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Systems thinking is recognized as an essential skill for understanding complex problem solving and decision making associated with many of the contemporary issues faced by individuals and communities. In this article, our goal is to contribute to the knowledge of curriculum and pedagogy of formal systems thinking teaching in higher education. We believe that accumulating this knowledge can provide a better foundation for including systems thinking in higher-educational programs. To achieve this goal, the purpose of this study is to examine whether the use of a set of systems thinking concepts and methods can effectively promote systems thinking in higher-education settings. The study shows that systems thinking skills can be promoted effectively through the delivery of a combination of systems thinking methods and concepts.

PurposeThe purpose of this study is to investigate the latent interrelationships of causes and effects of design deficiencies (DDs) and to identify the most crucial ones by considering the interactions among them.Design/methodology/approachFirst, through a comprehensive literature review, the most critical causes of DDs were identified. The review eventuated in a list of 22 causes and 12 effects, which were categorized into six groups. Second, through the rules of system dynamics and the interactions between the causes and effects were modeled and illustrated using causal loop diagrams (CLDs). With the aid of semi-structured interviews with 20 competent experts, the resultant CLDs were also validated. Third, the opinions of 54 experts, who were chosen from the Iranian community of clients and consultants, were solicited concerning the degree of influence which each factor (causes or effects) exerts on others. Finally, the social network analysis (SNA) approach was deployed to analyze and prioritize factors based on the gathered data from experts.FindingsSNA results indicated that factors such as “design firms' staff rework” and “design firms' loss of reputation” are the most central factors affecting DDs. The model results also identified that factors such as “schedule variance”, “workload” and “lack of quality control and supervision during the design phase” have the highest overall impact on DDs. In the end, some recommendations to address major factors and links were also put forward. Overall, more communications between the pair of stakeholder groups and continuous learning from project experiences are believed to be the main strategies.Originality/valueIt is believed that this study has provided a comprehensive understanding of causal mechanisms among factors, which can assist project managers of different parties (clients, contractors and consulting firms) in taking more effective actions to ameliorate the quality of design documents.

BACKGROUND Despite health care advances, artificial intelligence and government interventions aiming to improve the health and wellbeing of citizens, huge disparities and failures in care provision exist. This is demonstrated by the rising number of medical errors, increase in readmission rates and mortality rates, and the failure of many health systems to successfully cope with events, such as pandemics and natural disasters. This shortfall is in part because of the complexity of the health care system, the interconnectedness of various parts of service, funding models, the complexity of patients' conditions, patient and carer needs, and the clinical processes needed for patients via multiple providers. OBJECTIVE The objective of this paper is to describe the use of system thinking methodologies to address complex problems such as those in the public health and health services domains. METHOD A description of the system thinking methodology and its associated methods including causal loop diagrams, social network analysis and soft system methodology are described with examples in the health care setting. RESULTS There are various models of knowledge translation that have been employed including the Joanna Briggs Institute model of implementation of evidence into practice, the triple C, and the Promoting Action on Research Implementation in Health Services. However, many of these models are neither scalable nor sustainable, and are most effective for localized projects implemented by trained clinicians and champions in relevant settings.System thinking is essentially a modelling process, which aims to create opportunities for change via an appreciation of perspective, and recognition that complex problems are a result of interconnected factors. The article argues that systems thinking applications need to move beyond that of addressing complex health issues pertaining to a population, and rather consider complex problems surrounding the delivery of high-quality health care. CONCLUSION It is important that methods to implement systems thinking methodologies in health care settings are developed and tested.

The essence of megacity ecosystem problems is the unbalanced relationship between humans and their living environment. The most notable features of this imbalance are the environmental quality decline and resource shortages, which cause human survival crises. This paper combines the drivers, pressures, state, impact, and response (DPSIR) framework to explore a new system dynamics (SD) model to achieve megacity ecosystems’ sustainability. First, indicator selection is conducted using the DPSIR framework model. Second, causal loop diagrams and stock-flow charts of systems are generated with the SD model to simulate the change tendency inside the megacity ecosystem. Finally, to validate the applicability of the proposed method, we select the urban ecosystem of Beijing as the case study. This study utilizes the proposed research framework to analyze the effect of the main driving factors among five development strategies and current trends. The results show that the combination of population, environmental protection policies and technical means had the greatest sustainability potential. This study reveals a dynamic relationship between the main influencing factors within megacity ecosystems and offers suggestions to the sustainability of the environment, resources and social economy of megacities.

Green innovation is fundamental for the achievement of a "win-win" state between economic growth and environmental protection. Pivotal to maintaining the vitality of green innovation is the effectiveness of government policies. First, this paper develops a theoretical model to capture the structure of a green innovation system, incorporating five subsystems: government, environment, technology, economy, and energy subsystems. It further explores the transmission effects of the five subsystems of green innovation systems between government policy-related actions and green innovation. Second, a causal loop diagram of green innovation is constructed to analyse how government fiscal, tax, financial, technical, and environmental policies influence green innovation through these subsystems and other relevant variables. Third, taking the Chinese manufacturing industry as an example, this work builds a stock and flow model that can more clearly reflect the relationships among all variables in a green innovation system. Then, it calculates the quantitative relationship between different variables in the model. Model effectiveness is verified by historical data and sensitivity analysis. Finally, based on the above work, this study simulates the evolution of the green innovation system in the Chinese manufacturing industry by changing the variables of fiscal, tax, financial, technical, and environmental policies. The results show that different types of policies and differentiated implementation strengths have varied impacts on the green innovation performance of the manufacturing industry. There is a synergistic relationship between different types of policies, implying a higher-level effectiveness of policy orchestration compared to the use of separate policies. This paper generates valuable implications for the government for formulating and optimizing green innovation policies.

The coronavirus pandemic has disturbed industries globally. Unlike agriculture and manufacturing, the services sector, particularly tourism, which primarily involves social activities requiring human interaction, is devastated. Against the backdrop of measures to contain the pandemic, travel behaviors have altered. Without an effective recovery plan, the effect of the pandemic on tourism may be felt over a prolonged period of time. With the objective of contributing to a better understanding of how tourism can recover, we use systems thinking to recommend interventions to help restart local tourism. Through causal loop diagrams, we argue that rebooting tourism is key to rebooting the economy. We propose insights for policy action well before the crisis deepens and permanently derails the tourism industry.

Jakarta Cempaka Putih Islamic Hospital (RSI) experienced a decline in performance. Judging from the 2013 Bed Occupancy Rate (BOR) of 70.59%, it then dropped to 44.12% in 2016. Efforts to improve employee performance by coaching have been carried out, but not comprehensively in each Hospital unit. The study aims to look at the role of leadership coaching with a dynamic system model on employee performance at the Jakarta Cempaka Putih Hospital. Besides that, it is also to find out the role of inspirators, facilitators, motivators, as well as the pattern of system behavior characteristics between the role of leadership coaching on employee performance. Analytical research using quantitative methods with explanatory research design. The research sample was 86 taken by accidental sampling technique from the population of inpatient staff and medical support in May 2018. Data processing techniques were carried out in stages including univariate analysis, bivariate Chi-Square, multivariate logistic regression, and dynamic system models of causal loop diagrams formulated to the flow diagram. The instrument used in the form of a questionnaire. In general, the test results showed the influence of the role of leadership coaching on employee performance. Specifically, it shows the influence of the role of leadership coaching as an inspiration, facilitator, and motivator on employee performance. Then the pattern of system behavior characteristics for the next 10 years is in the form of exponential growth and in the next 20 years in the form of S-Shaped growth. Likewise, the behavior pattern of the coaching leadership system role for the next 10 years in the form of exponential growth. The leadership coaching role was found to have an effect on improving employee performance.

This paper aims to analyze national policies of Pakistan taking into account the complexity of electric power generation, growth, and complying with multilateral agreements. Systems thinking has been applied to understand the complexity of energy scenario of Pakistan by representing it with a causal loop diagram (CLD) which displays the interconnectedness and feedbacks of the system. Analysis is based on systems archetypes to diagnose the system behavior, i.e., falling into the vicious cycle of coal. A stock-and-flow model was employed to capture dynamics of energy generation quantitatively, indicating that a 5% GDP growth rate could be sustained based on current planning to increase electric power generation in Pakistan. Thus, in order to achieve a 7% GDP growth rate, as targeted in Vision 2025 of Pakistan, energy generation targets would need to be revised in the view of the sensitivity of increase in energy demand associated with GDP growth rate, while ensuring compliance with multilateral agreements.

Background Children with disabilities face unique challenges in humanitarian aid settings and education may provide protective measures against abuse and exploitation. There are growing calls for inclusive education of children with disabilities in formal education, but little guidance exists on how to enhance inclusion in complex and resource-constrained contexts of humanitarian settings. Case presentation This study used a community-based system dynamics approach to understand key stakeholders’ perspectives of the drivers and effects of inclusion and wellbeing for children with disabilities, and to elicit recommendations to enhance educational inclusion in a refugee camp in Eastern Africa. Community-based system dynamics sessions, designed based on group model building scripts and facilitated by a team of four people, took place with organization staff, community leaders, and parents and caregivers of children with disabilities. The process produced a causal loop diagram depicting the stakeholders’ perspectives of how multiple components interact in a system to drive inclusion and wellbeing of children with disabilities over time. Conclusions Findings indicate participants have a broad conceptualization of inclusion, highlighting the value of community interaction and importance of meeting basic needs, and also demonstrate that including children in mainstream educational settings in a complex humanitarian context requires a more nuanced approach given the lack of existing resources to support Western models of educational inclusion fully.

Background Obesity is a chronic disease that contributes to additional comorbidities including diabetes, kidney disease and several cancers. Change4Campbelltown implemented a ‘whole of system’ approach to address childhood overweight and obesity. We present methods to track implementation and stakeholder engagement in Change4Campbelltown. Methods Change4Campbelltown aimed to build capacity among key leaders and the broader community to apply techniques from systems thinking to develop community-led actions that address childhood obesity. Change4Campbelltown comprised development of a stakeholder-informed Causal Loop Diagram (CLD) and locally-tailored action plan, formation of key stakeholder and community working groups to prioritise and implement actions, and continuous monitoring of intervention actions. Implementation data included an action register, stakeholder engagement database and key engagement activities and were collected quarterly by the project management team over 2 years of reporting. Results Engagement activities increased level of community engagement amongst key leaders, the school-sector and community members. Community-led action increased as engagement increased and this action is mapped directly to the primary point of influence on the CLD. As action spread diversified across the CLD, the geographical spread of action within the community increased. Conclusions This paper provides a pragmatic example of the methods used to track implementation of complex interventions that are addressing childhood overweight and obesity.

Cyberbullying has become a social problem as malicious text messages and online comments among teenagers have increased in the late 2000s. Some serious reporting has attempted to impress on us the need to pay more attention to reducing malicious online content as a typical type of cyberbullying. Meanwhile, despite environmental changes that have made it easier to report perpetrators of such messages, it is often the case that the crime occurs in a public place and is tolerated. However, there is a growing tendency for people to exhibit the bystander effect, the problem of personal indifference to witnessing or knowing about crimes, but individuals do not offer any means of help to a victim when other people are present. This effect is rampant in the case of cybercrimes. This study aims to extract the motivations behind posting malicious comments through in-depth interviews and to suggest recommendations for relative issues by demonstrating how the bystander effect can be reduced using causal relationship diagrams of the system dynamics methodology. Hopefully, this work will contribute to a better understanding of factors that could cause a decrease in malicious online comments.

Vaccinations are given to healthy people to prevent specific diseases which are proven tool of public health. Nowadays lot of hesitant movement are active around the globe. Application of system thinking should be adopted to solve this complex phenomenon. The objective is to study the barriers and solutions of Immunization enlisted by Policy makers and administrators at Malappuram district, Kerala, South India. Descriptive qualitative method was the design espoused in this study. Free listing is the technique adopted to enlist barriers and solution at Malappuram district. The data was analysed using Visual Anthropac software. Further barriers and solutions of immunization was enumerated on basis of descending order of Smith S value. Causal loop diagram was used to depict complex phenomenon regarding barriers of immunization. The policy makers and administrators had solicited barriers as Religious belief, antivaccine lobby, negative propaganda by alternative systems and ineffective logistic management. The main solutions set forth to break barriers were strengthening Information Education Communication (IEC), bring in behavioural change communication and adopt policy reforms. The study determined by conscripting community and health system enabled barriers, with solutions for it encompassing global networking, engaging various stakeholders and applying system approach for health system strengthening.

Most of the knowledge in the construction industry is tacit rather than explicit, and its sharing is imperative for enhanced project performance. Tacit Knowledge Sharing (TKS) is heavily influenced by an array of human factors, such as behaviour, attitude, skills, experience, personal contact, and interaction. These factors interact in multiple ways resulting in positive as well as negative loops for TKS, leading towards complexity. The purpose of this study is to examine the role of TKS in developing countries and thereafter, develop a System Dynamics (SD) model for addressing the aforementioned complexity. The study delineates the interrelations between nineteen shortlisted contributing factors of TKS using systems thinking and causal loop diagram (CLD). In total, CLD encompassed four reinforcing and two balancing loops. Furthermore, CLD was used to develop a SD model that contained four stocks. An additional stock named TKS was incorporated to visualize the combined effect of all stocks. The model was simulated over five years and results indicated an increase in TKS efficiency under the defined system and hence improvement in construction project performance. The resultant CLD and SD models reflect the system’s thinking and behaviour over time for TKS in construction. The study adopts a novel methodology in form of SD for holistically addressing the construction culture to be favourable for TKS and thereby improving construction project performance.

Automated production systems (aPS) have a long lifetime, which requires significant maintenance cost. During the commissioning phase of aPS, which often occurs at customer sites, the on-site engineers are always under high pressure because the customers would like to start the production at the earliest. There, some compromises, so-called technical debt (TD), might be chosen. A technical compromise taken in the commissioning phase can provide a short-term benefit, but could yield a long-term negative impact on the maintenance phase. This study aims to apply Causal Loop Diagram (CLD) to model technical compromises in the aPS domain. A concept, namely CLD+TD, is proposed. Application examples of CLD+TD on some technical compromises collected from an industrial company working in automation are reported. A loop dominance analysis on a CLD+TD model is performed to derive the circular trend of technical compromise over time; thus, relevant maintenance activities could be planned accordingly. In addition, challenges leading to the technical compromises addressed in the presented use cases can support practitioners in developing appropriate solutions to manage the reported technical compromises in the commissioning phase.

The epidemics and pandemics can severely affect food supply chains, including producers, retailers, wholesalers, and customers. To minimize their impacts, it is fundamental to implement effective policies that ensure continuity in the provision, affordability, and distribution of basic food items. This research identifies the main impacts of pandemics and epidemics on food supply chains and policies that can minimize these impacts. Based on a systematic literature review (SLR), 173 documents are analysed to propose a taxonomy of impacts on four supply chain links: demand-side, supply-side, logistics and infrastructure, and management and operation. The taxonomy presents the main impacts and respective mitigation policies. In addition, the literature review leads to the development of a comprehensive causal loop diagram (CLD) with the identification of main variables and their relationship with food supply chains. Finally, a specific research agenda is proposed by identifying the main research gaps. These findings provide a structured method for evaluating policies that ensure the functioning of food supply chains, particularly in disruptions such as epidemics and pandemics.

Service platforms make software applications available as a service to end users. Platforms enable noticeable economic benefits for scaling and transforming a business. Their long-term competitiveness is ensured in controlled cooperation with channel intermediaries and network partners. Hence, service platforms must be designed to harness self-enforcing effects of value generation, so-called network effects. In an exaptation of existing knowledge, we present an information systems design theory to inform the design of methods that analyze, describe, and guide the design of service platforms through the means of causal loops and control methods. We describe the theory's purpose and scope as well as the underlying justificatory knowledge behind the constructs and principles of form and function. The design theory covers the design of all service platform participants and activities as well as their transactions and influences in areas of staged platform authority, using enforcing and incentivizing control methods. We demonstrate the principles of implementation with an expository instantiation and apply it to the M-Engineering service platform, which offers surveillance, control, and data acquisition solutions. Furthermore, we present and discuss testable propositions and a study design to evaluate our design principles.

Objective Digitisation and automation are expected to change the transport system and settlement structures in a disruptive way. Due to new developments in sensor and communication technology different business models of automated vehicles (AV) - such as private AV, car-sharing-AV, ride-sharing-AV and public transport-AV – are likely to enter the transport market. Further, different penetration rates of AVs, extension of user groups (elderly and young, people without driving licenses etc.), different cost scenarios of AV veh-kms, parking regimes/fees, etc. will have significant impact on future transport demand. The objective of the work presented in this paper was to develop a simulation-based approach to analyse the potential impacts of different vehicle automation scenarios in Austria. Method A multitude of complex cause-effect-chains and feedback loops characterise the relationship between AV take up, travel demand and environmental effects. The method of System Dynamics (SD) is designed to deal with such complexities. As a first step the qualitative method of Causal Loop Diagrams (CLD) was used to identify all potential automation related factors influencing the attractiveness of car and public transport use. In a second step the identified factors were coded into an operational version of the Stock-Flow based land use and transport interaction model MARS (Metropolitan Activity Relocation Simulator). As a third step sensitivity tests and scenarios were defined and simulated. Finally the resulting quantitative impacts were assessed and discussed. Results In this paper we describe briefly how MARS was adapted to be able to simulate the effects of different AV-take up rates on the national level of Austria. Simulation results are presented for the scenario elements road capacity, remote parking, value of travel time, access for new user groups in the business models private car, car-sharing and ride-sharing and automation of the first and last mile in public transport. The results show that with a fleet share of 90% of private AVs in 2050, the nationwide changes in veh-kms travelled are between −2% (impact on road capacity) and +22 percent (new user groups in the case of AVs as private cars). Policy implications An uncontrolled market take-up of AVs into the transport system will very likely increase the dependency on motorized transport, veh-kms driven and related emissions. Compensating policies have to be implemented in parallel to avoid un-sustainable developments.

To address the increasingly serious problem of “haze” pollution, this analysis uses the motor vehicle as an example and introduces the strategies of penalties, air pollution charging fees, and subsidies in a successive manner to tackle this issue. In addition, a collaborative strategy model for motor vehicle pollutant emission reduction combined with the system dynamics of the VEMSIM software is constructed. Using a causal loop analysis and simulation analysis, it was found that an air pollution charging fee policy would have a “double dividend” effect, which could achieve the dual goals of congestion alleviation and emission reduction. However, at the same time, it would induce the growth of illegal trips. Although a single penalty policy could effectively reduce the number of illegal trips of vehicles and make up for the deficiency of the air pollution charging fee policy, it would greatly reduce the public transport supply level. Subsidies would significantly improve the public transport supply level, but this policy also showed a certain “weak congestion alleviation” effect and “weak emission reduction” effect. A collaborative strategy that has multiple performances and complementary advantages would overcome the limitations of a single policy. These findings have provide a decision-making basis to improve haze control schemes.

This study focused on the dynamics of Maternal Health Services utilization in Kebbi State using a Systems Thinking approach. The broad objective was to understand the effect of interventions intended to promote utilization of Maternal Health Services. The study evolved a model to represent the causal interrelationship, interdependencies and feedback influences of the multifactorial and multisectoral public health approach on utilization of public maternal health services using a Systems Thinking approach. This enabled us draw inferences on the effect on the mother, the intended end-beneficiary from these interventions. Using a Causal Loop Diagram, we were able to identify reinforcing and balancing feedback loops that could explain the behavior or outcomes being observed. The findings revealed that the feedback in the system is driven by limited resources at the household levels, technical quality of health care services, and knowledgeableness of women on maternal health services. From this, we were able to recommend that policy-makers should try to effectively address socio-economic inadequacies at the household level including socio-cultural practices leading to low level of girl-child school enrolment, and several factors affecting motivation of health care workers. While efforts to ensure quality of care and community awareness should be maintained, emphasis and priority needs to be given to interventions that target economic improvements of households.

Purpose The purpose of this paper is to apply a systems thinking methodology to analyse Indonesia’s new and renewable energy (NRE) electricity sector to describe the complex interrelations between its actors and variables, identify the systemic patterns and formulate recommendations for the policymakers. Design/methodology/approach Systems thinking methodology is used to observe the NRE electricity system and compile the corresponding data into a meaningful diagram to describe and recommend solutions for the sector’s issues. Causal loop diagram is used as the main method in this study with a deeper analysis of system archetypes to uncover the system behaviour. Soft system methodology and critical system heuristic are used partially to clarify the system boundaries, cultivate the perspective of the involved actors and problem categorization. Findings A comprehensive diagram is developed to present interrelation between all the components within the NRE electricity sector in Indonesia and the expected impact of any act or change to the entire system. Based on the causal interrelations between variables, typical systemic patterns or archetypes are used to identify unproductive patterns towards achieving the NRE electricity sector objectives. Originality/value The findings provide an initial outlook on the variables and systemic patterns within the system as a critical consideration in the decision-making process and policy development for the NRE electricity sector.

The human body is regarded as a system of high complexity, not only because it is consisted of millions of interrelated and interdependent functional units -the cells-, but because it is also an evolving system. It changes over time, initially to achieve the full growth of organs and bones but subsequently as a response to environmental factors to retain its vital internal indexes stable, to achieve homeostasis. In this context, the in depth understanding of the connections between these indexes that drive the dynamics of the system is crucial. Yet, malfunctions occur and their accumulation causes diseases, which are regarded as internal crises that due to tight relations between the different organ systems, affect various body parts. The application of systems and causal loop thinking while combating diseases is examined and the need to treat not the body part that is ailing, but the patient as a system is underscored through examples of diseases. The importance of examining the risk and trigger factors of diseases from a systemic perspective is also highlighted through examples from the medical literature. The patient itself is viewed in the context of the Swiss Cheese Model and the causal agents that lead to a system failure and patient harm are examined, as well as ways of strengthening the healthcare system in order to minimize the vulnerabilities and the possibility of failures, with particular regard at modelling doctor-patient relations as Paskian Conversations. The Triumvirate of Public Health concept is discussed as a valuable practice in the healthcare policy making sector, regarding both top-down and bottom-up modes.

A new public project usually provides economic benefits to property owners. In general, a delay caused by a government budget shortage proportionally reduces the future cash flow of the private developer potentially benefitted from a new public project. Based on that eventuality, this study examines a mechanism of willingness to pay, which asks private developers to voluntarily participate in sharing the budget shortage. This participation process is investigated by applying system dynamics, which demonstrate several causal loops, such as between the delay cause and the reaction of the private developer. In spite of difficulty in predicting the actual effect of this idea due to its conceptual origin, this innovative approach can contribute to real-world exigencies in two ways: the provision of background for research on the on-time completion of public projects via private developer cost-sharing participation and the illustration of an alternative that minimizes private developers’ future revenue deduction caused by delays. First published online 23 June 2020

Patent and proprietary medicine vendors (PPMVs) increase access to antibiotics through non-prescription sales in their drug retail outlets. This fosters irrational antibiotic use among people, thus contributing to the growing burden of resistance. Although training programmes on antibiotic use and resistance exist, they have disproportionately targeted health workers in hospital settings. It’s unclear if there is a relationship between such trainings and non-prescription sales of antibiotics among PPMVs which are more embedded in communities. Therefore, a cross-sectional study was conducted to elicit the determinants of non-prescription antibiotic sales among PPMVs in Kano metropolis, Nigeria. Through brainstorming, causal loop diagrams (CLDs) were used to illustrate the dynamics of factors that are responsible for non-prescription antibiotic sales. Multilevel logistic regression model was used to determine the relationship between training on antibiotic use and resistance and non-prescription antibiotic sales, after controlling for potential confounders. We found that two-third (66.70%) of the PPMVs reported that they have sold non-prescribed antibiotics. A total of three CLDs were constructed to illustrate the complex dynamics of the factors that are related to non-prescription antibiotic sales. After controlling for all factors, PPMVs who reported that they had never received any training on antibiotic use and resistance were twice as more likely to sell antibiotic without prescription compared with those who reported that they have ever received such training (OR = 2.07, 95% CI: 1.27–3.37). This finding suggests that there is an association between training on antibiotic use and resistance and non-prescription sales of antibiotics. However, the complex dynamics of the factors should not be ignored as it can have implications for the development of intervention programmes. Multifaceted and multicomponent intervention packages (incorporating trainings on antibiotic use and resistance) that account for the inherent complexity within the system are likely to be more effective for this setting.

Background Systems thinking is a conceptual approach that can assist stakeholders in understanding complexity and making progress on persistent public health challenges. Neglected tropical diseases (NTDs), a complex global health problem, are responsible for a large disease burden among impoverished populations around the world. This aim of this study was to better discern the many complexities of the global NTD system in order to identify and act on leverage points to catalyse progress towards ending NTDs. Methods Existing frameworks for systems change were adapted to form the conceptual framework for the study. Using a semi-structured interview guide, key informant interviews were conducted with NTD stakeholders at the global level and at the country level in Nigeria. The interview data were coded and analysed to create causal loop diagrams that resulted in a qualitative model of the global NTD system. Results The complete qualitative model is discussed and presented visually as six separate sub-components that highlight key forces and feedback loops within the global NTD system. Conclusions We identified five leverage points for NTD system change, namely (1) clarify the potential for and assess realistic progress towards NTD elimination, (2) increase support for interventions besides drug delivery, (3) reduce dependency on international donors, (4) create a less insular culture within the global NTD community, and (5) systemically address the issue of health worker incentives. The specific findings for NTDs raise a number of uncomfortable questions that have not been addressed, at least in part, because it is easier to continue focusing on ‘quick win’ solutions. The study provides a model of a systems thinking approach that can be applied to other complex global health and development challenges in order to understand complexity and identify leverage points for system change.

Repeat removals, where parents lose successive infants and children to out-of-home care, is a systems problem requiring a systems approach to broaden our thinking and expand our choices for action. A transdisciplinary group of key stakeholders in Australia jointly constructed a causal loop diagram to bring forth the systemic structure underlying the issue and identify system conditions that need to be altered. Analysis of the causal loop diagram surfaced eight dynamic positive feedback loops which result in a self-reinforcing system. While the model reflects the understanding of a relatively small group and requires further testing, it adds to current conceptualisations of repeat removal by hypothesising systemic causes and offers new directions for prevention. Stakeholders homed in on stigmatised stereotypes of recurrent birth mothers and the child protection culture, practitioner decision-making, parent–practitioner interactions and parental participation in child protection case planning as ways of correcting against vicious feedback loops. A systems approach contributed useful insights into the problem of repeat removals and could productively be used in respect of a range of other complex child protection challenges.

High volumes of non-revenue water (NRW) threaten water security in many developing countries. The traditional technocentric water management regime largely neglects social and systemic complexities that need to be addressed for successful reform. This paper explores the challenges of water sector reform and NRW reduction in Malaysia to identify possible drivers that can accelerate the NRW management reform. The analysis uses a system thinking approach, with key systemic relationships represented with causal loop diagrams (CLDs). Findings reveal that the NRW management reform is influenced by technical, environmental, economic, social, institutional, and corporate governance factors. Using the CLDs, leverage points that can accelerate NRW management reform are identified. Policies and strategies that can accelerate the NRW management reform in Malaysia are recommended: (1) water supply security and sustainable development must be emphasised as the main concern for water sector reform; (2) understanding of the socio-economic benefits of water tariff adjustment by stakeholders is necessary to build political alliances for water tariff increments; and (3) the newly privatised water services providers in Malaysia require an integrated NRW reduction plan to optimise the time taken for NRW reduction and at the same time, transforming their current human resources that were inherited from the previous public water utilities.

Automation technology is emerging, but the adoption rate of autonomous vehicles (AV) will depend upon how policymakers and the government address various challenges such as public acceptance and infrastructure development. This study follows a five-stage method to understand these barriers to AV adoption. First, based on a literature review followed by discussions with experts, ten barriers are identified. Second, the opinions of eighteen experts from industry and academia regarding inter-relations between these barriers are recorded. Third, a multicriteria decision making technique, the grey-based Decision-making Trial and Evaluation Laboratory (Grey-DEMATEL), is applied to characterize the structure of relationships between the barriers. Fourth, robustness of the results is tested using sensitivity analysis. Fifth, the key results are depicted in a causal loop diagram (CLD), a systems thinking approach, to comprehend cause-and-effect relationships between the barriers. The results indicate that the lack of customer acceptance (LCA) is the most prominent barrier, the one which should be addressed at the highest priority. The CLD suggests that LCA can be mitigated by addressing two other prominent and more tangible barriers – lack of industry standards and the absence of regulations and certifications. The study’s contribution lies in demonstrating that the barriers to AV adoption do not exist in isolation but are linked with each other in overlapping loops of cause and effect relationships. These insights can help different stakeholders in prioritizing their endeavors to expedite AV adoption. From the methodological perspective, this is the first study in the transportation literature that integrates Grey-DEMATEL with systems thinking.

Prerequisite for the development of production linkages in the oil and gas (O&G) industry is the existence of a skilled and experienced workforce. Resource-rich countries, however, are either in short supply or lack of the requisite local capacity. This paper adopts system thinking (ST) methodology to provide a comprehensive approach in identifying, analysing and understanding the interconnections and interrelationship among the variables affecting the challenge of human resource development (HRD) in the oil industry. The concept of feedback embedded in ST allows complex issues to be viewed as an interconnected set of circular relationship rather than the linear cause-and-effect. Consequently, ST tool of causal loop diagram (CLD) aids in visualising the understanding of HRD factors, their relationships in the causal factors and the strategies for sustainable development of domestic skills, know-how and local capacity. Policies for developing human resource in the oil and gas industry are recommended to policymakers and stakeholders.

Mental models focused on the efficiency of products and services deliveries, typical of projects, can generate system archetypes that disturb the development of programs. The main goal of this article is to identify and describe the system archetypes that can occur in program management, improving the decision-making process, and consequently, increasing the probability of organizations to reach their strategic objectives through successful programs. Research was carried out with the participation of organizations that conduct programs, under a descriptive purpose and using system dynamics qualitative modeling, with the intent of building causal loop diagrams, and identifying and describing the system archetypes that may occur from the organizational policies. It was pointed out in the research, through the analysis of the four archetypes found, that the short-term vision problem impairs the achievement of results and benefits by the programs, the mere delivery of new capabilities by the projects not being sufficient for the effective engagement of stakeholders.

Rationale: Increasing digitalization and automation is expected to significantly change the transport system, mobility and settlement structures. A decade ago automated, self-driving vehicles were nothing more than an unrealistic (boyhood) dream. But today the concept of highly and fully automated vehicles is rapidly becoming a reality, with a series of real-world trial applications underway. Government plans and industry predictions expect automation to be introduced from the early 2020s onwards. Nevertheless, there is still a high level of uncertainty in which form and to what extent automated vehicles will enter the market. Furthermore, there are ongoing discussions concerning net effects of positive and negative aspects of automation. Background: The authors have been involved in several research projects analyzing potential impacts of automated driving. The EU funded project CityMobil (Towards Advanced Road Transport for the Urban Environment) was one of first to address automated driving on a large scale. As part of this project the System Dynamics based model MARS (Metropolitan Activity Relocation Simulator) was adapted to assess scenarios of automated driving in four European cities. Simulations demonstrated that automated vehicles integrated into public transport have a potential to reduce car kilometers travelled and improve carbon footprint. On the contrary, privately owned automated vehicles lead to an increase in car kilometers travelled and carbon footprint, unless propulsion technology is changed. While the focus of CityMobil was on the urban scale, the nationally funded Austrian project Shared Autonomy (Potential Effects of the Take-up of Automated Vehicles in Rural Areas – own translation) focused on rural areas. The findings of Shared Autonomy show potential contributions of automated cars to improve the environmental situation and social inclusion in rural areas. Finally, the nationally funded Austrian project SAFiP (System Scenarios Automated Driving in Personal Mobility) takes a look at the national territory of Austria. Method: The relationship between vehicle automation, travel demand and environmental effects consists of a multitude of complex cause-effect-chains. The toolbox of System Dynamics offers appropriate methods to tackle such complexities. Causal Loop Diagrams are used to analyze and discuss relevant cause-effect-chains and are used to adapt an existing Stock-Flow-Model of the Austrian land use and transport demand system. The modified Stock-Flow-Model is used for a quantitative impact assessment. Sensitivity analysis in form of Monte-Carlo-Simulations is employed to tackle the high level of uncertainty concerning key factors. Findings, results: The key factors, influencing mode choice and travel demand, are generalized costs of travel time, weighted costs of use and availability. The automation of driving, expressed as the share of highly and fully automated vehicles in the fleet, is influencing all three key factors via different cause-effect-chains and feedback loops. In SAFiP we identified four key impact sources: automated and remote parking, road capacity and travel speed, value of in-vehicle time and widening the range of users. Sensitivity tests for each of the impact sources have been carried out. Widening the range of users has the highest impact on a national level, potentially increasing car kilometers by about 17 percent in 2050. Remote parking increases car kilometers by about 5 percent in total, ranging from about 1 percent in peripheral districts to about 17 percent in Vienna.

Design for safety (DfS) is increasingly gaining relevance in improving construction occupational safety and health. Specifically, Occupational Safety and Health in Construction Industry (Management) (OSHCI(M)) guidelines were established in Malaysia to improve DfS practices. Therefore, the need to gauge the DfS knowledge, attitude and practices (KAP) of construction stakeholders is significant. The objective of this paper is twofold. Firstly, to investigate the DfS KAP between the academics and practitioners. Secondly, to recommend the mechanisms for improving the learning of DfS among the key stakeholders. This study used a KAP survey and a discussion forum from five DfS workshops, followed by the development of framework using a Causal Loop Diagram (CLD). The findings revealed that stakeholders are very positive towards DfS implementation. Creating a culture of shared DfS learning, continuous engagement in education and training, and organisational lifelong DfS learning were highlighted as ways to improve DfS learning. The CLD shows that the effectiveness of DfS learning is attributed to funding, early learning, capacity building, and practical DfS guidance. This study helps advance DfS learning towards improving the KAP of construction professionals, hence facilitating DfS diffusion within and beyond the organisation and construction projects.

Purpose The purpose of this paper is to explore the humanitarian service management categories that influence long-term transformation within complex community-based service ecosystems. Design/methodology/approach This study utilizes mixed methods to present a dynamic model that provides insight into the complexities of supplying, distributing and transporting charitable resources to underserved communities. The interdisciplinary study draws on the theory of service-dominant logic and service science, presents critical elements of transformative service research and uses system dynamics approach to propose a visual causal loop model. Findings This study develops a dynamic model for studying humanitarian service and value propositions in underserved communities. This paper combines the extant literature to emphasize key humanitarian service categories that influence, and are influenced by, service exchanges within community-based contexts. Research limitations/implications This paper is limited in providing quantitative methods in analyzing the case study data. However, the research is still helpful in providing acumen via the causal loop diagram to specifically look into each variable and see their cause and effect relationships in the community-based ecosystem. The research represents an opportunity to model the humanitarian aid and relief scenarios to help make more effective decision-making interventions. Practical implications The model serves as a managerial tool to determine critical services that optimize resource utilization within the community-based service ecosystems. Insights from this research are broadly applicable to the contexts of humanitarian logistics and supply chain management (HLSCM) solutions for community-based ventures. Originality/value This paper conceptualizes how the management of service-for-service exchanges, logistics services and charitable donation management provides transformational humanitarian services and value propositions within underserved communities. This study further provides fundamental contributions by addressing research gaps in the HLSCM domain by supporting service research and the community-based context.

Purpose The purpose of this paper is to investigate critical barriers hindering the adoption of green supply chain management (GSCM) and the opportunities that can be exploited with such an implementation in the construction industry of developing countries. It also devises strategies to avoid critical barriers in implementation and exploit opportunities for a better overall environmental performance of the construction industry. Design/methodology/approach This research relies upon an extensive literature review; data are collected from 163 professionals and 15 interviews of field professionals from 11 developing countries are conducted. The barriers and opportunities are synthesized through literature review and then data are collected over their significance from the construction professionals through an online survey. To highlight the interconnectedness of the critical barriers and opportunities, a causal loop framework is developed. Furthermore, expert opinion is sought to develop the strategies. Findings This research integrates information from different sources and provides a holistic view of the current situation of GSCM in developing countries. In total, 34 barriers and 23 opportunities are extracted from literature. The top 4 barriers fall under the “involvement and support” category, whereas the top four opportunities fall under the “environmental” category. Furthermore, the strategies to implement GSCM include suitable policies by top management to incorporate practices such as innovative green design, green procurement, green packaging, green distribution and even end-of-life management, which play a vital role in emission reduction. Originality/value This research is a first attempt at evaluating the barriers and opportunities facing GSCM in the construction sector of the developing countries. The findings encourage the stakeholders in adopting GSCM practices by presenting a clear picture of the potential benefits that can be exploited by implementing the proposed strategies to eliminate critical barriers in the construction industry.

Seeing as how cities nowadays have to face many challenges (such as: urban traffic management, revitalization, and adaptation to climate change.), different kinds of urban policies and actions are undertaken. Many of these actions result in changes that influence real estate, mostly by improving the conditions of public services. However, implementation of such urban policies is connected with significant costs that have to be covered by public funds. Therefore, the question arises how we can analyze the assumed benefits from the increase of real estate value? Which tool could allow stakeholders to search for potential added value? The aim of this paper is to present the methodological approach to improving the communication between stakeholders for the visualization of relations between public actions and potential benefits. The analyses cover benefits that can occur both in public and private budgets. The focal point of this paper is the presentation of causal loop diagrams as a tool that could be incorporated for public value identification on specific investments. The application of the suggested approach is visualized on two examples of urban redevelopment activities. Causal loop diagrams are prepared for the construction of a metro system and implementation of a water retention facility. The results show that both types of urban redevelopment actions have an impact on the creation of value, which can be observed both in public and private benefits. However, not all kinds of activities impact an increase in the market value of real estate and can be measured as incomes in budgets.

Background In Australia, around 67% of adults and 25% of children (5–17 years) are currently overweight or obese (Australian Bureau of Statistics, 4364.0.55.001 - National Health Survey: First Results, 2017–18, 2018). The Campbelltown – Changing our Future study will translate ‘a whole of system’ approach, previously trialed in rural communities in Victoria and the Australian Capital Territoty, to Campbelltown Local Government Area (LGA), a socioeconomically and ethnically diverse urban community in south western Sydney, NSW. Methods The study intervention will use a five-step approach; 1 – set up a childhood obesity monitoring system by collecting baseline data from children in primary schools across Campbelltown LGA to give a local context to the community when developing the systems map; 2 - key stakeholders develop systems maps which inform the development of the interventions; 3 - key stakeholders and community groups identify priority areas for action and form working groups; 4 - implementation of the interventions; 5 - evaluation of the interventions. The study will adopt a longitudinal pre/post design with repeated measures at baseline, 2 years and 4 years. Both qualitative and quantitative methods will be used to collect and analyse the data. Discussion Addressing childhood overweight and obesity is complex and requires a multifaceted intervention. This approach has the capacity to impact a range of factors that influence childhood overweight and obesity utilising existing capacity of multiple partners with broad community reach. Findings will develop local responses which capture the complexity of obesity at a community level and further our understanding of the interrelationships and relative importance of local factors impacting childhood overweight and obesity. This study aims to provide evidence for systems methods and approaches suitable for adaption and scaling and may provide evidence of successful community intervention elements.

Background Chronic stress increases chronic disease risk and may underlie the association between exposure to adverse socioeconomic conditions and adverse health outcomes. The relationship between exposure to such conditions and chronic stress is complex due to feedback loops between stressor exposure and psychological processes, encompassing different temporal (acute stress response to repeated exposure over the life course) and spatial (biological/psychological/social) scales. We examined the mechanisms underlying the relationship between exposure to adverse socioeconomic conditions and chronic stress from a complexity science perspective, focusing on amplifying feedback loops across different scales. Methods We developed a causal loop diagram (CLD) to interpret available evidence from this perspective. The CLD was drafted by an interdisciplinary group of researchers. Evidence from literature was used to confirm/contest the variables and causal links included in the conceptual framework and refine their conceptualisation. Our findings were evaluated by eight independent researchers. Results Adverse socioeconomic conditions imply an accumulation of stressors and increase the likelihood of exposure to uncontrollable childhood and life course stressors. Repetition of such stressors may activate mechanisms that can affect coping resources and coping strategies and stimulate appraisal of subsequent stressors as uncontrollable. We identified five feedback loops describing these mechanisms: (1) progressive deterioration of access to coping resources because of repeated insolvability of stressors; (2) perception of stressors as uncontrollable due to learned helplessness; (3) tax on cognitive bandwidth caused by stress; (4) stimulation of problem avoidance to provide relief from the stress response and free up cognitive bandwidth; and (5) susceptibility to appraising stimuli as stressors against a background of stress. Conclusions Taking a complexity science perspective reveals that exposure to adverse socioeconomic conditions implies recurrent stressor exposure which impacts chronic stress via amplifying feedback loops that together could be conceptualised as one vicious cycle. This means that in order for individual-level psychological interventions to be effective, the context of exposure to adverse socioeconomic conditions also needs to be addressed.

Indonesia has a high rate of illegal prescription medicine sales through unauthorized distribution facilities, and these violations have increased in the midst of the COVID-19 pandemic. Despite the fact that law enforcement has been conducted, it has continued to grow. Between 2018 and 2020, criminal cases related to this issue handled by the Indonesian Food and Drug Authority (BPOM) increased by 5.54 percent, and in the province of West Sumatra, which was the main focus of this study, cases of prescription medicine violations reached 68.35 percent in 2020. However, preventing and eradicating these cases has become increasingly difficult due to the interconnectedness of factors and actors. To address the issue, the system thinking approach was chosen as the best method for modeling the dynamic behavior of this complex system over time. To facilitate applicable solutions to resolve these violations that occur in West Sumatra Province, a tool known as a rich picture diagram (RPD) is proposed as a precursor to the development of a causal loop diagram (CLD). The study's system thinking approach enables the Indonesian Food and Drug Authority's business processes to fully comprehend the dynamics and develop robust systemic interventions during the supervision and investigation of such violations.

The objective of this research is to introduce a novel framework to quantify the risk of the reservoir system outside the design envelope, taking into account the risks related to flood-protection and hydro-energy generation under unfavourable reservoir element conditions (system element failures) and hazardous situations within the environment (flood event). To analyze water system behavior in adverse conditions, a system analysis approach is used, which is founded upon the system dynamics model with a causal loop. The capability of the system in performing the intended functionality can be quantified using the traditional static measures like reliability, resilience and vulnerability, or dynamic resilience. In this paper, a novel method for the assessment of a multi-parameter dynamic resilience is introduced. The multi-parameter dynamic resilience envelops the hydropower and flood-protection resilience, as two opposing demands in the reservoir operation regime. A case study of a Pirot reservoir, in the Republic of Serbia, is used. To estimate the multi -parameter dynamic resilience of the Pirot reservoir system, a hydrological model, and a system dynamic simulation model with an inner control loop, is developed. The inner control loop provides the relation between the hydropower generation and flood-protection. The hydrological model is calibrated and generated climate inputs are used to simulate the long-term flow sequences. The most severe flood event period is extracted to be used as the input for the system dynamics simulations. The system performance for five different scenarios with various multi failure events (e.g., generator failure, segment gate failure on the spillway, leakage from reservoir and water supply tunnel failure due to earthquake) are presented using the novel concept of the explicit modeling of the component failures through element functionality indicators. Based on the outputs from the system dynamics model, system performance is determined and, later, hydropower and flood protection resilience. Then, multi-parameter dynamic resilience of the Pirot reservoir system is estimated and compared with the traditional static measures (reliability). Discrepancy between the drop between multi-parameter resilience (from 0.851 to 0.935) and reliability (from 0.993 to 1) shows that static measure underestimates the risk to the water system. Thus, the results from this research show that multi-parameter dynamic resilience, as an indicator, can provide additional insight compared to the traditional static measures, leading to identification of the vulnerable elements of a complex reservoir system. Additionally, it is shown that the proposed explicit modeling of system components failure can be used to reflect the drop of the overall system functionality.

Purpose Cloud computing (CC) services have given a tremendous boost to the creation of efficient and effective solutions. With developing countries at a slow pace of adoption, this research aims to identify factors and their interrelationships influencing the adoption of CC in a developing country context. The developing countries are enjoying numerous benefits from CC services; however, its low adoption is still a question in developing economies; hence, the authors have selected the context of information and communication technology (ICT) firms in India. Design/methodology/approach The qualitative research method is used where experts from thirteen ICT firms in India are interviewed. Findings Sixteen factors, twenty-eight subfactors, and 25 interrelationships are revealed through content analysis. Further, causal loop diagrams are proposed to display the behavior of cause and effect of these factors from a system's perspective. This will help to understand the relationships among the factors in order to enhance the speed of CC adoption. Possible financial loss and resistance to change are found as the key barriers to adoption. The proposed interrelationships can guide both policymakers and service providers for designing effective CC policies. Originality/value This is the first scholarly work that identifies interrelationships among factors and subfactors, thereby providing a holistic picture to decision-makers while making a choice on whether to adopt cloud services or continue with on premise data centers and servers.

The contribution of smart campuses to smart cities’ development and vice versa has been elucidated in extant literature. The micro-transfer of smart technologies and probable procurement and contracting models remain critical for such contributions to take place. This study used a systems thinking approach to establish the interrelationships existing between smart campus technologies which can be scaled towards the development of smart cities and assess the critical failure factors negating the micro-transfer of these technologies to smart city development initiatives in developing countries. To achieve its objective, the study adopted a phenomenological research design wherein qualitative data was elicited from a purposively selected sample of seven interviewees in South African Universities. The next phase of the analysis involved a thematic approach for the production of a causal loop diagram (CLD) reflecting the interrelationships between the abovementioned facets and the associated impact on the transference of knowledge and technologies from smart campuses to smart cities. This CLD was subsequently validated by a cohort of five experts. Findings from the validation phase were incorporated in an improved CLD which provided different archetypes for engendering successful transference. This study holds salient implications for universities, cities and other stakeholders seeking to engage in a quadruple helix innovative arrangement for smart campus/city development. This study concluded that smart campuses could act as living labs for future smartness of cities globally. Government funding and willingness to produce smart cities from campuses is a fundamental feature of creating smart infrastructure in cities.

Farmers and policy makers pursue management practices that enhance water quality, increase landscape flood resiliency, and mitigate agriculture’s contribution to climate change, all while remaining economically viable. This study presents a holistic assessment of how two practices influence the supply of these ecosystem services—the use of an aerator prior to manure application in haylands, and the stacked use of manure injection, cover crops, and reduced tillage in corn silage production. Field data are contextualized by semi-structured interviews that identify influences on adoption. Causal loop diagrams then illustrate feedbacks from ecosystem services onto decision making. In our study, unseen nutrient pathways are the least understood, but potentially the most important in determining the impact of a practice on ecosystem services supply. Subsurface runoff accounted for 64% to 92% of measured hydrologic phosphorus export. Average soil surface greenhouse gas flux constituted 38% to 73% of all contributions to the equivalent CO2 footprint of practices, sometimes outweighing carbon sequestration. Farmers identified interest in better understanding unseen nutrient pathways, expressed intrinsic stewardship motivations, but highlighted financial considerations as dominating decision making. Our analysis elevates the importance of financial supports for conservation, and the need for comprehensive understandings of agroecosystem performance that include hard-to-measure pathways.

IntroductionThe debate over the impact of vertical programmes, including mass vaccination, on health systems is long-standing and often polarised. Studies have assessed the effects of a given vertical health programme on a health system separately from the goals of the vertical programme itself. Further, these health system effects are often categorised as either positive or negative. Yet health systems are in fact complex, dynamic and tightly linked. Relationships between elements of the system determine programme and system-level outcomes over time.MethodsWe constructed a causal loop diagram of the interactions between mass polio vaccination campaigns and government health systems in Ethiopia, India and Nigeria, working inductively from two qualitative datasets. The first dataset was 175 interviews conducted with policymakers, officials and frontline staff in these countries in 2011–2012. The second was 101 interviews conducted with similar groups in 2019, focusing on lessons learnt from polio eradication.ResultsPursuing high coverage in polio campaigns, without considering the dynamic impacts of campaigns on health systems, cost campaign coverage gains over time in weaker health systems with many campaigns. Over time, the systems effects of frequent campaigns, delivered through parallel structures, led to a loss of frontline worker motivation, and an increase in vaccine hesitancy in recipient populations. Co-delivery of interventions helped to mitigate these negative effects. In stronger health systems with fewer campaigns, these issues did not arise.ConclusionIt benefits vertical programmes to reduce the construction of parallel systems and pursue co-delivery of interventions where possible, and to consider the workflow of frontline staff. Ultimately, for health campaign designs to be effective, they must make sense for those delivering and receiving campaign interventions, and must take into account the complex, adaptive nature of the health systems in which they operate.

Socio-institutional factors are poorly addressed in the risk assessment of groundwater contamination. This paper contributes to the development of a socio-institutional assessment framework based on a case study of contamination by on-site sanitation (OSS) in an informal settlement of Bwaise (Kampala, Uganda). We conducted a snapshot survey of the recent extent of groundwater contamination by OSS using microbial and hydro-chemical indicators. Through transition arenas and key informant interviews, we investigated the socio-institutional drivers of the contamination. Overall, 14 out of the 17 sampled groundwater sources tested positive for Escherichia coli during the wet season. Nitrate concentrations at four sources exceeded the World Health Organization guideline value (50 mg/L), attributed to OSS. Despite the high contamination, the community highly valued groundwater as an alternative to the intermittent municipal water supply. We deduced six drivers of groundwater contamination, including land-use management, user attributes, governance, infrastructure management, groundwater valuation, and the operating environment (“LUGIVE”). Qualitative indicators for each of the drivers were also construed, and their interlinkages presented in a causal loop diagram, representing a socio-institutional assessment framework. The framework can help policymakers and the community to analyze various socio-institutional control levers to reduce the risk of groundwater contamination by OSS in informal settlements.

Home health care (HHC) services are of vital importance for the health care system of many countries. Further increases in their demand must be expected and with it grows the need to sustain these services in times of disasters. Existing risk assessment tools and guides support HHC service providers to secure their services. However, they do not provide insights on interdependencies of complex systems like HHC. Causal-Loop-Diagrams (CLDs) are generated to visualize the impacts of epidemics, blackouts, heatwaves, and floods on the HHC system. CLDs help to understand the system design as well as cascading effects. Additionally, they simplify the process of identifying points of action in order to mitigate the impacts of disasters. In a case study, the course of the COVID-19 pandemic and its effects on HHC in Austria in spring 2020 are shown. A decision support system (DSS) to support the daily scheduling of HHC nurses is presented and applied to numerically analyze the impacts of the COVID-19 pandemic, using real-world data from a HHC service provider in Vienna. The DSS is based on a Tabu Search metaheuristic that specifically aims to deal with the peculiarities of urban regions. Various transport modes are considered, including time-dependent public transport.

There have been recent calls for Human Factors and Ergonomics (HFE) to expand its reach and focus to address larger scale societal and global issues. An area of growing awareness is the issue of the gender data gap, whereby women are under-represented in research data, leading to inequitable outcomes when research findings are used to design real world technologies, products, environments, processes, and policies. The aim of this paper is to showcase how structured HFE methods can be used to address the gender data gap. We applied the Sociotechnical Systems Design Toolkit which involved using causal loop diagrams and abstraction hierarchy modelling from Cognitive Work Analysis to understand the system in which the issue occurs and key pain points, followed by the application of the Design with Intent Toolkit to generate design ideas. A total of 43 ideas were developed that could be implemented by universities to address the research data gap. The application demonstrates the utility of HFE methods in tackling complex issues and offers an opportunity for the HFE community to reflect upon the importance of gender sensitive research practices and gender equity more broadly.

BackgroundThe objective of this paper was to describe the role of dietary practices and physical activity in the interaction of the social determinants of non-communicable diseases (NCDs) in Nepal.MethodThe study was a qualitative study design guided by systemic intervention methodology. Qualitative data were collected through key informant interviews (n=63) and focus group discussions (n= 12), and case study-based thematic analysis was carried out. Causal loop diagram was utilised to illustrate the dynamic interactions of the social determinants based on the themes. The study also involved sense-making sessions with policy level and local stakeholders.FindingsFour key interacting themes emerged from the study. Dietary and physical activity practices have shifted significantly at community level contributing to increased risk of NCDs. The practice of healthy and locally produced meals was gradually being displaced by junk food and linked to junk food availability and declining agricultural activities. Health system was ineffective in preventing unhealthy practices. Gender and social economic factors were driving the poor dietary practices and physical inactivity.ConclusionWhile the current dietary and physical activity-related practices within communities were poor, the broader determinants such as socio-economic circumstances and gender further fuelled such practices. The health system has potential to play an effective role in the prevention of the behavioural and social determinants of NCDs.

ObjectivesThis paper presents the iterative process of participatory multistakeholder engagement that informed the development of a new national tuberculosis (TB) policy in Georgia, and the lessons learnt.MethodsGuided by realist evaluation methods, a multistakeholder dialogue was organised to elicit stakeholders’ assumptions on challenges and possible solutions for better TB control. Two participatory workshops were conducted with key actors, interspersed by reflection meetings within the research team and discussions with policymakers. Using concept mapping and causal mapping techniques, and drawing causal loop diagrams, we visualised how actors understood TB service provision challenges and the potential means by which a results-based financing (RBF) policy could address these.SettingThe study was conducted in Tbilisi, Georgia.ParticipantsA total of 64 key actors from the Ministry of Labour, Health and Social Affairs, staff of the Global Fund to Fight AIDS, TB and Malaria Georgia Project, the National Centre for Disease Control and Public Health, the National TB programme, TB service providers and members of the research team were involved in the workshops.ResultsFindings showed that beyond provider incentives, additional policy components were necessary. These included broadening the incentive package to include institutional and organisational incentives, retraining service providers, clear redistribution of roles to support an integrated care model, and refinement of monitoring tools. Health system elements, such as effective referral systems and health information systems were highlighted as necessary for service improvement.ConclusionsDeveloping policies that address complex issues requires methods that facilitate linkages between multiple stakeholders and between theory and practice. Such participatory approaches can be informed by realist evaluation principles and visually facilitated by causal loop diagrams. This approach allowed us leverage stakeholders’ knowledge and expertise on TB service delivery and RBF to codesign a new policy.

The COVID-19 pandemic outbreak remains one of the most influential events in the global economy over the recent years. While being primarily public health related, it has a tremendous impact on many other aspects, including business management. Many businesses were forced to introduce rapid changes to their business models in order to survive. The aim of this paper is to show the complexity and interrelations of changes triggered by COVID-19 outbreak. Understanding of this complexity is crucial for developing business resilience to similar events in the future. The paper uses systems thinking approach to analyze influence of COVID-19 pandemic on business operations and to show the importance of the proper government response to the COVID-19 crisis. A causal loop diagram is used to show the complicated mechanisms behind the impact of pandemic on several aspects of business operation and manage- ment. Perceptions of some variables play more important roles than actual variables, and it often requires more than one actor to solve a particular problem. Adaptive business management may prove to be a particular challenge for small business owners. The paper provides useful insights into the complex nature of contemporary business operation and management in the wake of a major epidemiological crisis. It may contribute to a better understanding of important factors that often tend to be disregarded and not paid enough attention to. It offers food for thought not only for academics, but also to business owners/managers, aware of the complexity of contemporary world and to government-level decision-makers.

Modern consumer lending, which is carried out by banks, financial companies, and, to a lesser extent, credit unions, is a complex system. This system includes many blocks that interact with each other and affect the result. As a result of their interaction in dynamics, the values of indicators of effectiveness are formed. The task that arises is to identify the mutual dependency of the constituent units and their influence on the result of consumer lending over time. The aim of the article is to model consumer lending processes using system dynamics methods. The model proposed in the paper by the system of dynamics makes it possible to display the behaviour of the consumer lending system over time. To display the logic of the system, we used the causal loop diagram tool. This made it possible to visualize the consumer credit system taking into account interconnections. The system is structured into blocks that characterise the main components of the functioning of the lending system. When building the model, four important units of the system were analyzed: technological rating, marketing funding, marketing strategy, and risk management. For this, a simulative analysis was applied. Based on this, it is shown that the marginal results are quite different. The ways are provided to optimize priority of expenses. The dependency of income management has a specific non-linear form. It is possible to find out the level of rigidity of risk management by using simulation analysis.Article received 27.04.2019

The objective of the current study is to explore System Dynamics modelling to quantify and understand the effects of nursing workload on nurse burnout, absenteeism, and quality of patient care. A literature search was performed to identify the causal relationships between factors related to the problem and build a conceptual causal loop diagram. Each of these factors was then operationalised and a simulation model was built using quantitative empirical data from the literature, supplemented with expert input. The model results showed that long nurse shifts and work weeks double nurse fatigue levels, while increasing burnout by up to 6 times, absenteeism by up to 5 times, and medical errors for the patients increasing by up to 150%. The study demonstrates a novel application of System Dynamics in healthcare to examine the impact of management strategies and healthcare system design on nurses' wellbeing and on care quality. Practitioner summary: System Dynamics Modelling allows for the integration of available scientific evidence and expertise to reveal the relationship between nurse workload, burnout and care quality in terms of medical errors. Such models can reveal possible responses from proposed policy or system design changes that could not be quantified with conventional approaches. Abbreviations: HF: human factors; SD: system dynamics; CLD: causal loop diagram; OFAT: one factor at a time.