Document Detail

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.
MedLine Citation:
PMID:  23014150     Owner:  NLM     Status:  In-Data-Review    
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.
Irene Akua Agyepong; Augustina Kodua; Sam Adjei; Taghreed Adam
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Health policy and planning     Volume:  27 Suppl 4     ISSN:  1460-2237     ISO Abbreviation:  Health Policy Plan     Publication Date:  2012 Oct 
Date Detail:
Created Date:  2012-09-27     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8610614     Medline TA:  Health Policy Plan     Country:  England    
Other Details:
Languages:  eng     Pagination:  iv20-iv31     Citation Subset:  H    
Ghana Health Service, Greater Accra Regional Health Directorate, P.O. Box 184, Accra, Ghana. E-mail:
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