ‘resistors to change:’ recurrent costs, income lost, staff stress, and brain drain. Conclusion: This study provides a systems view on the scaling up of surgery from a district level perspective. Its results enable a critical appraisal of the feasibility of implementing the NSOAP. Our results suggest that policy-makers should be wary of ‘quick fixes’ that have short term gains only. Long term policy that considers the complex dynamics of surgical systems and that allows for periodic evaluation and adaption is needed to scale up surgery in a sustainable manner.

scholarly journals Integrating complex systems science into road safety research and practice, Part 2: applying systems tools to the problem of increasing pedestrian death rates

2019 ◽  
Vol 26 (5) ◽  
pp. 424-431 ◽  
Author(s):  
Rebecca B Naumann ◽  
Jill Kuhlberg ◽  
Laura Sandt ◽  
Stephen Heiny ◽  
Wesley Kumfer ◽  
...  
Keyword(s):  
Model Building ◽  
Research Policy ◽  
Unintended Consequences ◽  
Systems Science ◽  
Group Model ◽  
Vehicle Speed ◽  
Theory Approach ◽  
Death Rates ◽  
Research And Practice ◽  
Safety Research

ObjectivesTo provide a specific example of how systems dynamics tools can increase understanding of stakeholder ‘mental models’ and generate robust systems-based hypotheses about the escalating problem of rising pedestrian death rates in the USA.MethodsWe designed and facilitated two group model building (GMB) workshops. Participants generated causal loop diagrams (CLDs) individually and in small groups to explore hypotheses concerning time–dynamic interacting factors underlying the increasing rates of pedestrian deaths. Using a grounded theory approach, research team members synthesised the structures and hypotheses into a single CLD.ResultsCLDs from the 41 participants indicated four core factors hypothesised to have a direct impact on pedestrian fatalities: pedestrian–vehicle crashes, vehicle speed at the time of the crash, vehicle size/dimensions and emergency response time. Participants diagrammed how actions and reactions impacted these proximal factors over time and led to ripple effects throughout a larger system to generate an increase in pedestrian deaths. Hypothesised contributing mechanisms fell within the following broad categories: community responses; research, policy and industry influence; potential unintended consequences of responses to pedestrian deaths; and the role of sprawl.ConclusionsThis application of systems science tools suggested several strategies for advancing injury prevention research and practice. The project generated robust hypotheses and advanced stakeholder communication and depth of understanding and engagement in this key issue. The CLD and GMB process detailed in this study provides a concrete example of how systems tools can be adopted and applied to a transportation safety topic.

scholarly journals Current Practices and Future Pathways towards Competencies in Education for Sustainable Development

2021 ◽  
Vol 13 (16) ◽  
pp. 8733
Author(s):  
Gisela Cebrián ◽  
Mercè Junyent ◽  
Ingrid Mulà
Keyword(s):  
Sustainable Development ◽  
Informal Education ◽  
Model Building ◽  
Education For Sustainable Development ◽  
Project Based Learning ◽  
Assessment Tools ◽  
Educational Institutions ◽  
Group Model ◽  
Recent Developments ◽  
Competencies Development

The 2030 Agenda for Sustainable Development reflects the urgency to embed the principles of education for sustainable development (ESD) into all levels of education. ESD, understood as an integral part of quality education and where all educational institutions, from preschool to higher education and in non-formal and informal education, can and should foster the development of sustainability competencies. This Special Issue entitled “Competencies in Education for Sustainable Development II” responds to this urgency and the papers presented deliver recent developments in the field of sustainability and ESD competencies. They focus on various perspectives: systematic literature reviews and conceptual contributions; curriculum developments and pedagogical approaches to explore competencies’ development, such as action research, serious games, augmented reality, multi-course project-based learning and group model building processes; testing and validation of assessment tools and processes for linking sustainability competencies to employability and quality assurance processes. The contributions show how the field of sustainability and ESD competencies has become a major focus in recent years and present emerging research developments. Further research efforts need to be put into operationalizing sustainability competencies and developing tools that help measure and assess students’ and educators’ competencies development.

Meconium Stained Liquor: A View from a District Hospital

1996 ◽  
Vol 26 (1) ◽  
pp. 14-17
Author(s):  
Ludwig M Apers
Keyword(s):  
Recent Literature ◽  
District Hospital ◽  
Current Knowledge ◽  
Fetal Outcome ◽  
District Level ◽  
Adverse Fetal Outcome

Meconium stained liquor (MSL) is a common problem in obstetrics, but its management at district level causes some specific questions. Recent literature was reviewed to obtain an insight in the current knowledge about the significance, the related pathology and the possible strategies to prevent adverse fetal outcome. The acquired data were used to propose some recommendations to tackle this problem at district level.

Group model building effectiveness: a review of assessment studies

2002 ◽  
Vol 18 (1) ◽  
pp. 5-45 ◽  
Author(s):  
Eti�nne A. J. A. Rouwette ◽  
Jac A. M. Vennix ◽  
Theo van Mullekom
Keyword(s):  
Model Building ◽  
Group Model ◽  
Group Model Building

Exploring construction workers' attitudinal ambivalence: a system dynamics approach

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Sheng Xu ◽  
Mengge Zhang ◽  
Bo Xia ◽  
Jiangbo Liu
Keyword(s):  
System Dynamics ◽  
Model Building ◽  
Safety Management ◽  
Negative Attitude ◽  
Construction Workers ◽  
Group Model ◽  
Group Model Building ◽  
Content Type ◽  
Work Pressure ◽  
Safety Attitude

PurposeThis study aimed to identify driving factors of safety attitudinal ambivalence (AA) and explore their influence. Construction workers' intention to act safely can be instable under conflicting information from safety management, co-workers and habitual unsafe behaviour. Existing research explained the mechanism of unsafe behaviours as individual decisions but failed to include AA, as the co-existence of both positive and negative attitude.Design/methodology/approachThis study applied system dynamics to explore factors of construction workers' AA and simulate the process of mitigating the ambivalence for less safety behaviour. Specifically, the group model building approach with eight experts was used to map the causal loop diagram and field questionnaire of 209 construction workers were used to collect empirical data for initiating parameters.FindingsThe group model building identified five direct factors of AA, namely the organisational safety support, important others' safety attitude, emotional arousal, safety production experience and work pressure, with seven feedback paths. The questionnaire survey obtained the initial values of the factors in the SD model, with the average ambivalence at 0.389. The ambivalence between cognitive and affective safety attitude was the highest. Model simulation results indicated that safety experience and work pressure had the most significant effects, and safety experience and positive attitude of co-workers could compensate the pressure from tight schedule and budget.Originality/valueThis study provided a new perspective of the dynamic safety attitude under the co-existence of positive and negative attitude, identified its driving factors and their influencing paths. The group model building approach and field questionnaire surveys were used to provide convincible suggestions for empirical safety management with least and most effective approaches and possible interventions to prevent unsafe behaviour with tight schedule and budget.

Microworld Development

2008 ◽  
Vol 40 (1) ◽  
pp. 84-97 ◽  
Author(s):  
Mathias M. Fischer ◽  
Federico Barnabè
Keyword(s):  
Production Process ◽  
Model Building ◽  
Calcium Carbide ◽  
Group Model ◽  
Interactive Learning Environment ◽  
Industrial Firms ◽  
Chemical Company ◽  
Production Processes ◽  
Computer Based ◽  
Building Project

The article presents the outcomes of a group model-building project at a chemical company that produces calcium carbide. The project led not only to the creation of a system dynamics model describing the production process but also to a microworld, a computer-based interactive learning environment meant to reproduce most of the features of the operating and controlling software actually used in the company. The process of organizational learning, the gaining of a better common understanding of the production process, and the development of the different mental models of the plant operators were some of the project's main goals. Moreover, the method followed during the project can be considered as general and can be used mainly in a variety of production processes in most manufacturing industrial firms both for the modeling of production processes and for teaching and training the operators who manage such systems.

Group Model Building

2015 ◽  
Vol 21 ◽  
pp. S79-S83 ◽  
Author(s):  
Ian M. Thomas ◽  
Stacia R. Reilly
Keyword(s):  
Model Building ◽  
Group Model ◽  
Group Model Building
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