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

Holmstrom 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.

Automated summary

Holmstrom and co-authors advocate for integrating system dynamics into action research to address the increasing complexity in healthcare. However, they overlook the aspect of normative complexity, which involves multiple conflicting values that actors in healthcare systems must pragmatically respond to in their daily practices. We argue that a better understanding of value multiplicity and how actors navigate value conflicts can enhance discussions about complexity in healthcare. We propose the alternative methodology of 'value exnovation' to expand the scope of system-based thinking and action research in healthcare.