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A System of Systems of Mental Health in Cities: Digging Deep into the Origins of Complexity
KTH, School of Engineering Sciences in Chemistry, Biotechnology and Health (CBH), Biomedical Engineering and Health Systems, Health Informatics and Logistics.ORCID iD: elhabib@kth.se
KTH, School of Engineering Sciences in Chemistry, Biotechnology and Health (CBH), Biomedical Engineering and Health Systems, Health Informatics and Logistics.
SKL.
KTH, School of Engineering Sciences in Chemistry, Biotechnology and Health (CBH), Biomedical Engineering and Health Systems, Health Informatics and Logistics.ORCID iD: 0000-0003-1126-3781
2019 (English)In: Article in journal (Refereed) Submitted
Abstract [en]

Mental health in urban environments is often treated from a healthcare provision perspective. Research in recent decades showed that mental illness in cities is a result of dysfunctional coordination between different city systems and structures. Given the nature of the city as a system of systems, this work builds participatorily a general system dynamic model of factors that affect mental health in urban and regional environments. Through this method, we investigated the challenges of the application of such methodology to identify important factors, feedback loops, and dependencies between systems to move forward in planning for mental health in cities. The outcome is a general model that showed the importance of factors that vary from individuals, families to communities and feedback loops that span multiple systems such as the city physical infrastructures, social environments, schools, labor market, and healthcare provision.

Place, publisher, year, edition, pages
2019.
Keywords [en]
Mental Health, System Dynamics, Participatory Methods, Urban Health
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
URN: urn:nbn:se:kth:diva-243017OAI: oai:DiVA.org:kth-243017DiVA, id: diva2:1284849
Note

QC 20190208

Available from: 2019-02-01 Created: 2019-02-01 Last updated: 2019-02-08Bibliographically approved
In thesis
1. Assessment of Application of Participatory Methods for Complex Adaptive Systems  in the Public Sector
Open this publication in new window or tab >>Assessment of Application of Participatory Methods for Complex Adaptive Systems  in the Public Sector
2019 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The provision of services by the public sector is the result of a complex adaptive system at work, and involves a large number of stakeholders from different institutions and organisations. In the era of rapid change in requirements and expectations from the public sector, the management of change processes asks for the involvement of many stakeholders from different layers and positions.

Participatory methods provide the ability to involve a wide range of stakeholders, but despite their case-wise documented successes, and well described application in involving citizens in governmental decision-making, very little evidence exists of their role when engaging professionals.

This study assesses the application of participatory methods as an approach to support change processes in the public sector from a complex adaptive system perspective. The purpose of this two-phase exploratory sequential mixed method study with descriptive parts is to first qualitatively explore which needs for change in the public sector could benefit from participatory methods, and then to apply participatory methods for six experiments to assess how effective such methods are to support change processes of complex adaptive systems in the public sector.

Four methods have been included: participatory simulation, gamification, Q methodology and participatory model building. Each of the cases has been scored on a set of frameworks. The cases have been obtained from the fields of road networks, transit and healthcare.

Analysis across the experiment found several trends. Firstly, experiments at the field-level, where expertise and knowledge outside one organisation are required, showed stronger democratisation and focus on mapping out diversity compared to other levels. Similarly, experiments at the sub-system level are more likely to be focused on reaching consensus and using participants for advising. Secondly, a pattern has been found between higher participatory level of a method, a higher degree of power-sharing between the participants, and better results of an assessment.  A correlation was observed between overall assessment and other parameters of applications: communication efficiency, knowledge between causes and effects, and direction from leadership.

The recognition that the public sector is a complex adaptive system proved to be more present in the service-oriented fields than in the infrastructure fields. Larger-scale issues at the organisation-level or even field-level proved to be more complex than issues at the subsystem level.

Participatory methods proved to be effective for providing a grip on issues of a complex nature. Particular strengths were the ability to provide for open structures for thinking outside the box, and the use for identification of bottlenecks and constraints in systems. The ability to identify differences in stakeholder perspectives proves valuable, and can be gathered from a wide range of sources in and around a participatory setting.

However, successful participatory methods need high communication efficiency, use retroactive evaluation and need to be done based on high stakeholder collaboration. These costs can outweigh all benefits if the problem is not complex or preparation has not been appropriately performed. Access to the right people, support from the organisation and motivated participants, as well as the right choice for the level of participation proved crucial for its success.

Abstract [sv]

Offentliga sektorns tillhandahållande av tjänster är resultatet av ett komplext adaptivt system och involverar ett stort antal intressenter från olika institutioner och organisationer. I en tid av snabba förändringar av kraven och förväntningar från offentliga sektorn förändras behövs förändringsprocesser som involverar intressenter från olika nivåer och positioner.

Participativa metoder ger möjlighet att involvera ett brett spektrum av intressenter. Även om participativa metoder visat sig framgångsrika i enstaka fall, och tillämpningar när det gäller att involvera medborgarna i myndighetsbeslut är väl beskrivna, så finns mycket litet bevis på metodens roll när det gäller yrkesverksamma.

Denna studie undersöker tillämpningen av participativa metoder för stödja förändringsprocesser i den offentliga sektorn ur ett komplext adaptivt systemperspektiv. Syftet med denna tvåstegs explorativa sekventiella blandade metodstudie med deskriptiva delar är att först kvalitativt undersöka vilka förändringsbehov i den offentliga sektorn som kan dra nytta av participativa metoder och sedan att tillämpa participativa metoder i sex experiment för att bedöma hur effektiva sådana metoder är i att stödja förändringsprocesser av komplexa adaptiva system inom den offentliga sektorn.

Fyra metoder har innefattats: participativ simulering, gamification, Q-metodik och participativ modellbyggnad. Vart och ett av fallen har poängsatts utifrån ett ramverk. Fallen har hämtats från områdena vägnät, transit och hälsovård.

Analys av experimenten påvisar flera trender. För det första visade experiment på fältnivå, där expertis och kunskap utanför en organisation krävs, en starkare demokratisering och fokus på att kartlägga mångfalden jämfört med andra nivåer. På samma sätt visar experiment på delsystemnivå mer sannolikt att fokus ligger på att nå konsensus och använda deltagare för rådgivning. För det andra har ett mönster påvisats mellan högre deltagande nivå av en metod, högre grad av fördelning mellan deltagarna och bättre resultat av en bedömning. En korrelation observerades mellan övergripande bedömning och andra applikationsparametrar: kommunikationseffektivitet, kunskap om orsaker och effekter och ledarskapsdirektiv.

Erkännandet av att den offentliga sektorn är ett komplext adaptivt system visade sig vara mer närvarande i de serviceorienterade områdena än inom infrastrukturen. Storskaliga problem på organisationsnivå eller till och med på fältnivå visade sig vara mer komplexa än problem på delsystemnivå.

Participativa metoder visade sig vara effektiva för att handlägga frågor av komplex natur. Särskilda styrkor var förmågan att tillhandahålla öppna strukturer för att tänka utanför lådan och att identifiera flaskhalsar och begränsningar i system. Möjligheten att identifiera skillnader i intressentperspektiv visar sig vara värdefull och kan samlas från ett brett spektrum av källor i och kring en deltagarmiljö.

Framgångsrika participativa metoder kräver hög kommunikationseffektivitet, användandet av retroaktiv utvärdering och måste baseras på samarbete med intressenter på hög nivå. Kostnader kan överskugga alla fördelar om problemet inte är komplext nog eller om förberedelserna inte har utförts på lämpligt sätt. Tillgång till rätt personer, stöd från organisationen och motiverade deltagare, liksom det rätta valet för nivån på deltagande visade sig vara avgörande för framgång.

Place, publisher, year, edition, pages
Stockholm, Sweden: KTH Royal Institute of Technology, 2019. p. 81
Series
TRITA-CBH-FOU ; 2019:5
Keywords
: participatory methods, complex adaptive system, public sector, change process, assessment, participativa metoder, komplext adaptivt system, offentlig sektor, förändringsprocess, bedömning
National Category
Social Sciences
Identifiers
urn:nbn:se:kth:diva-243022 (URN)978-91-7873-095-7 (ISBN)
Public defence
2019-02-26, T1 (Emmy Rappesalen), Hälsovägen 11, Huddinge, 10:30 (English)
Opponent
Supervisors
Note

QC 20190204

Projekt BVFF 2013-078

Available from: 2019-02-04 Created: 2019-02-01 Last updated: 2019-02-04Bibliographically approved

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A system of systems of MH(781 kB)28 downloads
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Kornevs, MaksimsMeijer, Sebastiaan

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