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Deborah Jay Field Research Paper

Health care delivery systems are inherently complex, consisting of multiple tiers of interdependent subsystems and processes that are adaptive to changes in the environment and behave in a nonlinear fashion. Traditional health technology assessment and modeling methods often neglect the wider health system impacts that can be critical for achieving desired health system goals and are often of limited usefulness when applied to complex health systems. Researchers and health care decision makers can either underestimate or fail to consider the interactions among the people, processes, technology, and facility designs. Health care delivery system interventions need to incorporate the dynamics and complexities of the health care system context in which the intervention is delivered. This report provides an overview of common dynamic simulation modeling methods and examples of health care system interventions in which such methods could be useful. Three dynamic simulation modeling methods are presented to evaluate system interventions for health care delivery: system dynamics, discrete event simulation, and agent-based modeling. In contrast to conventional evaluations, a dynamic systems approach incorporates the complexity of the system and anticipates the upstream and downstream consequences of changes in complex health care delivery systems. This report assists researchers and decision makers in deciding whether these simulation methods are appropriate to address specific health system problems through an eight-point checklist referred to as the SIMULATE (System, Interactions, Multilevel, Understanding, Loops, Agents, Time, Emergence) tool. It is a primer for researchers and decision makers working in health care delivery and implementation sciences who face complex challenges in delivering effective and efficient care that can be addressed with system interventions. On reviewing this report, the readers should be able to identify whether these simulation modeling methods are appropriate to answer the problem they are addressing and to recognize the differences of these methods from other modeling approaches used typically in health technology assessment applications.

The main difference between inductive and deductive approaches to research is that whilst a deductive approach is aimed and testing theory, an inductive approach is concerned with the generation of new theory emerging from the data.

A deductive approach usually begins with a hypothesis, whilst an inductive approach will usually use research questions to narrow the scope of the study.

For deductive approaches the emphasis is generally on causality, whilst for inductive approaches the aim is usually focused on exploring new phenomena or looking at previously researched phenomena from a different perspective.

Inductive approaches are generally associated with qualitative research, whilst deductive approaches are more commonly associated with quantitative research. However, there are no set rules and some qualitative studies may have a deductive orientation.

One specific inductive approach that is frequently referred to in research literature is grounded theory, pioneered by Glaser and Strauss.

This approach necessitates the researcher beginning with a completely open mind without any preconceived ideas of what will be found. The aim is to generate a new theory based on the data.

Once the data analysis has been completed the researcher must examine existing theories in order to position their new theory within the discipline.

Grounded theory is not an approach to be used lightly. It requires extensive and repeated sifting through the data and analysing and re-analysing multiple times in order to identify new theory. It is an approach best suited to research projects where there the phenomena to be investigated has not been previously explored.

The most important point to bear in mind when considering whether to use an inductive or deductive approach is firstly the purpose of your research; and secondly the methods that are best suited to either test a hypothesis, explore a new or emerging area within the discipline, or to answer specific research questions.

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See also: Using Conceptual Frameworks in Qualitative Research

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