The Dynamics of Care

This book describes numerous projects which shed light on some of the most persistent issues of the day in health and social care. The work demonstrates the importance of embedding the concept of flow into everyday health and social care thinking and creates insights into patient journeys through different conditions and treatments. It suggests that improving throughput across agencies is the key way to improving the performance of health treatment, whereas increasing capacity is the key way to improving the performance of social care by retaining independent living. The authors conclude that for state-provided care, balancing health and social care provision can eliminate the many stressful fire-fighting strategies hospitals have to undertake when faced with high demands, and this is a win-win scenario in terms of patients, staff and costs. Further, that there is a need for better understanding of the dynamics of population ageing, the dynamics of health conditions and the provision of better, integrated information systems. The book will be a valuable resource for practitioners, clinicians, managers and academics in health, social work, public health and public policy in many countries.



In this important book Eric Wolstenholme and Douglas McKelvie bring two lifetimes of award-winning experience in applying system dynamics to improving our very clinically advanced but often dysfunctional care systems.
- David F. Andersen, O’Leary Distinguished Service Professor, Emeritus, State University of New York, Albany, USA.


Health and social care suffer from some persistent and serious problems which not only undermine well intended care but also impose considerable costs in many societies. This very welcome and exceptional book offers the hope of sound and sustainable solutions to many of these issues. 
- Kim Warren, Strategy Dynamics, London, UK

“A recent report in the British Medical Journal (Global Health) addressed the issue of health system modelling research, emphasising that models should capture the dynamic interactions between the main health system components and acknowledge constraints. This new book by Eric Wolstenholme and Douglas McKelvie describes a methodology (system dynamics) which eminently satisfies that call. Through a number of examples distilled from their extensive consultancy roles in health and social care, they urge a move away from considering specific departments, to a consideration of coupled health systems which transcend organisational boundaries, where inter-connections, inter-dependencies, flows and stocks become the new perspective instead. Those involved in planning for improved service delivery in health and social care can now learn how to rehearse their ideas in silico by deploying simulations which capture the nuances of health systems and can leverage counter-intuitive policy responses.” (Brian Dangerfield, School of Management, University of Bristol, UK)

“Wolstenholme and McKelvie bring two lifetimes of award-winning experience in applying system dynamics to the creation of this new book. In spite of amazing advances in all areas of medical science our medical system as a whole is facing multiple crises. These problems arise from how components of care are organized into a coherent overall system of care. Focused on flows and throughput as key analytic concepts, this new book condenses and focuses insights from over 80 empirical studies within a coherent analytical frame.  All of us interested in and concerned about the cost and quality of maintaining a health population need to read and come to grips with the points that they are making in this important new book.” (David F. Andersen, O’Leary Distinguished Service Professor, Emeritus, Nelson A. Rockefeller College of Public Affairs and Policy, University at Albany, State University of New York, Albany, New York) 

“This very welcome book offers the hope of sound and sustainable solutions to persistent and serious problems that not only cause untold misery to millions but also impose considerable costs in many societies. The exceptional work illustrates that it is now feasible to simulate most management and policy challenges we face. These working, quantified simulations are powerful because they mimic the observable behaviour of the systems we want to better-manage. They allow us to experiment, boldly and at trivial cost, with software facsimiles of the real world, rather than on the real world itself. This potential is now recognised in the UK Government report "Computational modelling: Blackett review", which makes clear that every executive, advisor and policy-maker, in every field of endeavour, should understand what such simulations can do and know how to implement and exploit them.” (Kim Warren, Managing Director Strategy Dynamics, London, UK)

“Since its inception, the NHS has become one of the great unchanging features of the British landscape. The flip side of such permanence is its inability to move with the times and the great frustration of successive governments has been its imperviousness to change in the way that revolutionised air travel or manufacturing. In this timely book, Eric and Douglas peel back the mystique around care delivery. They introduce two key concepts, feedback and flow, and show why any attempt to modernise delivery will fail without carefully responding to these underlying principles. The strength of this book is in the weight of examples culled over many years and explained in the light of two lifetimes of practical experience.” (Terry Young, Professor Emeritus of Health Care Systems, Brunel University, London and Director, Datchet Consulting)

 

Eric Wolstenholme: Eric began his career in engineering in which he holds a first degree and doctorate. Following a master’s degree in operational research he worked in the Operational Research Executive and Purchasing Department of British Coal before becoming an academic in Management Science at the Bradford School of Management. He has held full Professorial posts at, Stirling Leeds Beckett and London South Bank Universities in Management Science and Business Learning as well as helping to establish and direct two management consultancies - Cognitus and Symmetric. He has written two previous books and a wide range of peer reviewed research articles. Eric has an international reputation for his academic and consulting work and has been President of both the International Systems Dynamics Society and its UK Chapter. He was the founding Editor of the System Dynamics Review and in 2004 received the prestigious Jay Wright Forrester award for his contribution to System Dynamics. In2019 he received an Outstanding Contribution award from the UK Chapter of the System Dynamics Society.

Douglas McKelvie: Prior to joining Symmetric, Douglas worked for over 20 years in social work and social work education, including 10 years as a professional adviser for a national regulatory body. He has developed system dynamics models in health and social care services and for the criminal justice system. He works with policy analysts, public health experts, service commissioners and workforce planners, covering adult and children services, including mental health. Douglas is a member of the Policy Council of the UK Chapter of the System Dynamics Society and was President in 2016.