Authors: A

external image 20px-Ajphlogo.jpgAmerican Journal of Public Health: Special Issue on Systems Thinking
external image Pdf.jpgAgency for Healthcare Research and Quality (2004). Community-Based Participatory Research: Assessing the Evidence. Evidence Report/Technology Assessment. Rockville, MD, Agency for Healthcare Research and Quality.
Notes & Quotes:
"Community-based participatory research (CBPR) is an approach to health and environmental research meant to increase the value of studies for both researchers and the community being studied. This approach is particularly attractive for academics and public health professionals struggling to address the persistent problems of health care disparities in a variety of populations (identified by factors such as social or economic status, lack of health insurance, or membership in various racial and ethnic groups).1-6.
"In 2001, the Agency for Healthcare Research and Quality (AHRQ), in collaboration with several Federal agencies and the W.K. Kellogg Foundation, convened a 2-day conference “to promote and support the use of CBPR, to develop strategies to advance CBPR, and to explore the use of CBPR as a resource for policymakers to help guide their program development.”30 AHRQ organized the meeting specifically to address three key barriers to CBPR: (1) insufficient community incentives (staffing and resources) to play a partnership role in CBPR projects; (2) insufficient academic incentives (staffing and resources) for researchers to play a partnership role in CBPR projects; and (3) inadequate funding and insensitive funding mechanisms.*," (pg 1).
external image Pdf.jpgAnderson, R. A., L. M. Issel, et al. (2003). "Nursing homes as complex adaptive systems - Relationship between management practice and resident outcomes." Nursing Research 52(1): 12-21.
Abstract:
"Background: Despite numerous clinical and regulatory efforts, problems of poor quality of care in nursing homes continue, suggesting a need for effective management practices.
Objective: To test complexity hypotheses about the relationship between management practices (communication openness, decision making, relationship-oriented leadership, and formalization) and resident outcomes (aggressive behavior, restraint use, immobility of complications, and fractures), while controlling for case mix, size, ownership, and director's tenure and experience.
Method: A cross-sectional correlational field study design was used. Primary data were obtained from directors of nursing and registered nurses employed in 164 Texas nursing homes. Investigators administered self-report surveys onsite. Secondary data were obtained from 1995 Medicaid Cost Reports and the Texas nursing home Minimum Data Set (MDS) and were linked to primary data using a unique identifier.
Results: Hypotheses were supported in that each management practice explained one or more of the resident outcomes. Larger size and longer director of nursing tenure and experience also explained better resident outcomes. Predictors explained 11% - 21% of the variance.
Discussion: Complexity science was used to explain the results. The findings open the door to rethinking nursing home management practice. Practices that increase communication and interaction among people are needed for better resident outcomes," (pg 12).
Notes: From the Plexus Institute: "Improving quality is an important challenge in nursing homes. This article reports on the results of a study designed to test the hypothesis that management practices consistent with complexity science (open communication, participation in decision-making, relationship-oriented leadership...) improve resident outcomes. The hypothesis was supported, suggesting that traditional nursing home leadership pracitces need rethinking and that complexity-inspired practices should be adopted as a key strategy for enhancing the care of patients."
Quotes: "Despite widespread concern about poor quality of care in the United States’ nursing homes and numerous efforts to improve, serious problems persist (U.S. General Accounting Office, 1999). Improvements are available (e.g., best practice guidelines, quality improvement, models such as Wellspring [Reinhard & Stone, 2001], and tougher regulations). However, none of these efforts has yet led to broad-based improvement (Wunderlich & Kohler, 2001). For example, Reinhard and Stone (2001), in evaluating the Wellspring model, identified existing authoritative management practices as “stumbling blocks” and found these difficult to overcome. Indeed, there is a growing body of knowledge available to suggest that management practices can be employed to achieve better outcomes, but these practices are not based on authoritative management styles (Anderson & McDaniel, 1999). Rather, emerging theory and research (McDaniel & Driebe, 2001) suggests that management practices that change how people relate to one another, such as communication, participation in decision making, and relationship-oriented leadership, result in better outcomes. The purpose of this study was to explore the relationship between such management practices and resident outcomes in nursing homes while controlling for organizational context and manager characteristics." (p1)
"Self-organization is a central theme in complexity theory that is well documented in the physical (Prigogine, 1997) and biological (Capra, 1996) sciences. Increasingly, complexity science has been applied in healthcare (McDaniel & Driebe, 2001), revealing healthcare organizations to be complex adaptive systems. Complex adaptive systems are nonlinear systems in which diverse agents interact with each other and are capable of undergoing spontaneous self-organization (Cilliers, 1998). Selforganization is a property of all social systems that operates whether we recognize it or not. By recognizing it, however, managers can begin to influence it to facilitate better outcomes. Self-organizing is the process by which people mutually adjust their behaviors in ways needed to cope with changing internal and external environmental demands (Cilliers, 1998). As depicted in Figure 1, self-organization depends on at least three system parameters: the rate of information flow throughout the system, the nature of connections among people, and diversity of cognitive schema (Stacey, 1996). Higher levels of these system parameters provide conditions that allow people to create and recreate meaning of events; provide opportunities for higher-order learning that changes beliefs as opposed to simply knowing facts or rules; allow creativity; provide positive feedback (feedback that moves a system away from its present position); and provide opportunities for reflection and evaluation of performance. Thus, these system parameters alter the conditions necessary for self-organization, from which effective behaviors emerge. Understanding system parameters and self-organizing processes may explain why certain management practices work better than others." (p1-2)
" Using the theory of self-organization in complex adaptive systems, it is suggested that effective self-organization requires management practices that change personal relationships (Ashmos et al., 2002). In particular, management practices that influence the system parameters (Stacey, 1996) for self organization—the rate of information flow through the system, the nature of connections among people, and the diversity of cognitive schema— were hypothesized to produce better resident outcomes. The pattern of results demonstrates that management practices supporting constructive self-organization may lead to better results. The fact that different management practices related to different types of resident outcomes, suggests that a variety of management practices are needed to assure better resident outcomes in nursing homes. " (p18)
external image Pdf.jpgAnderson, R. A. and R. R. McDaniel (2000). "Managing health care organizations: Where professionalism meets complexity science." Health Care Management Review 25(1): 83-92.
Abstract:
"This article examines the intersection of professionalism and complexity science as a source of new insights for improving the health cave industry from both a clinical and business point of view. Viewing health care organizations as professional complex adaptive systems suggests eight leadership tasks for addressing the circumstances that engulf health care. Managers who adopt this view will be able to create new levers for positive movement in their organizations," (pg 83).
Notes & Quotes: From the Plexus Institute: "This work introduces health care leaders to complexity science, suggests that they view health care organizations as professional complex adaptive systems, and offers eight complexity-based leadership strategies – relationship building, loose coupling, complicating, diversifying, sense making, learning, improvising, and thinking about the future."
external image Pdf.jpgAshmos, D. P., D. Duchon, et al. (2000). "Physicians and decisions: A simple rule for increasing connections in hospitals." Health Care Management Review 25(1): 109-115.
Abstract:
"When hospitals are viewed as complex adaptive systems, simple rules can lead to behavior that emerges as complex and that enables creative, adaptive organizational responses. Based on empirical findings from a decade of research on hospital strategic decision making this article offers the simple rule of letting physicians help decide strategic issues. Seven managerial guidelines for implementing this rule are presented," (pg 109).
Notes & Quotes:
From the Plexus Institute: "A gem of an article, which explores a simple rule for hospitals: let doctors and nurses help decide key strategic issues. It documents the benefits of increased connections among key stakeholders - improved financial performance and more adaptable strategies."
external image Pdf.jpgexternal image 20px-Ajphlogo.jpgAyres, J. R. d. C. M., V. Paiva, et al. (2006). "Vulnerability, Human Rights, and Comprehensive Health Care Needs of Young People Living With HIV/AIDS." American Journal of Public Health 96(3): PAGE NUMBERS NOT FINALIZED.
Abstract:
"We sought to identify and understand the health care needs of young people living with HIV/AIDS, particularly in terms of their psychosocial well-being. We conducted a qualitative analysis of HIV-positive young people and their caregivers, focusing on the implications of an HIV diagnosis for health care needs. Stigma was a recurrent issue that arose in the interviews conducted with the respondents, and it was evident that youths had been denied many rights related to health. We concluded that young people living with HIV need comprehensive care based on a human rights approach. In this regard, we offer some practical recommendations for health programs," (first page).
Notes:
This is part of the AJPH Special Issue on Systems Thinking.

[edit]Authors: B

external image Book.jpg Baer, H. A., M. Singer, et al. (2003). Medical Anthropology and the World System, 2nd ed. Westport, CT, Praeger. ISBN 089789846X
Notes:
Book description from Amazon.com: "Medical anthropology is one of the youngest and most dynamic of anthropology's various subdisciplines, examining health-related issues in precapitalist indigenous and state societies, capitalist societies, and postrevolutionary of socialist-oriented societies. While critical medical anthropology draws heavily on neo-Marxian, critical, and world systems theoretical perspectives, it attempts to incorporate the theoretical contributions of other systems in medical anthropology, including biocultural or medical ecology, ethnomedical approaches, cultural constructivism, poststructuralism, and postmodernism. This is the first textbook to incorporate this perspective."
external image Pdf.jpgexternal image 20px-Ajphlogo.jpgBaker, D. W., K. A. Cameron, et al. (2006). "A System for Rapidly and Accurately Collecting Patients' Race and Ethnicity." American Journal of Public Health 96(3): 1-6 PAGE NUMBERS NOT FINALIZED.
Abstract:
"Objectives. We assessed the feasibility of collecting race/ethnicity data from patients using their own preferred racial/ethnic terms.
Methods. The 424 patients described their race/ethnicity using their own categories, and we compared their descriptions with their responses to the questions (1) "Do you consider yourself Latino or Hispanic?" and (2) "Which category best describes your race?" (7 response options in our computer interview). We also determined patients' preferences between the 2 approaches.
Results. The proportions of patients who described themselves with 1, 2, 3, or 4 terms were 46%, 33%, 14%, and 6%, respectively; 2 said only "American" (1%,) and 1 refused to answer (0.5%). The average completion time was 37 plus/minus 17 seconds. Rates of missing values and categorization as "other" race were lower than with the closed questions. Agreement between racial/ethnic categorization with openended and closed responses was 93% (?=0.88). Latino/Hispanic and multiracial/multiethnic individuals were more likely to prefer using their own categories to describe their race/ethnicity.
Conclusions. Collecting race/ethnicity data using patients' own racial/ethnic categories is feasible with the use of computerized systems to capture verbatim responses and results in lower rates of missing and unusable data than do standard questions," (first page).
Notes:
This is part of the AJPH Special Issue on Systems Thinking.
external image Pdf.jpgBammer, G. (2005). "Integration and Implementation Sciences: Building a New Specialization." Ecology and Society 10(2).
Abstract:
"Developing a new specialization—Integration and Implementation Sciences—may be an effective way to draw together and significantly strengthen the theory and methods necessary to tackle complex societal issues and problems. This paper presents an argument for such a specialization, beginning with a brief review of calls for new research approaches that combine disciplines and interact more closely with policy and practice. It posits that the core elements of Integration and Implementation Sciences already exist, but that the field is currently characterized by fragmentation and marginalization. The paper then outlines three sets of characteristics that will delineate Integration and Implementation Sciences. First is that the specialization will aim to find better ways to deal with the defining elements of many current societal issues and problems: namely complexity, uncertainty, change, and imperfection. Second is that there will be three theoretical and methodological pillars for doing this: 1) systems thinking and complexity science, 2) participatory methods, and 3) knowledge management, exchange, and implementation. Third, operationally, Integration and Implementation Sciences will be grounded in practical application, and generally involve large-scale collaboration. The paper concludes by examining where Integration and Implementation Sciences would sit in universities, and outlines a program for further development of the field. An appendix provides examples of Integration and Implementation Sciences in action," (pg 1 of pdf).
Quotes:
Numerous quotes p.10+ on comparisons between complexity and systems thinking
"The three pillars will be: -Systems thinking and complexity science: which orient us to looking at the whole and its relationship to the parts of an issue. -Participatory methods: which recognize that all the stakeholders have a contribution to make in understanding and, often, decision making about an issue. -Knowledge management, exchange, and implementation: which a..."(p2)
"IMPLEMENTATION SCIENCES COVER? There are three aspects to Integration and Implementation Sciences. First is that the specialization will aim to find better ways to deal with the defining elements of many current societal issues and problems—namely complexity, uncertainty, change, and imperfection. Second is that there will be three theoretical and methodological pillars for doing this: 1) systems thinking and complexity science, 2) participatory methods, and 3) knowledge management, exchange, and implementation. Third, operationally, Integration and Implementation Sciences will be grounded in practical application and will generally involve large-scale collaboration." (p7)
"Systems thinking and complexity science Although both systems thinking and complexity science concern themselves with looking at wholes, they encompass several schools of thought, which are noted, at best, for their indifference and, at worst, animosity, to each other. There is not only a gulf between systems thinking and complexity science, but also within different branches of, particularly, systems thinking. For example, schools of thought encompassed by systems thinking and some of their key practitioners include (adapted from Troncale 2000): l General Systems Theory (Bertalanffy, Boulding, Bateson, Mead); l Systems Analysis and Systems Engineering (RAND); l System Dynamics (Forrester, Sterman, Richardson); l Cybernetics (Wiener, von Neumann); l Operations Research (Churchman, Ackoff); l Soft Systems Practice (Checkland); l Learning Organizations (Senge); and l Critical Systems Thinking (Jackson, Flood, Midgley) Complexity science has spun off from systems thinking, and specifically tackles systems with selforganizing, emergent properties and nonlinear" (p8)
(p9) "dynamics. In particular, complexity science deals with systems that share some or all of the following characteristics (CSIRO Australia 2002): l Comprising many elements or subsystems connected together in irregular ways, l Spanning a large range of dimensions and scales; l Having non-linear connections between the elements of the system; l Exhibiting hysteretic or irreversible behavior; and l Having interaction between simpler elements which allows self-organization, that is the emergence of complex behavior that is not determined by information or controls imposed externally. Much of complexity science is highly mathematical, and other conceptual methods are poorly developed. There are three primary approaches (CSIRO 2002): 1. Dynamical systems theory. This uses methods that employ non-linear differential or difference equations to capture the dominant behavior (often the emergent behavior) of systems with very many degrees of freedom by a low dimensional set of differential equations. 2. Network theory, which concentrates on the structure and typology of the links between the system elements and the controls that these exert on the behaviors of the system. 3. Adaptive computing, which covers a wide range of so-called agent-based models, where elements of a system are allowed to interact in a virtual environment. The elements and the initial rules of interaction are specified a priori, but the evolution of the system thereafter is unconstrained. A large number of methodologies have been developed. In systems thinking, they include clustering theory, comparative systems analysis, computer modeling and simulation tools, control theory, critical path methods, decision analysis, divergence mapping, flowcharting, game theory techniques, input–output analysis, lifecycle analysis, linkage proposition analysis, network theory, optimization theory, relational database analysis, scenario building, viable system diagnosis, strategic assumption surfacing and testing, interactive planning, and critical systems heuristics (Flood and Jackson 1991, Troncale 2000). Complexity science analysis tools include fractals, chaos theory, lattice models, renormalization group theory, and agent-based modeling (CSIRO 2002) Despite these advances, there seems to be little progress in reaching agreement on key overarching theoretical concepts. As the following three examples illustrate, there does seem to be considerable scope for such unification. One suggestion for developing common elements in systems thinking has been made by Checkland (1984) who proposes two sets: emergence and hierarchy, and communication and control. For Integration and Implementation Sciences, hierarchy is valuable in terms of providing a structured way of thinking across scale, showing that systems are not closed, providing a big-picture view, including interactions between local and global, and showing linkages, including between sectors and stakeholders. Hierarchy also sets the context for emergent properties, in other words, properties that exist at one scale, but not at others. For example, wetness is an emergent property of water, a property that cannot be predicted from its component gaseous elements, hydrogen and oxygen. Emergent properties appear when a system is examined as a whole instead of as separate parts, or when separate parts of a system are examined as a coupled framework. Communication and control are important in terms of understanding vicious (reinforcing) and virtuous (balancing) cycles, effective points of intervention, and sources of unintended effects. A second example comes from Troncale (2000), in his development of a broader range of common elements to unify the physical and life sciences: l Hierarchies and emergence to deal with scale; l Flows, interactions, networks to deal with supply; l Boundaries, limits, and fields to deal with identity..."
external image Pdf.jpgexternal image 20px-Ajphlogo.jpgBar-Yam, Y. (2006). "Improving the Effectiveness of Health Care and Public Health: A Multiscale Complex Systems Analysis." American Journal of Public Health 96(3): 459-466 PAGE NUMBERS NOT FINALIZED.
Abstract:
"The US health care system is struggling with a mismatch between the large, simple (low-information) financial flow and the complex (high-information) treatment of individual patients. Efforts to implement cost controls and industrial efficiency that are appropriate for repetitive tasks but not high-complexity tasks lead to poor quality of care.
Multiscale complex systems analysis suggests that an important step toward relieving this structural problem is a separation of responsibility for 2 distinct types of tasks: medical care of individual patients and prevention/population health. These distinct tasks require qualitatively different organizational structures. The current use of care providers and organizations for both purposes leads to compromises in organizational process that adversely affect the ability of health care organizations to provide either individual or prevention/population services.
Thus, the overall system can be dramatically improved by establishing 2 separate but linked systems with distinct organizational forms: (a) a high-efficiency system performing large-scale repetitive tasks such as screening tests, inoculations, and generic health care, and (b) a high-complexity system treating complex medical problems of individual patients," (pg 459* not finalized).
Notes:
This is part of the AJPH Special Issue on Systems Thinking.
external image Pdf.jpgBarnsley, J., L. Lemieux-Charles, et al. (1998). "Integrating learning into integrated delivery systems." Health Care Management Review 23(1): 18-28.
Abstract:
"Integrated delivery systems that promote learning and flexibility will be better prepared to face the challenges imposed by a complex and competitive environment. The integration of learning into these systems requires a shared vision, facilitative leadership, and highly functioning communication channels within an organic structure. Strategies that promote positive attitudes toward change are necessary for learning as is the provision of resources, training, incentives, and rewards that support learning, and feedback on how new administrative and clinical practices advance the mission and goals of the system," (pg 18).
external image Pdf.jpgBaskin, K., J. Goldstein, et al. (2000). "Merging, De-merging, and Emerging at Deaconess Billings Clinic." The Physician Executive 26(3): 20-25.
Abstract:
"Complexity theory offers a powerful model for effective mergers of health care organizations that differs substantially from customary approaches. Exploring how Deaconess Billings Clinic in Montana evolved from two separate and very different cultures provides insight into how organizations can apply a complex adaptive system (CAS) model of mergers to create more truly integrated health care systems. DBC's merger illustrates the phenomenon of emergence in complex systems, whereby structures arise that are not a synthesis of the pre-existing cultures or the result of a new culture being imposed. Instead, the merger is understood as an ongoing, self-organizing process appropriately characterized by fits and starts, feelings of uncertainty, and other natural challenges of change and growth. By squarely surfacing the distinct cultures of the organizations through abundant interaction, relationship building, and information flow, differences can be creatively transformed, resulting in deep-seated change and the emergence of a genuine, shared health care system culture," (pg 20).
Notes:
From the Plexus Institute: "This is an encouraging story about an emergent approach to health care system creation, involving the merger of the Deaconess Medical Center and the Billings Clinic. From the abstract: "By squarely surfacing the distinct cultures of the organizations through abundant interaction, relationship building and information flow, differences can be creatively transformed, resulting in deep-seated change and the emergence of a genuine, shared health care system culture."
external image Pdf.jpgBatterham, R., D. Southern, et al. (2002). "Construction of a GP integration model." Social Science & Medicine 54(8): 1225-1241.
Abstract:
"There are frequent calls to improve integration of health services, within and between primary and secondary care sectors. In Australia, general medical practitioners (GPs) are central to these endeavours. This paper aims to better conceptualise GP integration and to develop a model and index based on this. A conceptualisation of integration is proposed based on integration fundamentally as an activity or process not structure. Integration process is the frequency and quality of episodes of information exchange involving the GP and another practitioner or patient and aimed at fulfilling the objectives of the health care system with regard to patient care. These are both direct responses to structural forces and emergent GP capacities and dispositions. The content of this typology was studied using Concept Mapping in I I groups of GPs, consumers and other practitioners. Clusters of related statements within thematic domains were used as the basis for a provisional model. This was tested using confirmatory factor analysis in a data set derived from a national probability sample of 501 GPs. Some re-specification of the model was necessary, with three integration process factors needing to be subdivided. One factor congeneric model assumptions were used to identify the constituent items for these factors, The result was a model in which 50 items measured nine integration process factors and 20 items measured five enabling factors. Two distinct but correlated higher order factors, relating to individual patient care and public (or community) health-in contrast to a single higher order factor for integration-were identified. The re-specified model was tested with a new sample of 151 GPs and exhibited strong psychometric properties. Reliability and validity were acceptable to this stage of the indices' development. Further testing of the index is necessary to demonstrate factor invariance of the indices in other contexts as well as their utility in cross-structural analysis. That said, the indices have immediate uses," (pg 1225).
external image Pdf.jpgBegun, J. W., B. Zimmerman, et al. (2003). Health care organizations as complex adaptive systems. Advances in health care organization theory. S. S. Mick and M. E. Wyttenbach. San Fransisco, CA, Jossey-Bass.
Abstract excerpted from above:
"From its roots in physics, mathematics, and biology, the study of complexity science, or complex adaptive systems, has expanded into the domain of organizations and systems of organizations. Complexity science is useful for studying the evolution of complex organizations – entities with multiple, diverse, interconnected elements. Evolution of complex organizations often is accompanied by feedback effects, nonlinearity, and other conditions that add to the complexity of existing organizations and the unpredictability of the emergence of new entities.
Health care organizations are an ideal setting for the application of complexity science due to the diversity of organizational forms and interactions among organizations that are evolving. Too, complexity science can benefit from attention to the world’s most complex human organizations. Organizations within and across the health care sector are increasingly interdependent. Not only are new, highly powerful and diverse organizational forms being created, but also the restructuring has occurred within very short periods of time.
In this chapter, we review the basic tenets of complexity science. We identify a series of key differences between the complexity science and established theoretical approaches to studying health organizations, based on the ways in which time, space, and constructs are framed. The contrasting perspectives are demonstrated using two case examples drawn from healthcare innovation and healthcare integrated systems research. Complexity science broadens and deepens the scope of inquiry into health care organizations, expands corresponding methods of research, and increases the ability of theory to generate valid research on complex organizational forms."
Notes:
Plexus Institute: "The authors explore the value of using a complexity science perspective to study complex organizations. After reviewing some basic concepts of complexity, they explore its relevance to understanding, studying, and managing health care organizations. They also point out that the study of "the world's most complex human organizations" can contribute to the science of complexity."
Quotes: (p38). "The focus of analysis in complexity research shifts from the externally imposed designs or intents of designers of systems to how things really unfold in systems. Traditional systems thinking has created a vicious cycle of (1) design a system, and (2) when the system does not act as predicted, redesign the system. The assumption is that leaders can control the evolution of complex systems by intentions and clear thinking. Complexity science leads one to ask different questions. For example, when an intended design does not play out as predicted, how do things continue to function? Stacey, Griffin and Shaw (2000:59) refer to this as the potential to “get things done anyway.” How do patients continue to get care, and clinicians provide care, despite the machinations of formal organizations? Complexity science focuses on how this “anyway” behavior unfolds through everyday interactions and in spite of the fact that leaders continue to focus on the “systems” that attempt to secure predicted changes."
external image Pdf.jpgBenko, S. S. and A. Sarvimaki (2000). "Evaluation of patient-focused health care from a systems perspective." Systems Research And Behavioral Science 17(6): 513-525.
Abstract:
"The purpose of this paper is to outline a hierarchic systems theory approach as a framework for patient-focused evaluation in nursing and other health care areas. Such a framework allows for complex features of processes in health care to appear by simultaneous analyses of relationships on different levels and with different methods. In nursing and caring research mostly a 'one-level' design has been employed. There is an awareness, however, that the outcome of the nursing process needs to be evaluated in a more differentiated manner. A systemic model is offered according to systems thinking where both system levels and system dynamics in the 'downward' as well as 'upward' direction are recognized as crucial in the analysis," (pg 513).
external image Pdf.jpgBerwick, D. M. (1997). "Medical associations: guilds or leaders?" BMJ 314(7094): 1564-1565.
Notes & Quotes:
This is an editorial.
external image Pdf.jpgBest, A., G. Moor, et al. (2003). "Health promotion dissemination and systems thinking: Towards an integrative model." American Journal Of Health Behavior 27: S206-S216.
Abstract:
"Objective: To help close the gap between health promotion research and practice by using systems thinking.
Methods: We reviewed 3 national US tobacco control initiatives and a project (ISIS) that had introduced systems thinking to tobacco control, speculating on ways in which systems thinking may add value to health promotion dissemination and implementation in general.
Results: The diversity of disciplines involved in tobacco control have created disconnection in the field; systems thinking is necessary to increase the impact of strategies.
Conclusion: Systems thinking has potential to improve synthesis, translation, and dissemination of research findings in other health promotion initiatives," (pg S206).
Notes:
This article was cited by Midgley, G. (2006). "Systemic Intervention for Public Health." American Journal of Public Health 96(3): 33-39 PAGE NUMBERS NOT FINALIZED.
external image Pdf.jpgBest, A., D. Stokols, et al. (2003). "An integrative framework for community partnering to translate theory into effective health promotion strategy." American Journal Of Health Promotion 18(2): 168-176.
Abstract:
"Introduction. Although there is general agreement about the complex interplay among individual-, family-, organizational-, and community-level factors as they influence health outcomes, there is still a gap between health promotion research and practice. The authors suggest that a disjuncture exists between the multiple theories and models of health promotion and the practitioners need for a more unified set of guidelines for comprehensive planning of programs. Therefore, we put forward in this paper an idea toward closing the gap between research and practice, a case for developing an overarching framework-with several health promotion models that could integrate existing theories-and applying it to comprehensive health promotion strategy. An Integrative Framework. We outline a theoretical foundation for future health promotion research and practice that integrates four models: the social ecology; the Life Course Health Development; the Predisposing, Reinforcing, and Enabling Constructs in Educational/Environmental Diagnosis and Evaluation-Policy, Regulatory and Organizational Constructs in Educational and Environmental Development; and the community partnering models. The first three models are well developed and complementary. There is little consensus on the latter model, community partnering. However, we suggest that such a model is a vital part of an overall framework, and we present an approach to reconciling theoretical tensions among researchers and practitioners involved in community health promotion. Integrating the Models: The Need for Systems Theory and Thinking. Systems theory has been relatively ignored both by the health promotion field and, more generally, by the health services. We make a case for greater use of systems theory in the development of an overall framework, both to improve integration and to incorporate key concepts from the diverse systems literatures of other disciplines. Vision for Healthy Communities. (1) Researchers and practitioners understand the complex interplay among individual-, family-, organizational-, and community-level factors as they influence population health; (2) health promotion researchers and practitioners collaborate effectively with others in the community to create integrated strategies that work as a system to address a wide array of health-related factors; (3) The Healthy People Objectives for the Nation includes balanced indicators to reflect health promotion realities and research-measures effects on all levels; (4) the gap between community health promotion "best practices" guidelines and the way things work in the everyday world of health promotion practice has been substantially closed.
Conclusions and Recommendations. We suggest critical next steps toward closing the gap between health promotion research and practice: investing in networks that promote, support, and sustain ongoing dialogue and sharing of experience; finding common ground in an approach to community partnering; and gaining consensus on the proposed integrating framework," (pg 168).
Notes:
This article was cited by Midgley, G. (2006). "Systemic Intervention for Public Health." American Journal of Public Health 96(3): 33-39 PAGE NUMBERS NOT FINALIZED.
external image Pdf.jpgBryant, J. W. and J. Darwin (2003). "Immersive drama: testing health systems." Omega-International Journal Of Management Science 31(2): 127-136.
Abstract:
This paper describes a workshop-based process bringing together for the first time two approaches-immersive drama and whole systems thinking-which was designed to test the extent to which health service systems are able to recognise and remedy emergent management and clinical problems. The workshop provided participating health service managers with insights into, and pointers to improvements in, current clinical governance arrangements. It also demonstrated the strengths of the immersive drama approach and how these might be augmented, as here, by a shortened version of a whole systems event," (pg 127).
external image Pdf.jpgBurke, J. P. and S. L. Pestotnik (1999). "Antibiotic resistance-systems thinking, chaos and complexity theory." Current Opinion in Infectious Diseases 12(4): 317-319.

"Excerpted from the article:
"Complexity theory appears to be a type of systems analysis, first applied to health care as early as 1938 by R.W. Revans who related concepts from physics to communication and information flow in a human system, including such ideas as noise and feedback loops. The description of the hospital as a human system by Revans is truly remarkable in its relevance to modern hospital epidemiology and its intro duction of the concept of social learning in a self-directing and self-organizing system (pg 2 of pdf version)."
external image Pdf.jpgBurke, J. P. and S. L. Pestotnik (2000). "Antibiotic cycling: what goes around come around." Current Opinion in Infectious Diseases 13(4): 367-369.

[edit]Authors: C

external image Pdf.jpgCabrera, D. and W. Trochim (2005). The Challenges of Systems Thinking in Public Health. American Public Health Association. Pittsburg, PA.
external image Pdf.jpgCabrera, D. A. (2006). A Methodological Review of the Systems Thinking in Public Health Literature., Cornell University.
access an excel version of this file here
external image Pdf.jpgCenters for Disease Control and Prevention and National Center for Chronic Disease Prevention and Health Promotion (2002). Introduction to the syndemics prevention network. Atlanta, GA, CDC.
Notes:
This document is an explanation of the CDC's Syndemics Prevention Network. This report gives the definition of syndemic as "two or more afflications, interacting synergistically, contributing to excess burden of disease in a population." It uses the "SAVA" syndemic as an example (SAVA stands for Substance Abuse, Violence, and AIDS).
external image Pdf.jpgexternal image Www.jpgCenters for Disease Control and Prevention and National Center for Chronic Disease Prevention and Health Promotion (2005). Spotlight on Syndemics. Washington, DC, Centers for Disease Control and Prevention. www.cdc.gov/syndemics/ Accessed February 13, 2006.
Notes:
This is the homepage for the CDC Syndemics Prevention Network.
external image Pdf.jpgChan, C.-P. C. A. (2001). "Implications of organizational learning for nursing managers from the cultural, interpersonal and systems thinking perspectives." Nursing Inquiry 8(3): 196-199.
Abstract:
"This paper discusses the implications of organizational learnin_g to healthcare administrators, in particular nursing managers, from the cultural, interpersonal and systems thinking perspectives. In the various perspectives the reasons for organizational ineffectiveness and remedies are presented. There is little doubt that pressure for nurses to perform is escalating as healthcare institutions attempt to improve the quality of service through restructuring and change, which leads to greater job dissatisfaction, higher turnover, lower morale and increased industrial actions of nurses. An integrated approach to organizational learning is arguably important for the effective management of nurses during periods of transition," (pg 196).
external image Pdf.jpgexternal image 20px-Ajphlogo.jpgChino, M. and L. DeBruyn (2006). "Building True Capacity: Indigenous Models for Indigenous Communities." American Journal of Public Health 96(3): PAGE NUMBERS NOT FINALIZED.
Abstract:
"Within the past 2 decades, community capacity building and community empowerment have emerged as key strategies for reducing health disparities and promoting public health. As with other strategies and best practices, these concepts have been brought to indigenous (American Indian and Alaska Native) communities primarily by mainstream researchers and practitioners. Mainstream models and their resultant programs, however, often have limited application in meeting the needs and realities of indigenous populations. Tribes are increasingly taking control of their local health care services. It is time for indigenous people not only to develop tribal programs but also to define and integrate the underlying theoretical and cultural frameworks for public health application," (first page of article).
Notes:
This is part of the AJPH Special Issue on Systems Thinking.
external image Pdf.jpgChong, L. and L. B. Ray (2002). "Whole-istic biology." Science 295(5560): 1661.
Notes:
This paper was cited by Leischow, S. J. and B. Milstein (2004). "Systems Thinking and Modeling for Public Health Practice." American Journal of Public Health 94(6): 403-405 PAGE NUMBERS NOT FINALIZED.
external image Pdf.jpgClark, M. W. (2002). "The Human Genome: One Family's Journey." Journey of Systemic Therapies 21(2): 41-54.
Abstract:
"The initial draft of the Human Genome (HG) sequence has been completed. This article explores the journey of one of the first families that tested positive for a genetic disease for which there is testing and treatment, but presently no cure. The family allows us to see a wholistic view of how a genetic disorder impacts their hopes and frustrations, joys and disappointments, expectations, and fears. Excerpts from interviews with the family, geneticists, and researchers in the field of human genetics, are merged with system thinking, and my reflections. Finally, suggestions are offered to therapists working with families who are first in line waiting for further HG discoveries," (pg 41).
external image MIA.jpg Clark, P. I. and M. J. Djordjevic (2003). "The Role of Smoking Topography in Assessing Human Smoking and its Utility for Informing Machine-Smoking Protocols."
Notes:
I wasn't able to find any information about this report anywhere on-line. This citation comes only from the "ST in PH gets" document.
external image Pdf.jpgCole, C. R., E. H. Blackstone, et al. (1999). "Heart-rate recovery immediately after exercise as a predictor of mortality." New England Journal Of Medicine 341(18): 1351-1357.
Abstract:
"Background: The increase in heart rate that accompanies exercise is due in part to a reduction in vagal tone. Recovery of the heart rate immediately after exercise is a function of vagal reactivation. Because a generalized decrease in vagal activity is known to be a risk factor for death, we hypothesized that a delayed fall in the heart rate after exercise might be an important prognostic marker.
Methods: For six years we followed 2428 consecutive adults (mean [+/-SD] age, 57+/-12 years; 63 percent men) without a history of heart failure or coronary revascularization and without pacemakers. The patients were undergoing symptom-limited exercise testing and single-photon-emission computed tomography with thallium scintigraphy for diagnostic purposes. The value for the recovery of heart rate was defined as the decrease in the heart rate from peak exercise to one minute after the cessation of exercise. An abnormal value for the recovery of heart rate was defined as a reduction of 12 beats per minute or less from the heart rate at peak exercise.
Results: There were 213 deaths from all causes. A total of 639 patients (26 percent) had abnormal values for heart-rate recovery. In univariate analyses, a low value for the recovery of heart rate was strongly predictive of death (relative risk, 4.0; 95 percent confidence interval, 3.0 to 5.2; P<0.001). After adjustments were made for age, sex, the use or nonuse of medications, the presence or absence of myocardial perfusion defects on thallium scintigraphy, standard cardiac risk factors, the resting heart rate, the change in heart rate during exercise, and workload achieved, a low value for heart-rate recovery remained predictive of death (adjusted relative risk, 2.0; 95 percent confidence interval, 1.5 to 2.7; P<0.001).
Conclusions: A delayed decrease in the heart rate during the first minute after graded exercise, which may be a reflection of decreased vagal activity, is a powerful predictor of overall mortality, independent of workload, the presence or absence of myocardial perfusion defects, and changes in heart rate during exercise," (pg 1351).
Notes:
From the Plexus Institute: "This article documents the importance of physiologic variability and adaptability, specifically recovery after exercise, as a predictor of mortality."
external image Pdf.jpgexternal image Book.jpgCommittee on Assuring the Health of the Public in the 21st Century, Board on Health Promotion and Disease Prevention, et al. (2002). The Future of the Public's Health in the 21st Century. Washington, DC, The National Academies Press.
Notes & Quotes:
From the Institute of Medicine of the National Academies website:
The Future of the Public's Health in the 21st Century reviews the nation's public health capabilities and presents a comprehensive framework for how the government public health agencies, working with multiple partners from the public and private sectors as an intersectoral public health system, can better assure the health of communities by:
  • Adopting a population health approach that considers the multiple determinants of health
  • Strengthening the governmental public health infrastructure, the backbone of the public health system
  • Building a new generation of intersectoral partnerships
  • Requiring accountability from and among all sectors of the public health system
  • Making evidence the foundation of decision-making
  • Enhancing and facilitating communication within the public health system
external image MIA.jpg Cooney, M. M. (1995). "Managed Health-Care - Managing The Risks Of Laboratory Testing In An Integrated Delivery System." American Journal Of Clinical Pathology 104(4): S50-S53.
Abstract:
"Decentralized testing must be viewed as a component of the decentralized patient care that is prevalent today. It cannot be considered a separate component of the total laboratory process, but must be examined in the context of test ordering and test performance through test result disposition and use. The evolving configuration of the health-care delivery system necessitates a redefinition of risk to include four categories of risk: business, financial, insurable, and clinical quality. Reengineering the clinical laboratory process in today's health-care environment needs to incorporate all these risk issues, systems thinking, and available technology along with the changing practice of medicine," (pg S50).
Notes:
This item is at the Veterinary library.
external image Pdf.jpgCorso, L. C., P. J. Wiesner, et al. (2005). "Developing the MAPP Community Health Improvement Tool." Journal of Public Health Management & Practice 11(5): 387-392.
Abstract:
"From 1997 to 2001, the National Association of County and City Health Officials, in collaboration with the Centers for Disease Control and Prevention's Public Health Practice Program Office, developed a new community strategic planning tool, titled Mobilizing for Action through Planning and Partnerships (MAPP). This article provides a chronological description of the development of MAPP, devoting significant attention to pivotal decisions, development milestones, and distinguishing features of this new public health planning tool. All phases of the development ensured a practice-driven process, ongoing substantive input from the field, careful attention to research and literature, and intentional linkage with related efforts. This deliberate process laid the foundation for a tool that is not only well grounded in research and concepts but also relevant for practical use in communities. The process also demonstrates how practice-based research can be conducted in a way that effectively balances the need for applied relevance with intellectual integrity," (pg 387).

[edit]Authors: D

external image Pdf.jpgexternal image 20px-Ajphlogo.jpgDaniels, N. (2006). "Toward Ethical Review of Health System Transformations." American Journal of Public Health 96(3): 14-18 PAGE NUMBERS NOT FINALIZED.
Abstract:
"Efforts to transform health systems constitute social experiments on a population. Like clinical research, they deploy measures that are unproven in the context of the reform, and they often impose significant risks on some people in order to achieve a social goal: the improvement of health delivery.
The rationale for proactively evaluating clinical experimentation on human subjects also applies to these social experiments. We used the "benchmarks of fairness" methodology to illustrate the elements such an evidence-based review should encompass, leaving open the question of who should perform it. The review must include the ethical objectives of reform, namely, an integrated approach to equity, accountability, and efficiency; the fit between measures taken and these objectives; and the governance of the reform," (pg 14).
Notes:
This is part of the AJPH Special Issue on Systems Thinking.
external image 20px-Binder.jpg Dardik, I. I. (1997). "The Origin of Disease and Health, Heart Waves: The Single Solution to Heart Rate Variability and Ischemic PreconditioningThe Origin of Disease and Health, Heart Waves: The Single Solution to Heart Rate Variability and Ischemic Preconditioning." Frontier Perspectives 6(2): 18-32.
Notes:
From the Plexus Institute: "This provocative article explores the concepts of the heart waves and heart rate variability as indicators of health and disease and proposes a route to increase the fractal complexity, and hence health, of human physiologic systems through a novel approach to physical activity and exercise. Don’t miss this one."
external image Pdf.jpgDavies, H. T. O. and S. M. Nutley (2000). "Developing learning organisations in the new NHS." British Medical Journal 320(7240): 998-1001.
Summary Points:
  • "The national quality strategy for the new NHS highlights lifelong learning as a way of improving health care
  • Learning is something achieved by individuals, but “learning organisations” can configure themselves to maximise, mobilise, and retain this learning potential
  • Learning occurs at different levels—single loop learning is about incremental improvements to existing practice; double loop learning occurs when organisations rethink basic goals, norms, and paradigms; and meta learning reflects an organisation's attempts to learn about (and improve) its ability to learn
  • Learning organisations attempt to maximise learning capacity by developing skills in double loop learning and meta­learning
  • Learning organisations exhibit several common characteristics and are underpinned by distinctive organisational cultures which the NHS may need to adopt if it is to achieve substantial quality improvements," (pg 998).
external image Pdf.jpgDavis, M. V., W. A. Sollecito, et al. (2004). "Examining the Impact of a Distance Education MPH Program: A One-Year Follow-Up Survey of Graduates." Journal of Public Health Management & Practice 10(6): 556-563.
Abstract:
"This article addresses the critical issue of measuring impact of a distance education Master of Public Health degree program on public health practitioners. It is based on an online survey of the 49 graduates of the Public Health Leadership Program at the School of Public Health of the University of North Carolina at Chapel Hill. The survey was carried out 1-year postgraduation and had a 73% response rate. Results indicated that graduates continued to have a high level of satisfaction with the program; 97% of respondents indicated they would recommend the program to others, and 75% said that their overall opinion about the program had increased since graduation. On a scale of 1 to 10, 79% of respondents rated the program with a score of 8 or higher in terms of the impact of the program on their ability to do their current job. Regarding new opportunities, 75% of respondents reported that they had new professional affiliations or service commitments, and 31% had job promotions since graduating. The methodology and results reported here may be a model for assessing the impact of a distance learning degree program for mid-career professionals. These results support the viability of a distance-education format for providing necessary training at the master's level for the public health workforce," (pg 556).
external image Pdf.jpgDekker, J. M., R. S. Crow, et al. (2000). "Low heart rate variability in a 2-minute rhythm strip predicts risk of coronary heart disease and mortality from several causes - The ARIC study." Circulation 102(11): 1239-1244.
Abstract:
"Background-Low heart rate variability (HRV) is associated with a higher risk of death in patients with heart disease and in elderly subjects and with a higher incidence of coronary heart disease (CHD) in the general population.
Methods and Results-We studied the predictive value of HRV for CHD and death from several causes in a population study of 14 672 men and women without CHD, aged 45 to 65, by using the case-cohort design. At baseline, in 1987 to 1989, 2-minute rhythm strips were recorded. Time-domain measures of HRV were determined in a random sample of 900 subjects, for all subjects with incident CHD (395 subjects), and for all deaths (443 subjects) that occurred through 1993. Relative rates of incident CHD and cause-specific death in tertiles of HRV were computed with Poisson regression for the case-cohort design. Subjects with low HRV had an adverse cardiovascular risk profile and an elevated risk of incident CHD and death. The increased risk of death could not be attributed to a specific cause and could not be explained by other risk factors.
Conclusions-Low HRV was associated with increased risk of CHD and death from several causes, It is hypothesized that low HRV is a marker of less favorable health," (pg 1239).
Notes:
From the Plexus Institute: "The authors hypothesize from the results of this large study that low heart rate variability (HRV) is a marker of ill health and suggest that low HRV “precedes manifest disease”. Such findings suggest that HRV may be a general marker of the vitality of human physiology."
external image Pdf.jpgDeRidder, D., M. Depla, et al. (1997). "Beliefs on coping with illness: A consumer's perspective." Social Science & Medicine 44(5): 553-559.
Abstract excerpted from above:
"This article discusses the results of a study on beliefs on coping with illness and coping with the health care system. Using the concept mapping method, members of patient organizations (n = 172) sorted their beliefs on coping with illness and coping with the health care system into two dimensions (priority and content). Statistical analysis reveals eight beliefs on coping with illness, with autonomy and acceptance of illness as the most important. It also reveals eight beliefs on coping with the health care system, of which the most important is a professional relationship with the physician based on mutual trust and respect between two equal partners. It is argued that these beliefs represent idealized images of coping with illness and coping with the health care system. In relation to the political debate on responsible use of the health care system in Western countries, these findings show many patients are willing to act as responsible consumers of health care, that is, if providers of health care create an environment in which patients receive guidance in determining alternatives."
external image Pdf.jpgexternal image 20px-Ajphlogo.jpgDes Jarlais, D. C., S. Galea, et al. (2006). "Stigmatization of Newly Emerging Infectious Diseases: AIDS and SARS." American Journal of Public Health 96(3): PAGE NUMBERS NOT FINALIZED.
Abstract:
"Objectives. We assessed relationships between sociodemographic characteristics and mental health status and knowledge of, being worried about, and stigmatization of 2 emerging infectious diseases, AIDS and SARS.Methods. We conducted a random-digit-dialed survey of 928 residents of the New York City metropolitan area as part of a study of the effects of the September 11, 2001, terrorist attacks. Questions added for this study concerned respondents' knowledge of, worry about, and support of stigmatizing actions to control AIDS and SARS.Results. In general, respondents with greater personal resources (income, education, social support) and better mental health status had more knowledge, were less worried, and were less likely to stigmatize. This pattern held for both AIDS and SARS.Conclusions. Personal resources and mental health factors are likely to influence the public's ability to learn about, rationally appraise the threat of, and minimize stigmatization of emerging infectious diseases such as AIDS and SARS," (first page of article).
Notes:
Part of the AJPH Special Issue on Systems Thinking.
external image Pdf.jpgDevers, K. J., S. M. Shortell, et al. (1994). "Implementing organized delivery systems: An integration scorecard." Health Care Management Review 19(3): 7-20.
Abstract:
"Vertically organized integrated health systems are in a key position to play a major role in present health care reform efforts. To demonstrate a competitive advantage in the new health care environment, however, integration efforts must be successful. Based on a national study of 9 organized delivery systems, measures of 3 types of integration that occur in vertically integrated health systems are developed: 1. functional, 2. physician-system, and 3. clinical. Measuring these key areas of integration fosters systems thinking, helps identify the mechanisms and implementation activties that enhance overall system performance and provides a device with which to gauge progress," (pg 7).
external image Pdf.jpgDonaldson, L. (2004). "When will health care pass the orange-wire test?" The Lancet 364(9445): 1567-1568.
Abstract:
"The World Alliance will be very important in facilitating the development of patients' safety policy and practice in WHO's 192 member states. The Alliance will deliver several core functions and short-term initiatives, which will be set out in an annual work programme (panel). In delivering these programmes WHO will bring together its technical experts from all parts of the world. The Alliance will be supported by senior policy-makers and international experts with a common objective to stop health care causing harm to patients," (summary from the Lancet website).
external image Pdf.jpgDoran, D. M. I., G. R. Baker, et al. (2002). "Achieving clinical improvement: An interdisciplinary intervention." Health Care Management Review 27(4): 42-56.
Abstract:
"This study evaluates whether training health care teams in continuous quality improvement methods results in improvements in the care of and outcomes for patients. Nine of the 25 teams who participated in the study were successful in improving the care/outcomes for patients. Successful teams were more effective at problem solving, engaged in more functional group interactions, and were more likely to have physician participation. Involvement of physicians in the quality improvement team was associated with the team being able to improve the processes or outcomes of care. A variety of factors could have been instrumental including historical working relationships among team members, the focus of the quality improvement project, and the coordinating mechanisms and management structures within the hospital that encourage participation and decentralized decision-making," (pg 42).

[edit]Authors: E

external image Pdf.jpgEditors (2001). "Ways of understanding." British Medical Journal 323(7315).
Notes:
This piece is the editor's note at the beginning of this particular issue of the British Medical Journal. It simply summarizes several of the articles within.
Text of article: "This week in our series on complexity science Paul Plsek and Tim Wilson illustrate how the ideas of complexity theory can be applied to health care (p 746). The theory sees an organisation as a complex adaptive system that responds flexibly to its environment and in reaching its goals. Unlike the metaphor of a machine, a complex organisation operates with a few flexible rules—or minimum specifications. Plsek and Wilson cite examples from an American report contrasting old approaches to health care (professionals control care, the system reacts to needs, cost reduction is sought) with new rules (the patient is the source of control, needs are anticipated, waste is continually decreased); and they show how such thinking can be applied to the problem of administering thrombolysis within 60 minutes of the onset of chest pain. Trying to divine the rules underpinning the way something operates is an illuminating method of analysis, and William Thompson and colleagues use a similar technique in their qualitative study of general practitioner’s attitudes to their own health (p 728). These doctors were reluctant to declare themselves physically (let alone psychologically) ill, felt under pressure to seem well so as not to let down partners and patients, and were poor at looking after themselves. The authors synthesised these findings into an “informal shadow contract”: “I undertake to protect my partners from the consequences of my being ill . . . I will protect my partners by working through any illness up to the point where I am unable to walk . . . I expect my partners to do the same and reserve the right to make them feel uncomfortable if they violate this contract.” This week’s Career Focus looks at initiatives in Britain that help doctors spend time working overseas, particularly in developing countries (Classified supplement). Nick Banatvala and Ivan Scott explain how some colleges are supporting overseas work—for example, through links with Voluntary Service Overseas—but they want more partnerships that will enable NHS hospitals to release career grade doctors to international agencies. Just how great the needs are comes through in Edwin and Peta Martin’s personal view on their work in Arhiba, Djibouti—the poorest area of one of the world’s poorest countries (p 759). “Walking away from insoluble problems . . . suddenly seems less logical when you have a dying baby held by a marasmic mother in front of you.” Yet, the problems do seem insoluble: “What can any government do in a tiny country, totally desert, surrounded by wars, and therefore swamped by refugees . . . The result is misery and starvation beyond belief.”
external image Pdf.jpgEdwards, N., J. Mill, et al. (2004). "Multiple intervention research programs in community health." Canadian Journal of Nursing Research 36(1): 40-54.
Abstract:
"The authors describe an organizing framework for multiple interventions in community health. The framework provides a foundation for programmatic research on multiple interventions and poses critical questions that need to be addressed in the next generation of research in this field. Multiple intervention programs are characterized by the use of multiple strategies targeted at multiple levels of the socio-ecological system and delivered to multiple target audiences. Consequently, they complement the growing literature on the broad determinants of health and health promotion. The authors describe a 4-stage framework and identify gaps and challenges in this field of research. There are 5 key research areas requiring concerted action; researchers must: examine nested determinants, develop integrated conceptual frameworks, examine ways to optimize synergies among interventions, describe spin-offs from multiple intervention programs, and monitor the sustainability of their impact," (pg 40).

[edit]Authors: F

external image Pdf.jpgFahey, D. K., E. R. Carson, et al. (2004). "Applying systems modelling to public health." Systems Research And Behavioral Science 21(6): 635-649.
Abstract:
"Public health is complex and previous work has demonstrated the value of systems modelling in understanding its complexity. Today the need for systems modelling in public health has increased because the delivery of the public health function is being reengineered with an additional layer of complexity. The service is now more distributed and as a consequence there is a demand that information and communication technologies (ICT) should be employed to a greater extent in ensuring public health provision. It is essential that a good public health service is maintained within this new framework and the public health network (PHN) has been proposed as the solution. We aim to demonstrate the potential value of systems modelling in this newly re-engineered public health environment by showing how it can be used to convert the complex input of the public health network project into a realistic, holistic and potentially successful plan to implement and evaluate the network," (pg 635).
Notes:
This article was cited in Midgley, G. (2006). "Systemic Intervention for Public Health." American Journal of Public Health 96(3): 33-39 PAGE NUMBERS NOT FINALIZED.
external image Pdf.jpgexternal image 20px-Ajphlogo.jpgFajans, P., R. Simmons, et al. (2006). "Helping Public Sector Health Systems Innovate: The Strategic Approach to StrengtheningReproductive Health Policies and Programs." American Journal of Public Health 96(3):PAGE NUMBERS NOT FINALIZED.
Abstract:
"Public sector health systems that provide services to poor and marginalized populations in developing countries face great challenges. Change associated with health sector reform and structural adjustment often leaves these already strained institutions with fewer resources and insufficient capacity to relieve health burdens.The Strategic Approach to Strengthening Reproductive Health Policies and Programs is a methodological innovation developed by the World Health Organization and its partners to help countries identify and prioritize their reproductive health service needs, test appropriate interventions, and scale up successful innovations to a subnational or national level. The participatory, interdisciplinary, and country-owned process can set in motion much needed change.We describe key features of this approach, provide illustrations from country experiences, and use insights from the diffusion of innovation literature to explain the approach's dissemination and sustainability," (pg first page of pdf).
Notes:
This is part of the AJPH Special Issue on Systems Thinking.
external image Pdf.jpgFinlayson, B. and S. Dewar (2001). "Reforming complaints systems: UK and New Zealand." The Lancet 358(9290): 1290.
Abstract:
"In the long term there would be merit in investigating a national one-stop-shop approach for the UK, to collate complaints (unresolved at the local level), concerns about health-care professionals, and adverse events. It would encompass both public and private health services, and provide a single point of entry into professional, organisational, and legal systems of redress as well as a coordinated investigative process. This system could ensure that problems are identified and lessons learned. In the short term, the key may lie in concentrating on the common needs across agencies-- for example, establishing national criteria for investigations at any level and under the auspices of any agency. This measure would enable a quick and clean passing of accountability between the NHS complaints procedure and systems for professional and legal redress, as well as introduce flexibility and interconnectedness. Integrated solutions are starting to be considered in the UK. A recent Commission for Health Improvement report suggested that UK complaints data should be added to the planned national system for reporting adverse events. The Kennedy report into children's heart surgery at the Bristol Royal Infirmary called for two new UK Councils, one to bring together those bodies that regulate health-care standards and institutions, and a second to oversee those bodies that regulate health-care professionals. However, even this attractive proposition would leave NHS complaints, the logging of adverse events, and concerns about healthcare professions in different "silos"," (abstract from the ProQuest website).
external image Pdf.jpgFoote, J. L., D. J. Houston, et al. (2002). "Betwixt and between: Ritual and the management of an ultrasound waiting list." Health Care Analysis 10(4): 357-377.
Abstract:
"Hospital waiting lists are a feature of publicly funded health services that results when demand appears to exceed supply. While much has been written about hospital waiting lists, little is known about the dynamics of diagnostic waiting lists, or more generally why hospital waiting lists behave in perverse and often counter-intuitive ways. This paper attempts to address this gap by applying a recent development in critical systems thinking called boundary critique to understand how a particular ultrasound waiting list was managed. A new waiting list metaphor based on waiting lists as ritual forms is proposed," (pg 357)
external image Pdf.jpgexternal image 20px-Ajphlogo.jpgFreudenberg, N., M. Fahs, et al. (2006). "The Impact of New York City's 1975 Fiscal Crisis on the Tuberculosis, HIV, and Homicide Syndemic." American Journal of Public Health 96(3): 424-434 PAGE NUMBERS NOT FINALIZED.
Abstract:
"In 1975, New York City experienced a fiscal crisis rooted in long-term political and economic changes in the city. Budget and policy decisions designed to alleviate this fiscal crisis contributed to the subsequent epidemics of tuberculosis, human immunodeficiency virus (HIV) infection, and homicide in New York City.
Because these conditions share underlying social determinants, we consider them a syndemic, i.e., all 3 combined to create an excess disease burden on the population. Cuts in services; the dismantling of health, public safety, and social service infrastructures; and the deterioration of living conditions for vulnerable populations contributed to the amplification of these health conditions over 2 decades.
We estimate that the costs incurred in controlling these epidemics exceeded $50 billion (in 2004 dollars); in contrast, the overall budgetary saving during the fiscal crisis was $10 billion. This history has implications for public health professionals who must respond to current perceptions of local fiscal crises," (pg 424, PAGE NUMBERS NOT FINALIZED).
Notes:
This is part of the AJPH Special Issue on Systems Thinking.
external image Pdf.jpgFrumkin, H. (2001). "Beyond Toxicity: Human Health and the Natural Environment." American Journal of Preventive Medicine 20(3): 234-244.
Abstract:
"Research and teaching in environmental health have centered on the hazardous effects of various environmental exposures, such as toxic chemicals, radiation, and biological and physical agents. However, some kinds of environmental exposures may have positive health effects. According to E.O. Wilson's "biophilia" hypothesis, humans are innately attracted to other living organisms. Later authors have expanded this concept to suggest that humans have an innate bond with nature more generally. This implies that certain kinds of contact with the natural world may benefit health. Evidence supporting this hypothesis is presented from four aspects of the natural world: animals, plants, landscapes, and wilderness. Finally, the implications of this hypothesis for a broader agenda for environmental health, encompassing not only toxic outcomes but also salutary ones, are discussed. This agenda implies research on a range of potentially healthful environmental exposures, collaboration among professionals in a range of disciplines from public health to landscape architecture to city planning, and interventions based on research outcomes," (pg 234).
Notes:
From the Plexus Institute: "This landmark review article explores a wide variety of research findings that support the hypothesis that interaction with the natural environment - specifically with animals, plants, landscapes and wilderness – has a positive effect on human health. This hypothesis is based on the fact that “for the great majority of human existence, human biology has been embedded in the natural environment.” The author suggests that the field of environmental health needs to move beyond its present focus on toxicity to explore more deeply health benefits of contact with the nature."
external image Pdf.jpgFuenmayor, R. and A. Fuenmayor (1999). "Researching-acting-reflecting on public health services in Venezuela. I. A conceptual framework." Systemic Practice And Action Research 12(1): 35-53.
Abstract:
"This is the first of a "duology" of articles reporting on an action research project about public health services in Venezuela. This first paper presents a summary of a conceptual framework from which a process of intervention was launched. The second paper, which follows immediately in this special issue, presents a narrative of the intervention process and a final discussion about it. The conceptual framework is constituted by two types of interpretive models of the role of the state concerning health services. On the one hand, four "logical" interpretive models are summarized. They correspond to four theories about the socioeconomic mission of the state in a modern society. Different thematic interpretations concerning the role of the state in health services are derived from such general missions. On the other hand, two different and, to a certain degree, opposed "historical" interpretive models about the present Venezuelan socioeconomic-political situation and their corresponding power structures are outlined. The four "logical" interpretive models are discussed in the light of the two "historical" models in terms of desirable and feasible courses of political action," (pg 35).
external image Pdf.jpgFuenmayor, A. and R. Fuenmayor (1999). "Researching-acting-reflecting on public health services in Venezuela. II. Community action and critique." Systemic Practice And Action Research 12(1): 55-75.
Abstract:
"This paper, the second in a "duology" reporting on an action research project about public health services in Venezuela, presents a narrative of an intervention process launched on the basis of the conceptual framework presented in the first paper of the "duology." Thereafter, a deeper reflection on such process, its meaning and its historical possibilities is presented. In this way a cycle of research-action-research is completed," (pg 55).

[edit]Authors: G

external image Pdf.jpgexternal image 20px-Ajphlogo.jpgGarfinkel, M. S., D. Sarewitz, et al. (2006). "A Societal Outcomes Map for Health Research and Policy." American Journal of Public Health 396(3): PAGE NUMBERS NOT FINALIZED.
Abstract:
"The linkages between decisions about health research and policy and actual health outcomes may be extraordinarily difficult to specify. We performed a pilot application of a "road mapping" and technology assessment technique to perinatal health to illustrate how this technique can clarify the relations between available options and improved health outcomes. We used a combination of datamining techniques and qualitative analyses to set up the underlying structure of a societal health outcomes road map. Societal health outcomes road mapping may be a useful tool for enhancing the ability of the public health community, policymakers, and other stakeholders, such as research administrators, to understand health research and policy options," (pg PAGE NUMBERS NOT FINALIZED).
Notes:
This is part of the AJPH Special Issue on Systems Thinking.
external image Pdf.jpgGebbie, K. M. and I. Hwang (2000). "Preparing Currently Employed Public Health Nurses for Changes in the Health System." American Journal Of Public Health 90(5): 716-721.
Abstract:
"OBJECTIVES: This article describes a core public health nursing curriculum, part of a larger project designed to identify the skills needed by practicing public health workers if they are to successfully fill roles in the current and emerging public health system.
METHODS: Two focus groups of key informants, representing state and local public health nursing practice, public health nursing education, organizations interested in public health and nursing education, federal agencies, and academia, synthesized material from multiple sources and outlined the key content for a continuing education curriculum appropriate to the current public health nursing workforce.
RESULTS: The skills identified as most needed were those required for analyzing data, practicing epidemiology, measuring health status and organizational change, connecting people to organizations, bringing about change in organizations, building strength in diversity, conducting population-based intervention, building coalitions, strengthening environmental health, developing interdisciplinary teams, developing and advocating policy, evaluating programs, and devising approaches to quality improvement.
CONCLUSIONS: Collaboration between public health nursing practice and education and partnerships with other public health agencies will be essential for public health nurses to achieve the required skills to enhance public health infrastructure," (pg 716).
external image Pdf.jpgGerberding, J. L. (2005). "Protecting Health--The New Research Imperative." Journal of the American Medical Association 294(11): 1403-1406.
external image Pdf.jpgGloberman, J. (1999). "Hospital restructuring: Positioning social work to manage change." Social Work In Health Care 28(4): 13-30.
Abstract:
"In the shifts to programmatic hospital organizations, social workers are having to learn to reframe their work, reorganize their thinking, and restructure their professional disciplines in order to survive. The experience is frequently one of frustration, anger, and impotence. Yet, social workers are masters of systems thinking in hospitals, and are well positioned to effect change. The beauty of shifting to a flattened hierarchy that is patient focused, is that it endorses change consistent with the social work mission in health. The challenge for social work is to grapple with the big issues: our belief in ourselves; defining our roles and functions and priorities; defining our vision in programmatic hospital organizations; being critical of what we do; and articulating what we have to offer. This paper identifies ways social workers can position themselves to effect positive change in hospitals undergoing restructuring," (pg 13).
external image Pdf.jpgGlouberman, S. and B. Zimmerman (2002). Complicated and Complex Systems: What Would Successful Reform of Medicare Look Like? Commission on the Future of Health Care in Canada.
Notes:
From the Plexus Institute: "Authors Glouberman and Zimmerman have written a discussion paper on health care reform in Canada in response to the Commission on the Future of Health Care in Canada. The paper presents a history of the Canadian health system, and suggests how an alternative theoretical frame is needed for viewing and understanding the complexities of health care. They take a look at some of the "intractable choices" or opposing views appearing in the health care debates, and present a few case studies to highlight governmental approaches to health care concerns: first, through a study of France's ranking in WHO health care systems; the second, is a look at Brazil's attempts to address HIV/AIDS. The final section of the paper addresses how complexity might be taken up in reforming Canada's health care sustem."
external image Pdf.jpgGodin, P. J. and T. G. Buchman (1996). "Uncoupling of biological oscillators: A complementary hypothesis concerning the pathogenesis of multiple organ dysfunction syndrome." Critical Care Medicine 24(7): 1107-1116.
Abstract:
"Objective: To present a complementary hypothesis concerning the pathogenesis of the multiple organ dysfunction syndrome.
Data Sources: Primary reports and reviews published in peer-reviewed medical and scientific journals.
Hypothesis: We suggest that healthy organs behave as biological oscillators, which couple to one another during human development, and that this orderly coupling is maintained through a communications network, including neural, humoral, and cytokine components, We suggest that the systemic inflammatory response syndrome initiates disruption of communication and uncoupling, and further suggest that progression into the multiple organ dysfunction syndrome reflects progressive uncoupling that can become irreversible, Resolution of the inflammatory response and reestablishment of the communications network are necessary but may not be, by itself, sufficient to allow organs to appropriately recouple, This hypothesis is testable using existing laboratory and clinical tools," (pg 1107).
Notes:
From the Plexus Institute: "A number of researchers are studying multiple organ dysfunction syndrome (MODS) from a complexity perspective. MODS is the most common cause of death in intensive care units, and is a poorly understood process. The authors suggest that studying interconnections and biological oscillations among organ systems could shed light on this syndrome."
external image Pdf.jpgGoldberger, A. L. (1996). "Non-linear dynamics for clinicians: Chaos theory, fractals, and complexity at the bedside." Lancet 347(9011): 1312-1314.
Notes:
This is an essay with no abstract. From the Plexus Institute: "A wonderful introductory article for medical personnel by a physician who has delved deeply into human health and physiology from the complexity and chaos perspectives. Suggests new definitions for health and ill-health, and new diagnostic and therapeutic approaches. Contains comprehensive reference list of other medically related articles."
external image 20px-Binder.jpg Goldberger, A. L. (1997). "Fractal variability versus pathologic periodicity: Complexity loss and stereotypy in disease." Perspectives In Biology And Medicine 40(4): 543-561.
Abstract (from the database Proquest):
"Goldberger explores the fact that individuals with a wide range of different illnesses are often characterized by strikingly periodic and predictable dynamics, even though the disease processes themselves are referred to as dis-orders."
Notes:
From the Plexus Institute: "This comprehensive article proffers new complexity-based definitions of health and disease. Goldberger develops the case that healthy physiologic systems are characterized by fractal complexity, while unhealthy systems are marked by highly periodic (regular) dynamics and a concomitant loss of adaptability. A must read for anyone interested in complexity and human health."
external image 20px-Binder.jpg Goldberger, A. L., D. R. Rigney, et al. (1990). "Chaos And Fractals In Human Physiology." Scientific American 262(2): 43-49.
Abstract:
"Examines the chaos and fractals in human physiology. Association between the subjects of chaos and fractals and the discipline of nonlinear dynamics; Dynamics of embryonic development and evolution; Tools for analyzing the dynamics of a complex nonlinear system," (pg 43).
Notes:
"This pioneering work was among the first to suggest how developments in nonlinear dynamics, fractal geometry and chaos theory could lead to advances in understanding of human physiology."
external image 20px-Binder.jpg Goodwin, J. S. (1997). "A piece of my mind. Chaos, and the limits of modern medicine." Journal Of The American Medical Association 278(17): 1399-1400.
Notes:
From the Plexus Institute: "A provocative short piece which suggests that chaos and complexity theory can contribute to advancing the practice of medicine by viewing people as complex systems and going beyond traditional scientific medicine."
external image Pdf.jpgGreen, L. W. (1970). "Should health education abandon attitude change strategies: perspectives from recent research." Health Education Monographs 1(30): 25-48.
external image Pdf.jpgexternal image 20px-Ajphlogo.jpgGreen, L. W. (2006). "Public Health Asks of Systems Science: To Advance Our Evidence-Based Practice, Can You Help Us Get More Practice-Based Evidence?" American Journal of Public Health 96(3): 1-4 PAGE NUMBERS NOT FINALIZED.
Abstract:
"Public health asks of systems science, as it did of sociology 40 years ago, that it help us unravel the complexity of causal forces in our varied populations and the ecologically layered community and societal circumstances of public health practice.
We seek a more evidence-based public health practice, but too much of our evidence comes from artificially controlled research that does not fit the realities of practice.
What can we learn from our experience with sociology in the past that might guide us in drawing effectively on systems science?" (pg PAGE NUMBERS NOT FINALIZED).
Notes:
This is part of the AJPH Special Issue on Systems Thinking.
external image 20px-Binder.jpg Green, L. W., M. McGinnis, et al. (1987). "Strategies for Promoting Health for Specific Populations." Journal of Public Health Policy 8(3): 369-423.
Notes:
This is a reprint of a US Dept. of Health and Human Services report from 1981: Green, L. W., M. McGinnis, T. S. Phillips, M. Devereaux, and H. Montes. 1981. Strategies for Promoting Health for Specific Populations. DHHS (PHS) Publication No. 81 50169, US Office of Health Information and Health Promotion, Washington, DC.
external image Pdf.jpgGregory, W. J. and G. Midgley (2000). "Planning for disaster: developing a multi-agency counselling service." Journal Of The Operational Research Society 51(3): 278-290.
Abstract:
"Multi-agency planning is becoming increasingly important to organisations, especially those concerned with delivering services for the benefit of the community. This paper describes how a modified version of the methods from soft systems methodology (SSM), chosen through methodological reflections informed by critical systems thinking, was used to support the planning of a multi-agency counselling service that could be activated in the event of a disaster. Representatives of nineteen agencies were involved in this exercise, working together in six, one-day workshops. Feedback from participants, using four evaluation criteria (derived from the principles of SSM and the stated priorities of workshop participants), suggests that the methods of SSM, modified as described, show a great deal of promise as a support to multi-agency planning," (pg 278).
external image Pdf.jpgexternal image 20px-Ajphlogo.jpgGrossman, D., C. Ellertson, et al. (2006). "Do Product Labeling and Practice Guidelines Deter Contraceptive Use?" American Journal of Public Health 96(3): PAGE NUMBER NOT FINALIZED.
Abstract:
"Many contraceptives are encumbered with potentially unnecessary restrictions on their use. Indeed, fear of side effects, fostered by alarmist, legalistic labeling, is a leading reason that women do not use contraceptives. In the United States, hormonal methods currently require a prescription, although research suggests that women can adequately screen themselves for contraindications, manage side effects, and determine an appropriate initiation date, leaving little need for routine direct physician involvement. Sizing, spermicidal use, and length-of-wear limits burden users of cervical barriers and may be unnecessary. Despite recent changes in the labeling of intrauterine devices, clinicians commonly restrict use of this method and in some countries may limit the types of providers authorized to insert them. Although in some cases additional research is necessary, existing data indicate that evidence-based demedicalization of contraceptive provision could reduce costs and improve access," (pg PAGE NUMBERS NOT FINALIZED).
Notes:
This is part of the AJPH Special Issue on Systems Thinking.
external image Pdf.jpgGustafson, D. H., C. P. Helstad, et al. (1995). "The Total Costs Of Illness - A Metric For Health-Care Reform." Hospital & Health Services Administration 40(1): 154-171.
Abstract:
"Systems thinking is a fundamental element of quality management and should be a fundamental element of health care reform. An implication of systems thinking is that one aim of health care should be to minimize the total costs of illness, not simply the direct medical expenditures. If we are to continue to improve health care over time, we should measure its impact on the total costs of illness to the patient, family, employer, and society. Thus a system of measurement is needed that quantifies total costs of illness and also suggests how these constituencies can collaborate to improve processes and reduce total costs. This article introduces the total costs of illness concept, contrasts it with societal costs of illness, describes a measurement system we developed to quantify it, and describes a case study examining the total costs of back injury illness to employers. We found that medical expenditures accounted for less than half of the total costs of illness, the average total costs of illness varied by over 350 percent among employers, and a simple metric (days off work) explained 62.5 percent of the variance in total costs of illness," (pg 154).
external image Pdf.jpgexternal image 20px-Ajphlogo.jpgGuth, A. A., A. O'Neill, et al. (2006). "Public Health Lessons Learned from New York City Subway Injuries." American Journal of Public Health 96(3): PAGE NUMBERS NOT FINALIZED.'
Abstract:
"Subway injuries are devastating, with young victims and a high mortality and amputation rate. This report identifies the urban population at greatest risk for subway injuries, looks at the influence of a local economy on injury rates, and proposes the use of changes in social conditions as a trigger for increased vigilance and protective measures at times of higher risk," (pg PAGE NUMBERS NOT FINALIZED).
Notes:
This is part of the AJPH Special Issue on Systems Thinking.

[edit]Authors: H

external image Pdf.jpgexternal image 20px-Ajphlogo.jpgHammett, T. M. (2006). "HIV/AIDS and Other Infectious Diseases Among Correctional Inmates: Transmission, Burden, and Appropriate Response." American Journal of Public Health 96(3): 13-17 PAGE NUMBERS NOT FINALIZED.
Abstract:
"Correctional inmates engage in drug-related and sexual risk behaviors, and the transmission of HIV, hepatitis, and sexually transmitted diseases occurs in correctional facilities. However, there is uncertainty about the extent of transmission, and hyperbolic descriptions of its extent may further stigmatize inmates and elicit punitive responses.
Whether infection was acquired within or outside correctional facilities, the prevalence of HIV and other infectious diseases is much higher among inmates than among those in the general community, and the burden of disease among inmates and releasees is disproportionately heavy. A comprehensive response is needed, including voluntary counseling and testing on request that is linked to high-quality treatment, disease prevention education, substance abuse treatment, and discharge planning and transitional programs for releasees," (pg 13 PAGE NUMBERS NOT FINALIZED).
Notes:
This is part of the AJPH Special Issue on Systems Thinking.
external image Www.jpgHealth Policy Special Interest Group and International System Dynamics Society (2006). HPSIGWiki: Community Portal. Albany, NY, International System Dynamics Society. Accessed February 17, 2006.
Notes & Quotes:
This wiki site is primarily a repository of information for the Health Policy Special Interest Group of the International System Dynamics Society.
external image Pdf.jpgHirsch, G. and C. S. Immediato (1999). "Microworlds and generic structures as resources for integrating care and improving health." System Dynamics Review 15(3): 315-330.
Abstract:
"Decision-makers in the U.S. health care industry face three major changes: (1) a transition from a fee-for-service to a capitated payment system; (2) a shift from autonomous providers to integrated delivery of care; and (3) an expanded definition of health care to include health improvement and prevention rather than a narrow focus on treatment of illness. System dynamics provides valuable tools for managing change of this magnitude and improving working relationships for these decision-makers. Health care providers have created a number of learning consortia to develop microworld learning environments that illuminate strategic choices and their consequences. This article presents the advantages of microworld learning environments to meet these needs and describes two system dynamics-based microworld learning environments and their use by health care providers as they navigate through complexity and uncertainty. In particular, the paper focuses on how system archetypes (or generic structures) are used as a device to capture what is learned about the dynamics of these three changes and to help microworld users apply what is learned to similar situations in their own organizations," (pg 315).
external image Pdf.jpgHoffmann, D. and I. Hoffmann (1997). "The changing cigarette, 1950-1995." Journal Of Toxicology And Environmental Health 50(4): 307-364.
Abstract:
"Nicotine is recognized to be the major inducer of tobacco dependence. The smoking of cigarettes as an advantageous delivery system for nicotine, accelerates and aggravates cardiovascular disease, and is causally associated with increased risks for chronic obstructive lung disease, cancer of the lung and of the upper aerodigestive system, and cancer of the pancreas, renal pelvis, and urinary bladder. It is also associated with cancer of the liver, cancer of the uterine cervix, cancer of the nasal cavity, and myeloid leukemia. In 1950, the first large-scale epidemiological studies documented that cigarette smoking induces lung cancer and described a dose-response relationship between number of cigarettes smoked and the risk for developing lung cancer. In the following decades these observations were not only confirmed by several hundreds of prospective and case-control studies but the plausibility of this causal association was also supported by bioassays and by the identification of carcinogens in cigarette smoke. Whole smoke induces lung tumors in mice and tumors in the upper respiratory tract of hamsters. The particulate matter of the smoke elicits benign and malignant tumors on the skin of mice and rabbits, sarcoma in the connective tissue of rats, and carcinoma in the lungs of rats upon intratracheal instillation. More than 50 carcinogens have been identified including the following classes of compounds: polynuclear aromatic hydrocarbons (PAH), aromatic amines, and N-nitrosamines. Among the latter, the tobacco-specific N-nitrosamines (TSNA) have been shown to be of special significance. Since 1950, the makeup of cigarettes and the composition of cigarette smoke have gradually changed. In the United States the sales-weighted average tar and nicotine yields have declined from a high of 38 mg tar and 2.7 mg nicotine in 1954 to 12 mg and 0.95 mg in 1992, respectively. In the United Kingdom, the decline was from about 32 mg tar and 2.2 mg nicotine to less than 12 mg tar and 1.0 mg nicotine per cigarette. During the same time, other smoke constituents changed correspondingly. These reductions of smoke yields were primarily achieved by the introduction of filter tips, with and without perforation, selection of tobacco types and varieties, utilization of highly porous cigarette paper, and incorporation into the tobacco blend of reconstituted tobacco, opened and cut ribs, and expanded tobacco. In most countries where tobacco blends with air-cured (burley) tobacco are used, the nitrate content of the cigarette tobacco increased. In the United States nitrate levels in cigarette tobacco rose from 0.3-0.5% to 0.6-1.35%, thereby enhancing the combustion of the tobacco. More complete combustion decreases the carcinogenic PAH, yet the increased generation of nitrogen oxides enhances the formation of the carcinogenic N-nitrosamines, especially the TSNA in the smoke. However, all analytical measures of the smoke components have been established on the basis of standardized machine smoking conditions, such as those introduced by the Federal Trade Commission, that call for I puff to be taken once a minute over a 2-s period with a volume of 35 mi. These smoking parameters may have simulated the way in which people used to smoke the high-yield cigarettes; however, they no longer reflect the parameters applicable to contemporary smokers, and especially nor those applicable to the smoking of low- and ultra-low-yield filter cigarettes. Recent smoking assays have demonstrated that most smokers of cigarettes with low nicotine yield take between 2 and 4 puffs per minute with volumes up to 55 mi to satisfy their demands for nicotine. The overview also discusses further needs for reducing the toxicity and carcinogenicity of cigarette smoke. From a public health perspective, nicotine in the smoke needs to be lowered to a level at which there is no induction of dependence on tobacco," (pg 307).
external image Pdf.jpgHolden, L. M. (2005). "Complex adaptive systems: concept analysis." Journal Of Advanced Nursing 52(6): 651-657.
Abstract:
"Aim. The aim of this paper is to explicate the concept of complex adaptive systems through an analysis that provides a description, antecedents, consequences, and a model case from the nursing and health care literature.
Background. Life is more than atoms and molecules - it is patterns of organization. Complexity science is the latest generation of systems thinking that investigates patterns and has emerged from the exploration of the subatomic world and quantum physics. A key component of complexity science is the concept of complex adaptive systems, and active research is found in many disciplines - from biology to economics to health care. However, the research and literature related to these appealing topics have generated confusion. A thorough explication of complex adaptive systems is needed.
Methods. A modified application of the methods recommended by Walker and Avant for concept analysis was used. Findings. A complex adaptive system is a collection of individual agents with freedom to act in ways that are not always totally predictable and whose actions are interconnected. Examples include a colony of termites, the financial market, and a surgical team. It is often referred to as chaos theory, but the two are not the same. Chaos theory is actually a subset of complexity science. Complexity science offers a powerful new approach - beyond merely looking at clinical processes and the skills of healthcare professionals.
Conclusion. The use of complex adaptive systems as a framework is increasing for a wide range of scientific applications, including nursing and healthcare management research. When nursing and other healthcare managers focus on increasing connections, diversity, and interactions they increase information flow and promote creative adaptation referred to as self-organization. Complexity science builds on the rich tradition in nursing that views patients and nursing care from a systems perspective," (pg 651).
external image Pdf.jpgHoltzhauer, F. J., J. C. Nelson, et al. (2001). "Improving Performance at the Local Level: Implementing a Public Health Learning Workforce Intervention." Journal of Public Health Management & Practice 7(4): 96-104.
Abstract:
"In an effort to continually improve performance of the essential public health services with community partners, the diverse public health workforce in a major metropolitan area engaged in an organizational learning process. Core public health organizational competencies, identified in a multi-year collaborative applied research initiative, provided the curricula content for the public health learning experience. All members (about 600) of the Columbus and Franklin County (Ohio) Health Departments participated in four one-half day small group, highly interactive modules conducted during a 2-year period. The purpose of this article is to describe the design and implementation of this workforce intervention, the lessons learned, and implications for developing organizational capacity and improved performance," (pg 96)
external image Pdf.jpgHomer, J., J. Ritchie-Dunham, et al. (2000). "Toward a dynamic theory of antibiotic resistance." System Dynamics Review 16(4): 287-319.
Abstract:
"Many common bacterial pathogens have become increasingly resistant to the antibiotics used to treat them. The evidence suggests that the essential cause of the problem is the extensive and often inappropriate use of antibiotics, a practice that encourages the proliferation of resistant mutant strains of bacteria while suppressing the susceptible strains. However, it is not clear to what extent antibiotic use must be reduced to avoid or reverse an epidemic of antibiotic resistance, and how early the interventions must be made to be effective. To investigate these questions, we have developed a small system dynamics model that portrays changes over a period of years to three subsets of a bacterial population-antibiotic-susceptible, intermediately resistant, and highly resistant. The details and continuing refinement of this model are based on a case study of Streptococcus pneumoniae, a leading cause of illness and death worldwide. The paper presents the model's structure and behavior and identifies open questions for future work," (pg 287).
Notes:
This paper was cited in Sterman, J. D. (2006). "Learning from Evidence in a Complex World." American Journal of Public Health 96(3): 1-10 PAGE NUMBERS NOT FINALIZED.
external image Pdf.jpgexternal image 20px-Ajphlogo.jpgHomer, J. B. and G. B. Hirsch (2006). "System Dynamics Modeling for Public Health: Background and Opportunities." American Journal of Public Health 96(3): 19-25 PAGE NUMBERS NOT FINALIZED.
Abstract:
"The systems modeling methodology of system dynamics is well suited to address the dynamic complexity that characterizes many public health issues. The system dynamics approach involves the development of computer simulation models that portray processes of accumulation and feedback and that may be tested systematically to find effective policies for overcoming policy resistance.
System dynamics modeling of chronic disease prevention should seek to incorporate all the basic elements of a modern ecological approach, including disease outcomes, health and risk behaviors, environmental factors, and healthrelated resources and delivery systems. System dynamics shows promise as a means of modeling multiple interacting diseases and risks, the interaction of delivery systems and diseased populations, and matters of national and state policy," (pg 19 PAGE NUMBERS NOT FINALIZED).
Notes:
This is part of the AJPH Special Issue on Systems Thinking.
external image Pdf.jpgHonore, P. A., E. J. Simoes, et al. (2004). "Applying Principles for Outcomes-Based Contracting in a Public Health Program." Journal of Public Health Management & Practice 10(5): 451-457.
Abstract:
"A field of study for public health finance has never been adequately developed. Consequently, very little is known about the relationships, types, and amount of finances that fund the public health system in America. This research was undertaken to build on the sparse knowledge of public health finance by examining the value of performance measurement systems to financial analysis. A correlational study was conducted to examine the associations between public health system performance of the 10 essential public health services and funding patterns of 50 local health departments in a large state. The specific objectives were to investigate if different levels and types of revenues, expenditures, and other demographic variables in a jurisdiction are correlated to performance. Pearson correlation analysis did not conclusively show strong associations; however, statistically significant positive associations primarily between higher levels of performance and jurisdiction taxes per capita were found," (pg 451).
external image Pdf.jpgHorbar, J. D., J. H. Carpenter, et al. (2004). "Collaborative quality improvement to promote evidence based surfactant for preterm infants: a cluster randomised trial." BMJ 329(7473): 1004-1010.
Abstract:
"Objective To test a multifaceted collaborative quality improvement intervention designed to promote evidence based surfactant treatment for preterm infants of 23-29 weeks' gestation.
Design Cluster randomised controlled trial Setting and participants 114 neonatal intensive care units (which treated 6039 infants of 23-29 weeks gestation born in 2001).
Main outcome measures Process of care measures: proportion of infants receiving first surfactant in the delivery room, proportion receiving first surfactant more than two hours after birth, and median time from birth to first dose of surfactant.
Clinical outcomes: death before discharge home, and pneumothorax.
Intervention Multifaceted collaborative quality improvement advice including audit and feedback, evidence reviews, an interactive training workshop, and ongoing faculty support via conference calls and email.
Results Compared with those in control hospitals, infants in intervention hospitals were more likely to receive surfactant in the delivery room (adjusted odds ratio 5.38 (95% confidence interval 2.84 to 10.20)), were less likely to receive the first dose more than two hours after birth (adjusted odds ratio 0.35 (0.24 to 0.53)), and received the first dose of surfactant sooner after birth (median of 21 minutes v 78 minutes, P < 0.001). The intervention effect on timing of surfactant was larger for infants born in the participating hospitals than for infants transferred to a participating hospital after birth. There were no significant differences in mortality or pneumothorax.
Conclusion A multifaceted intervention including audit and feedback, evidence reviews, quality improvement training, and follow up support changed the behaviour of health professionals and promoted evidence based practice," (pg 1004).
external image Pdf.jpgHorbar, J. D., P. E. Plsek, et al. (2003). "NIC/Q 2000: Establishing habits for improvement in neonatal intensive care units." Pediatrics 111(4): 397-410.
Abstract:
"Objectives. The Vermont Oxford Network is a group of health professionals who are committed to improving the quality and safety of medical care for newborn infants and their families. Neonatal Intensive Care Quality Improvement Collaborative Year 2000 (NIC/Q 2000) was the second in a series of multiorganization improvement collaboratives organized and administered by the Vermont Oxford Network. The objective of this collaborative was to make measurable improvements in the quality and safety of neonatal intensive care, develop new tools and resources for improvement specific to the neonatal intensive care unit setting, evaluate improvement progress, and disseminate the learning.
Methods. The 34 centers that participated in NIC/Q 2000 learned and applied 4 key habits for improvement: the habit for change, the habit for evidence-based practice, the habit for systems thinking, and the habit for collaborative learning. A plan-do-study-act method of rapid-cycle improvement was an integral part of the habit for change. Multidisciplinary teams from the participating centers worked closely together in face-to-face meetings, conference calls, and dedicated e-mail listservs under the guidance of trained facilitators and expert faculty. Focus groups formed around specific improvement topics used critical appraisal of the published literature, detailed process analysis, benchmarking, and roundrobin site visits to identify potentially better practices (PBPs).
Results. The focus groups developed a total of 51 PBPs. Each focus group has developed a "resource kit" summarizing its work. Many of these PBPs have been tested and implemented at the participating centers using rapid-cycle improvement. The PBPs and descriptions of individual center PDSA cycles are available to participants on NICQ.org, the dedicated Internet site for the collaborative.
Conclusions. Collaborative quality improvement based on the 4 key habits can assist multidisciplinary neonatal intensive care unit teams in identifying, testing, and successfully implementing change," (pg 397).
external image Pdf.jpgHuz, S., D. F. Andersen, et al. (1997). "A framework for evaluating systems thinking interventions: An experimental approach to mental health system change." System Dynamics Review 13(2): 149-169.
Abstract:
"Researchers from the State University of New York at Albany and the New York State Office of Mental Health have been engaged in testing an experimental approach to evaluating systems thinking interventions. This research calls for a similar systems thinking intervention to be repeated in four counties with four control counties also selected and observed via pre- and post-intervention measures. The overall context of the project focuses on integration of mental health and vocational rehabilitation services. The experiment is designed to evaluate measurable outcomes, including shifts in goal structures and change strategies of the management team, shifts in relative alignment of the management team as a whole, perceived success of the intervention, and changes in systems and procedures necessary to improve client services. This article presents a framework for evaluating systems thinking interventions as well as preliminary findings from the pilot test," (pg 149).

[edit]Authors: I

external image Pdf.jpgIllich, I. (1995). "Death undefeated." BMJ 311(7021): 1652-1653.
external image Pdf.jpgexternal image Www.jpgInstitute for Healthcare Improvement. 2005. About Us. Accessed October 3, 2005. in. www.ihi.org/ihi
Notes & Quotes:
"IHI is a reliable source of energy, knowledge, and support for a never-ending campaign to improve health care worldwide. The Institute helps accelerate change in health care by cultivating promising concepts for improving patient care and turning those ideas into action... We will improve the lives of patients, the health of communities, and the joy of the health care workforce. We will accelerate the measurable and continual progress of health care systems throughout the world toward:
  • Safety
  • Effectiveness
  • Patient-Centeredness
  • Timeliness
  • Efficiency
  • Equity
We will be a recognized and generous leader, a trustworthy partner, and the first place to turn for expertise, help, and encouragement for anyone, anywhere who wants to change health care profoundly for the better," (about us). Access the website here
external image Www.jpgexternal image Book.jpgexternal image Cabreralib.jpgInstitute of Medicine (2001). Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC, National Academy Press. Executive summary: File
Crossing the Quality Chasm Notes & Quotes
external image Pdf.jpgexternal image Www.jpgInternational Healthy Cities Foundation. 1997-2002. Overview and History. Accessed October 3, 2005 in. www.healthycities.org/
Notes:
This is the website for an organization affiliated with the WHO that promotes healthy city planning. Excerpted from the website: "The mission of the IHCF is to facilitate linkages among people, issues and resources in order to support the development of Healthy Cities initiatives. The IHCF will both link people, organizations, and networks currently working to advance Healthy City goals and provide linkages with others dealing with significant and related areas of work. All aspects of health planning, promotion and prevention activities are needed for a balanced health system and will be included. All issues of community organization and governance will be involved. And finally, special interests, often regarded as separate areas of concern will be integrated into the ongoing work and goals of the IHCF."Access the website here
external image Pdf.jpgIntrocaso, D. M. (2005). "The Value of Social Network Analysis in Health Care Delivery." New Directions for Evaluation 107: 95-98.
Abstract:
"This chapter frames the use of social network analysis in understanding knowledge diffusion and discusses current uses of this methodology within a government agency," (pg 95).
external image Pdf.jpgIvanov, P. C., L. A. N. Amaral, et al. (1999). "Multifractality in human heartbeat dynamics." Nature 399(6735): 461-465.
Abstract excerpted from above:
"There is evidence that physiological signals under healthy conditions may have a fractal temporal structure(1). Here we investigate the possibility that time series generated by certain physiological control systems may be members of a special class of complex processes, termed multifractal, which require a large number of exponents to characterize their scaling properties(2-6). We report on evidence for multifractality in a biological dynamical system, the healthy human heartbeat, and show that the multifractal character and nonlinear properties of the healthy heart rate are encoded in the Fourier phases. We uncover a loss of multifractality for a life-threatening condition, congestive heart failure."
Notes:
From the Plexus Institute: "The article by a world-wide team of scientists in the internationally respected science journal presents evidence of the fractal nature of healthy human heart rate dynamics. This is contrasted with the discovery of the loss of fractality in the life-threatening condition, congestive heart failure. The following statement is presented in the closing paragraph of the article - "the detection of robust multi-fractal scaling in the heart-rate dynamics is of interest because it indicates that the control mechanisms regulating the heartbeat might interact as part of a coupled cascade of feedback loops in a system operating far from equilibrium.""

[edit]Authors: J

external image Pdf.jpgexternal image 20px-Ajphlogo.jpgJames, S. A., A. Fowler-Brown, et al. (2006). "Life-course Socioeconomic Position and Obesity in African American Women: The Pitt County Study." American Journal of Public Health 96(3): PAGE NUMBERS NOT FINALIZED.
Abstract:
"Objectives. We studied obesity in African American women in relationship to their socioeconomic position (SEP) in childhood and adulthood.
Methods. On the basis of parents' occupation, we classified 679 women in the Pitt County (North Carolina) Study into low and high childhood SEP. Women's education, occupation, employment status, and home ownership were used to classify them into low and high adulthood SEP. Four life-course SEP categories resulted: low childhood/low adulthood, low childhood/high adulthood, high childhood/low adulthood, and high childhood/high adulthood.
Results. The odds of obesity were twice as high among women from low versus high childhood SEP backgrounds, and 25% higher among women of low versus high adulthood SEP. Compared to that in women of high SEP in both childhood and adulthood, the odds of obesity doubled for low/low SEP women, were 55% higher for low/high SEP women, and were comparable for high/low SEP women.
Conclusions. Socioeconomic deprivation in childhood was a strong predictor of adulthood obesity in this community sample of African American women. Findings are consistent with both critical period and cumulative burden models of life-course socioeconomic deprivation and long-term risk for obesity in African American women," (pg PAGE NUMBERS NOT FINALIZED).
Notes:
This is part of the AJPH Special Issue on Systems Thinking.
external image Pdf.jpgJantzen, R. and P. R. Loubeau (1999). "Risk-sharing integration efforts in the hospital sector." Health Care Management Review 24(2): 83-92.
Abstract:
"The extent of hospital involvement in integrated delivery systems (IDS) during 1996 was assessed by a national sample of 235 short-term private general hospitals. Two out of 5 hospitals were participating in networks with some financial risk sharing, and another 3rd reported membership in IDS networks without financial obligations. Managed care's presence was the only significant factor moving hospitals from a standalone status to network membership. The decision to share financial risk was influenced not only by managed care pressures, but also by the level of local hospital competition and the severity of the inpatient case mix," (pg 83).
external image Pdf.jpgexternal image 20px-Ajphlogo.jpgJoffe, M. and J. Mindell (2006). "Complex Causal Process Diagrams for Analyzing the Health Impacts of Policy Interventions." American Journal of Public Health 96(3): 40-46 PAGE NUMBERS NOT FINALIZED.
Abstract:
"Causal diagrams are rigorous tools for controlling confounding. They also can be used to describe complex causal systems, which is done routinely in communicable disease epidemiology. The use of change diagrams has advantages over static diagrams, because change diagrams are more tractable, relate better to interventions, and have clearer interpretations.
Causal diagrams are a useful basis for modeling. They make assumptions explicit, provide a framework for analysis, generate testable predictions, explore the effects of interventions, and identify data gaps. Causal diagrams can be used to integrate different types of information and to facilitate communication both between public health experts and with experts in other fields. Causal diagrams allow the use of instrumental variables, which can help control confounding and reverse causation," (pg 40 PAGE NUMBERS NOT FINALIZED).
Notes:
This is part of the AJPH Special Issue on Systems Thinking.
external image Pdf.jpgexternal image 20px-Ajphlogo.jpgJohn, W. S. (1998). "Just what do we mean by community? Conceptualizations from the field." Health & Social Care In The Community 6(2): 63-70.
Abstract:
"The community is often part of the 'taken-for-granted' or assumed world of the community nurse. Community health nursing literature has a range of theoretical explanations of what the community is. A conception of 'community as client' is also a basic notion in the community health nursing literature. However, it is less clear whether these theoretical perspectives are useful, or which theoretical concepts assume the most importance in practice. This grounded theory research explores how 17 excellent practising community health nurses from a variety of community practice settings conceptualized and operationalized their notion of the community. In-depth interviews were carried out and fully transcribed. Data were analysed to identify participants' definitions of the community and how they described their interactions with the communities they themselves worked in and with. Participants understood the community at a global, abstract level in terms of systems thinking. However, the communities with which they worked were described in terms of geography, provision of resources, as a network and consisting of target groups. Data were also examined for examples of participants describing the communities they worked with as a 'client' or an entity. While there were instances where this occurred, this was by no means universal. The most important contextual factor in determining a community as a 'client' was found to be where community members were connected. Where a population was not connected, participants focused their attention on the next largest connected unit, usually a group or family," (pg 63).
external image Pdf.jpgexternal image 20px-Ajphlogo.jpgJones, A. P., J. B. Homer, et al. (2006). "Understanding Diabetes Population Dynamics Through Simulation Modeling and Experimentation." American Journal of Public Health 96(3): 55-61 PAGE NUMBERS NOT FINALIZED.
Abstract:
"Health planners in the Division of Diabetes Translation and others from the National Center for Chronic Disease Prevention and Health Promotion of the Centers for Disease Control and Prevention used system dynamics simulation modeling to gain a better understanding of diabetes population dynamics and to explore implications for public health strategy. A system dynamics simulation model was developed to explain the growth of diabetes since 1980 and portray possible futures through 2050. This model was used to conduct simulated experiments involving interventions for disease management and primary prevention.
The model simulations suggested characteristic dynamics of the diabetes population, including unintended increases in diabetes or prediabetes prevalence due to diabetes control or prediabetes management, the inability of diabetes control efforts alone to reduce diabetes-related deaths in the long term, and significant delays between primary prevention efforts and downstream improvements in diabetes outcomes. Simulated diabetes interventions often produce impacts that look different in the short term than they do in the long term. For example, intervention strategies that focus entirely on diabetes management may quickly reduce diabetes-related complications and deaths but are less effective in the long term than strategies that balance disease management with primary prevention.
System dynamics modeling can help diabetes planners identify more effective public health strategies and set appropriate goals," (pg 55 PAGE NUMBERS NOT FINALIZED).
Notes:
This is part of the AJPH Special Issue on Systems Thinking.
external image Pdf.jpgJones, M. L. H., S. Day, et al. (1999). "Implementation of a clinical pathway system in maternal newborn care: A comprehensive documentation system for outcomes management." Journal Of Perinatal & Neonatal Nursing 13(3): 1-20.
Abstract:
"This article describes the design, implementation, and evaluation of an interdisciplinary clinical pathway system for maternal newborn care in a perinatal regional referral institution. Core issues in the design of this system are addressed to promote outcomes management and ongoing performance improvement. A discussion of the implementation follows, illustrating the lessons learned, changes made, and associated evaluation. This clinical pathway system has improved communication and collaboration among all disciplines, enhanced the discharge coordination process, and established protocols available to all members of the health care team," (pg 1).

[edit]Authors: K

external image Pdf.jpgKelley, M. A. and J. M. Tucci (2001). "Bridging the quality chasm." BMJ 323(7304): 61-62.
external image Pdf.jpgKennedy, V. C. and F. I. Moore (2001). "A Systems Approach to Public Health Workforce Development." Journal of Public Health Management & Practice 7(4): 17-22.
Abstract:
"During the 1990s, several distinct but interrelated efforts to strengthen the public health infrastructure were launched. Defining public health work in terms of core functions and essential services, these efforts focused on the competence of the workforce and the performance of public health agencies. The systems approach offered here highlights the relationships and interdependencies among these three components of public health practice: (1) the work, (2) the worker, and (3) the work setting. The model suggests that advances in public health workforce development may require major public health organizational development efforts," (pg 17).
Notes:
This article is cited in Mays, G. P., M. C. McHugh, et al. (2006). "Institutional and Economic Determinants of Public Health System Performance." American Journal of Public Health 96(3): 1-9 PAGE NUMBERS NOT FINALIZED.
external image Pdf.jpgKitson, A. (2002). "Recognising relationships: reflections on evidence-based practice." Nursing Inquiry 9(3): 179-186.
Abstract:
"This paper argues for a broadening of the way evidence is developed and used in health-care. It contends that the current political and policy imperatives and the evidence-based practice movement are in direct tension with the other major ideological movements that promote patient-centred healthcare services. Nursing is affected by this tension because it is more naturally focused on relationships with clients to achieve health outcomes. The unresolved and mounting tension could be alleviated by embracing a broader definition of what counts as evidence and by focusing more on patient-centred healthcare methodologies and acknowledging the interdependency of distinct ways of generating new knowledge. A number of case studies are used to illustrate how research focusing on patient perspectives and nurses' response to patient experiences can improve the evidence base for nursing," (pg 179).
external image Pdf.jpgKnight, E. A., F. D. Scutchfield, et al. (2004). "Implementing the National Local Public Health System Performance Assessment: Evaluation of a Readiness Process in Kentucky." Journal of Public Health Management & Practice 10(3): 216-224.
Abstract:
"The objectives of the study described in this article were to test training and resource materials for preparing Kentucky public health agency staff to lead the National Local Public Health System Performance Assessment and to identify barriers encountered in implementation. Readiness supports provided to five Kentucky district and county health departments that led the system assessment process in 12 counties were evaluated using training pre- and posttests, performance assessment posttests, observations, and interviews. The training and materials provided in this study appeared to be the minimum needed for these Kentucky health departments. Training sequences need to allow time for independent study of assessment processes, and training in using and interpreting the assessment instrument should be included. Partner orientation materials targeted for nonpublic health partners would be useful. In Kentucky, barriers to completing the assessment included questions about its purpose and benefits and the lack of a self-identified local public health system. Formal training of health department staff, committed leadership, and adequate personnel resources can help overcome these barriers. The health departments that brought together system partners for the performance assessment considered it a valuable community-building educational event," (pg 216).
external image Pdf.jpgKrygiel, A. J. (1999). Behind the wizard's curtain: An integration environment for a system of systems. Washington, DC, National Defense University.
Notes:
This is a 274-page-long book about the use of systems in national defense-related contexts. It does not appear to be related to public health at all.

[edit]Authors: L

external image Pdf.jpgLammers, J. C. and V. Pandita (1997). "Applying systems thinking to public health leadership." Journal of Public Health Management & Practice 3(4): 39-49.
Abstract:
"A review of the public health literature reveals a dearth of research that focuses on applying management theories to public health work. This article applies systems thinking to public health practice. A sample of health officers and health department executives were asked to identify the key attributes of the most important problem they faced in their work in the last week. Problems involved an average of four other organizations, and most required two to six months to be resolved. Most decisions were expected to result in new problems. Several cases are presented as examples. Implications for future research, practice, and training are discussed," (pg 39).
external image Pdf.jpgLandau, R. (2000). "Ethical dilemmas in general hospitals: Social workers' contribution to ethical decision-making." Social Work In Health Care 32(2): 75-92.
Abstract:
"Thirty-two hospital social workers, fourteen of them directors of social work services and eighteen direct practitioners, were interviewed about their perception of the factors Influencing social workers' contribution to the resolution of ethical dilemmas in general hospitals in Israel. Findings revealed that while ethical decision-making in hospitals is an interdisciplinary process, social workers' contribution to the process is affected by rivalry between social workers and other members of the health team, personality differences, type of ward and the nature of the ethical dilemma. participants of the study had quite a clear perception of their role and of the unique knowledge-base social work can offer, including knowledge of the individual and family life course, understanding and skills in coping with diseases, and systems thinking. In order to increase their influence in ethical decision-making, the hospital social workers felt they must put more effort into developing their relationships with the other professionals involved in ethical decision-making both by making themselves more indispensable and by making their contribution explicit through greater documentation of their activities. The findings also implied that in order to gain more power and tie accepted as equal partners in multidisciplinary teams, hospital social workers should improve their communication skills when interacting with representatives of other health care professions," (pg 75).
external image Pdf.jpgLeape, L. L. and D. M. Berwick (2000). "Safe health care: are we up to it?" BMJ 320(7237): 725-726.
external image Pdf.jpgexternal image 20px-Ajphlogo.jpgLeischow, S. J. and B. Milstein (2006). "Systems Thinking and Modeling for Public Health Practice." American Journal of Public Health 94(6): 403-405 PAGE NUMBERS NOT FINALIZED.
Notes:
This is part of the AJPH Special Issue on Systems Thinking.
external image Pdf.jpgexternal image 20px-Ajphlogo.jpgLemon, S. C., J. G. Zapka, et al. (2006). "Challenges to Research in Urban Community Health Centers." American Journal of Public Health 96(3): PAGE NUMBERS NOT FINALIZED.
Abstract:
"Community health centers (CHCs) are important settings for research aimed at reducing health disparities. However, CHCs pose many challenges to research at patient, provider, and system levels. We summarized lessons learned from a multimethod, formative study to develop intervention strategies for improving colorectal cancer screening in CHCs, and make recommendations for future research. The call for research in "real world" settings such as CHCs must be matched with greater understanding of the challenges, as well as the resources to meet those challenges," (pg PAGE NUMBERS NOT FINALIZED).
Notes:
This is part of the AJPH Special Issue on Systems Thinking.
external image Pdf.jpgexternal image 20px-Ajphlogo.jpgLenaway, D., P. Halverson, et al. (2006). "Public Health Systems Research: Setting a National Agenda." American Journal of Public Health 96(3): PAGE NUMBERS NOT FINALIZED.
Abstract:
"The Institute of Medicine has recommended that policy decisions about improvement of national public health systems be guided by sound scientific evidence. However, to date there is no national research agenda to help guide public health systems. The Centers for Disease Control and Prevention was called upon to lead a collaborative consensus-based process to define key research questions and establish a framework to create opportunities to better coordinate, leverage, and identify public health resources, which are increasingly scarce. The public health systems research agenda that emerged from this process has 14 overarching priority research themes. This national agenda should stimulate and guide research to meet the urgent need to improve the nation's public health systems," (pg PAGE NUMBERS NOT FINALIZED).
Notes:
This is part of the AJPH Special Issue on Systems Thinking.
external image Pdf.jpgLenihan, P. (2005). "The public health system: An idea whose time has come." Journal of Public Health Management & Practice 11(2): 165-167.
Abstract:
"Shares thoughts about the importance of the public health system as a fundamental concept to public health thinking. Notion behind the public health system; Policies for strengthening the local public health practice; Consideration of the implications for the organization and structure of local public health agencies," (pg 165).
external image Pdf.jpgLenihan, P. (2005). "MAPP and the Evolution of Planning in Public Health Practice." Journal of Public Health Management & Practice 11(5): 381-388.
Abstract:
"Mobilizing for Action through Planning and Partnerships, the most recent planning tool in public health practice, is built upon a long history of planning by local public health agencies (LPHAs). Planning by LPHAs has evolved over half a century from the earliest problem/program-focused planning, through more comprehensive approaches like the Planned Approach to Community Health (PATCH) and the Assessment Protocol for Excellence in Public Health (APEXPH) to strategic planning of today. While LPHAs were not notably participants in the federally sponsored health planning of the 1960s and 1970s, this planning left a legacy in public health. Mobilizing for Action through Planning and Partnerships introduces strategic thinking and a systems orientation into public health planning that builds upon this legacy," (pg 381).
external image Pdf.jpgexternal image 20px-Ajphlogo.jpgLevy, D. T., J. E. Bauer, et al. (2006). "Simulation Modeling and Tobacco Control: Creating More Robust Public Health Policies." American Journal of Public Health 96(3): 61-65 PAGE NUMBERS NOT FINALIZED.
Abstract:
"Although previous empirical studies have shown that tobacco control policies are effective at reducing smoking rates, such studies have proven of limited effectiveness in distinguishing how the effect of policies depend on the other policies in place, the length of adjustment period, the way the policy is implemented, and the demographic groups considered.
An alternative and complementary approach to purely statistical equations is simulation models. We describe the SimSmoke simulation model and how we used it to assess tobacco control policy in a specific case study. Simulation models are not only useful for policy prediction and planning but also may help to broaden our understanding of the role of different public health policies within a complex, dynamic social system," (pg 61 PAGE NUMBERS NOT FINALIZED).
Notes:
This is part of the AJPH Special Issue on Systems Thinking.
external image Pdf.jpgLindberg, C., A. Herzog, et al. (1998). "Life at the Edge of Chaos - Health Care Applications of Complexity Science." The Physician Executive(January-February): 6-20.
Abstract:
"The authors explore complexity science, a relatively new field of inquiry, which holds for both clinicians and health care leaders the real possibility of stimulating fresh insights and approaches to health and medical care-both its provision and its organization. Two case studies are presented to illustrate how complexity theory can provide health care leaders with a new perspective on how to address the myriad challenges they confront daily: (1) a patient with dissociative identity disorder; and (2) a physician task group charged to advise on hospital medical staff reorganization and governance. These case studies help clinicians and leaders of health care organizations understand how complexity: (1) may be relevant, even helpful, as they consider difficult challenges in both patient and organizational management; and (2) might emerge as a synthesizing force as they face the extraordinarily complicated task of jointly creating integrated health care systems. A resource section is provided for those who may wish to further pursue the topic," (pg 6).
Notes:
From the Plexus Institute: "This article seeks to introduce health care practitioners to the science of complexity and show how it can be helpful in dealing with both medical and health care organizational issues."
external image 20px-Binder.jpg Lipsitz, L. A. and A. L. Goldberger (1992). "Loss Of Complexity And Aging - Potential Applications Of Fractals And Chaos Theory To Senescence." Journal Of The American Medical Association 267(13): 1806-1809.
Abstract:
"The concept of "complexity," derived from the field of nonlinear dynamics, can be adapted to measure the output of physiologic processes that generate highly variable fluctuations resembling "chaos." We review data suggesting that physiologic aging is associated with a generalized loss of such complexity in the dynamics of healthy organ system function and hypothesize that such loss of complexity leads to an impaired ability to adapt to physiologic stress. This hypothesis is supported by observations showing an age-related loss of complex variability in multiple physiologic processes including cardiovascular control, pulsatile hormone release, and electroencephalographic potentials. If further research supports this hypothesis, measures of complexity based on chaos theory and the related geometric concept of fractals may provide new ways to monitor senescence and test the efficacy of specific interventions to modify the age-related decline in adaptive capacity," (pg 1806).
Notes:
From the Plexus Institute: "New views of the aging by two leading researchers suggest that it is related to the loss of complex patterns in physiologic systems."
external image Pdf.jpgLuckett, S. and K. Grossenbacher (2003). "A critical systems intervention to improve the implementation of a district health system in KwaZulu-Natal." Systems Research And Behavioral Science 20(2): 147-162.
Abstract:
"This paper reports on a critical systems inquiry into the complexities of the implementation of a District Health System in the KwaZulu-Natal province of post-Apartheid South Africa. The inquiry process, which was governed by Checkland's Soft Systems Methodology (SSM) and followed the four-phase learning cycle developed by Kolb, produced conceptual models which enabled participant stakeholders to gain fresh perspectives on the context and, in so doing, to get the implementation process unstuck. At the theoretical/methodological level the paper contributes to the growing literature on the combination of systems methods by illustrating how conceptual models of purposeful human activity, a method intrinsic to SSM, were constructed from the participatory use of Concept Maps and Sign-graph Diagrams. We also reflect on the interrelationship between methodology/method combination and two other aspects of the intervention that we considered to be important for maintaining the systemicity of the intervention, viz., the inquiry context and boundary critique," (pg 147).

[edit]Authors: M

external image Pdf.jpgMacdonald, G. (2002). "Transformative unlearning: safety, discernment and communities of learning." Nursing Inquiry 9(3): 170-178.
Abstract:
"This paper aims to stimulate awareness about the intellectual and emotional work of 'unlearning' in knowledge workers in the emerging learning age. The importance of providing a safe space for dialogue to promote transformative learning, through building 'communities of learning', is highlighted. Unlearning is conceptualized within a transformative education paradigm, one whose primary orientation is discernment, a personal growth process involving the activities of receptivity, recognition and grieving. The author utilizes the metaphor of an unfolding spiral path to explore her experience of needing to 'unlearn' a trusted nursing practice prior to 'learning' new best caring practices related to infant sleep positions. Macro and micro approaches to facilitating unlearning in organizations, in learners and in nurses are suggested," (pg 170).
external image Pdf.jpgMargolis, P. A., C. M. Lannon, et al. (2004). "Practice based education to improve delivery systems for prevention in primary care: randomised trial." BMJ 328(7436): 388-393.
Abstract:
"Objective To examine the effectiveness of an intervention that combined continuing medical education with process improvement methods to implement "office systems" to improve the delivery of preventive care to children.
Design Randomised trial in primary care practices.
Setting Private paediatric and family practices in two areas of North Carolina.
Participants Random sample of 44 practices allocated to intervention and control groups. >br>Intervention Practice based continuing medical education in which project staff coached practice staff in reviewing performance and identifying, testing, and implementing new care processes (such as chart screening) to improve delivery of preventive care.
Main outcome measure Change over time in the proportion of children aged 24-30 months who received age appropriate care for four preventive services (immunisations, and screening for tuberculosis, anaemia, and lead).
Results The proportion of children per practice with age appropriate delivery of all four preventive services changed, after a one year period of implementation, from 7% to 34% in intervention practices and from 9% to 10% in control practices. After adjustment for baseline differences in the groups, the change in the prevalence of all four services between the beginning and the end of the study was 4.6-fold greater (95% confidence interval 1.6 to 13.2) in intervention practices. Thirty months after baseline, the proportion of children who were up to date with preventive services was higher in intervention than in control practices; results for screening for tuberculosis (54% v 32%), lead (68% v 30%), and anaemia (79% v 71%) were statistically significant (P < 0.05).
Conclusion Continuing education combined with process improvement methods is effective in increasing rates of delivery of preventive care to children," (pg 388).
external image Pdf.jpgMayer, J. P. (2003). "Are the Public Health Workforce Competencies Predictive of Essential Service Performance? A Test at a Large Metropolitan Local Health Department." Journal of Public Health Management & Practice 9(3): 208-213.
Abstract:
"Since many training initiatives employ the core public health workforce competencies as objectives, it is important to demonstrate an association between competency and essential service job performance. A crosssectional survey of 420 employees of a local health department was conducted in 1999, with a response rate of 76 percent. Each of ten essential service performance measures was regressed on four core competency measures, controlling for employee experience and education. The competencies explained 2 percent to 20 percent of the variance in essential service performance. While offering support for the core competencies as a foundation for training program content, the results also make clear the large role that other individual, organizational, and community influences may have. Explaining additional variance in performance will require incorporating these variables into future studies," (pg 208).
external image Pdf.jpgexternal image 20px-Ajphlogo.jpgMays, G. P., M. C. McHugh, et al. (2006). "Institutional and Economic Determinants of Public Health System Performance." American Journal of Public Health 96(3): 1-9 PAGE NUMBERS NOT FINALIZED.
Abstract:
"Objectives. Although a growing body of evidence demonstrates that availability and quality of essential public health services vary widely across communities, relatively little is known about the factors that give rise to these variations. We examined the association of institutional, financial, and community characteristics of local public health delivery systems and the performance of essential services.
Methods. Performance measures were collected from local public health systems in 7 states and combined with secondary data sources. Multivariate, linear, and nonlinear regression models were used to estimate associations between system characteristics and the performance of essential services.
Results. Performance varied significantly with the size, financial resources, and organizational structure of local public health systems, with some public health services appearing more sensitive to these characteristics than others. Staffing levels and community characteristics also appeared to be related to the performance of selected services.
Conclusions. Reconfiguring the organization and financing of public health systems in some communities--such as through consolidation and enhanced intergovernmental coordination--may hold promise for improving the performance of essential services," (pg 1 PAGE NUMBERS NOT FINALIZED).
Notes:
This is part of the AJPH Special Issue on Systems Thinking.
external image Pdf.jpgMcCubbin, M. and D. Cohen (1999). "A systemic and value-based approach to strategic reform of the mental health system." Health Care Analysis 7(1): 57-77.
Abstract:
"Most writers now recognize that mental health policy and the mental health system are extremely resistant to real changes that reflect genuine biopsychosocial paradigms of mental disorder. Writers bemoaning the intransigence of the mental health system tend to focus on a small analytical level, only to find themselves mired in the rationalities of the existing system. Problems are acknowledged to be system-wide, yet few writers have used a method of analysis appropriate for systemic problems. Drawing upon the General System Theory (GST) analytical perspective, this article advances a systematic approach to understand the mental health system and to facilitate the development of reform strategies that recognize the system's complexity and changing nature. The article first discusses the failure of major reform efforts in the mental health system and the limitations of mainstream analysis of mental health politics and policies with respect to the objectives of analysis and reform. This article describes how systems thinking has thus far influenced the study of the mental health policy and politics system, and argues that a systemic perspective is profitable for reconceiving the mental health system, enabling a fresh basis for the development of reform strategies. The mental health system should be seen as a social system influenced by larger political and economic dimensions, not just as a 'delivery system' scientifically constructed by neutral experts. Furthermore, the policy planning process should be viewed as part and parcel of a mental health system modeled as complex and dynamic. The systemic perspective outlined here should help both to clarify the value-based objectives that we hold for the system and, consequently, to plan for the strategic reforms that have so far eluded us," (pg 57).
external image Pdf.jpgMcDaniel, R. and D. J. Driebe (2001). Complexity Science and health care management. Advances in health care management. J. Blair, M. Fottler and G. Savage, Elsevier Science Ltd. 2: 11-36.
Notes:
From the Plexus Institute: "A professor of management from the University of Texas at Austin and a physicist from the Ilya Prigogine Center for Studies in Statistical Mechanics and Complex Systems team up to provide an insightful and comprehensive overview of complexity science and its implications for leadership in health care organizations."
external image Pdf.jpgexternal image 20px-Ajphlogo.jpgMcLeroy, K. (2006). "Thinking of Systems." American Journal of Public Health 96(3): 1 PAGE NUMBERS NOT FINALIZED.
Notes:
This is part of the AJPH Special Issue on Systems Thinking.
external image Pdf.jpgexternal image 20px-Ajphlogo.jpgMidgley, G. (2006). "Systemic Intervention for Public Health." American Journal of Public Health 96(3): 33-39 PAGE NUMBERS NOT FINALIZED.
Abstract:
"Many calls have been made for a systems approach to public health. My response is to offer a methodology for systemic intervention that (1) emphasizes the need to explore stakeholder values and boundaries for analysis, (2) challenges marginalization, and (3) draws upon a wide range of methods (from the systems literature and beyond) to create a flexible and responsive systems practice.
I present and discuss several well-tested methods with a view to identifying their potential for supporting systemic intervention for public health," (pg 33 PAGE NUMBERS NOT FINALIZED).
Notes:
This is part of the AJPH Special Issue on Systems Thinking.
external image Pdf.jpgMidgley, G. and A. Milne (1995). "Creating Employment Opportunities For People With Mental-Health Problems - A Feasibility Study For New Initiatives." Journal Of The Operational Research Society 46(1): 35-42.
Abstract:
"This paper describes a feasibility study for the development of a network of employment services for people with mental health problems (and others) who are unemployed. It highlights the problems of using debate-orientated, soft OR methods when there are difficulties of open communication between different interest groups. In this case, the interest groups were clients and professionals in the mental health system. To bypass these difficulties, a series of confidential interviews was conducted with stakeholders. The issue of who was to be interviewed was resolved through a rolling programme of recommendations, where each interviewee recommended others until most of the people being recommended were people who had already been seen. This approach allowed for the involvement of many people and agencies who the researchers did not initially suspect might be stakeholders. Having conducted the interviews, the researchers then produced a design in the form of an 'expert' report. Although they had serious reservations about taking such an approach instead of simply supporting the expertise of already identified stakeholders, it turned out, upon reflection, that they had made the right decision. The 'expert' approach allowed the views of service users to be taken into account. Also, the rolling programme of recommendations used to determine who should be interviewed actually uncovered hitherto 'hidden' stakeholders who were crucial to the success or failure of the whole project," (pg 35).
external image Pdf.jpgMiller, W. L., B. F. Crabtree, et al. (1998). "Understanding change in primary care practice using complexity theory." Journal Of Family Practice 46(5): 369-376.
Abstract:
"BACKGROUND. Understanding the organization of primary care practices is essential for implementing changes related to delivery of preventive or other health care services. A theoretical model derived from complexity theory provides a framework for understanding practice change.
METHODS. Data were reviewed from brief participant observation fieldnotes collected in the 84 practices of the Direct Observation of Primary Care (DOPC) study and in 27 practices from three similar studies investigating preventive services delivery. These data were synthesized with information from an extensive search of the social science, nursing, and health services literature concerning practice organization, and of the literature on complexity theory from the fields of mathematics, physics, biology, management, medicine, and family systems, to create a complexity model of primary care practice.
RESULTS. Primary care practices are understood as complex adaptive systems consisting of agents, such as patients, office staff, and physicians, who enact internal models of income generation, patient care, and organizational operations. These internal models interact dynamically to create each unique practice. The particular shape of each practice is determined by its primary goals. The model suggests three strategies for promoting change in practice and practitioner behavior: joining, transforming, and learning.
CONCLUSIONS. This model has important implications for understanding change in primary care practice. Practices are much more complex than present strategies for change assume. The complexity model identifies why some strategies work in particular practices and others do not," (pg 369).
Notes:
From the Plexus Institute: "From a significant study – The Direct Observation of Primary Care – the authors suggest that practices can be better understood by viewing them as complex adaptive systems. Such a view opens up new approaches to promoting and adapting to change."
external image Pdf.jpgMilstein, B. (2004). Syndemics. Encyclopedia of Evaluation. S. Mathison. Thousand Oaks, CA, Sage Publications, Inc.: 404-405.
Notes:
This is an encyclopedia entry authored by one of the organizers of the CDC's Syndemic Prevention Network.
external image Pdf.jpgMilstein, B. and J. B. Homer (2005). Background on system dynamics simulation modeling: With a summary of major public health studies. Washington, DC, Centers for Disease Control and Prevention, Syndemics Prevention Network.
external image Pdf.jpgMoody, R. C. (2004). "Nurse Productivity Measures for the 21st Century." Health Care Management Review 29(2): 98-106.
Abstract:
"The concept and measurement of nurses' productivity ranges from traditional economic interpretation of nurses as labor costs to human capital theory interpretation of nurses as intellectual capital assets," (pg 98).
external image Pdf.jpgexternal image 20px-Ajphlogo.jpgMuellerleile, P. and B. Mullen (2006). "Sufficiency and Stability of Evidence for Public Health Interventions using Cumulative Meta-Analysis." American Journal of Public Health 96(3): PAGE NUMBERS NOT FINALIZED.
Abstract:
"We propose cumulative meta-analysis as the procedure of completing a new meta-analysis at each successive wave in a research database. Two facets of cumulative knowledge are considered: the first, sufficiency, refers to whether the meta-analytic database adequately demonstrates that a public health intervention works. The second, stability, refers to the shifts over time in the accruing evidence about whether a public health intervention works. We used a hypothetical data set to develop the indicators of sufficiency and stability,and then applied them to existing, published datasets. Our discussion centers on the implications of the use of this procedure in evaluating public health interventions," (pg PAGE NUMBERS NOT FINALIZED).
Notes:
This is part of the AJPH Special Issue on Systems Thinking.
external image Pdf.jpgMullan, F. (1998). "Linda Headrick, MD: Seeking a Common Language in Primary Care." JAMA 280(7): 655-658.
external image Pdf.jpgMurphy-Smith, M., B. Meyer, et al. (2004). "Put prevention into practice implementation model: Translating practice into theory." Journal of Public Health Management & Practice 10(2): 109-115.
Abstract:
"Put Prevention into Practice (PPIP), a national initiative promoting evidence-based clinical preventive services, was atheoretical in its approach to change. In 1994, the Texas Department of Health began demonstration projects to implement PPIP in grantee primary care sites across the state. They funded implementation and evaluation projects that resulted in eight years of experience with the process. Gathering both qualitative and quantitative data, the Texas Department of Health and the University of Texas researchers found action research essential to learning how to successfully support clinical sites in the implementation of PPIP. The researchers also found the need for on-site consultative assistance and a participatory problem-solving approach in order to produce desired systems change," (pg 109).

[edit]Authors: N

external image MIA.jpgNational Cancer Institute (in preparation). Greater than the sum: Systems thinking in tobacco control. Smoking and Tobacco Control Monograph Series. Bethesda, MD, U.S. Department of Health and Human Services, National Institutes of Health.
Notes:
This document is in press. Trochim and Cabrera are authors

[edit]Authors: O

external image Pdf.jpgexternal image 20px-Ajphlogo.jpgOng, P., M. Graham, et al. (2006). "Policy and Programmatic Importance of Spatial Alignment of Data Sources." American Journal of Public Health 96(3): 66-71 PAGE NUMBERS NOT FINALIZED.
Abstract:
"Geographic information systems have proven instrumental in assessing environmental impacts on individual and community health, but numerous methodological challenges are associated with analyses of highly localized phenomena in which spatially misaligned data are used.
In a case study based on child care facility and traffic data for the Los Angeles metropolitan area, we assessed the extent of facility misclassification with spatially unreconciled data from 3 different governmental agencies in an attempt to identify child care centers in which young children are at risk from high concentrations of toxic vehicle-exhaust pollutants. Relative to geographically corrected data, unreconciled information produced a modest bias in terms of aggregated number of facilities at risk and a substantial number of false positives and negatives," (pg 66 PAGE NUMBERS NOT FINALIZED).
Notes:
This article is part of the AJPH Special Issue on Systems Thinking.

[edit]Authors: P

external image Pdf.jpgexternal image Www.jpgPartnership for the Public's Health. 2005. About the partnership: Overview. Accessed October 3, 2005. in. http://www.partnershipph.org/col1/about/overview.html
Notes:
Excerpted from the website: (Section: Meeting the Challenge: The California Endowment and the Public Health Institute establish the Partnership for the Public’s Health) "PPH is both a place-based and people-based strategy. PPH supports strong, dynamic partnerships that bring residents, community groups and health departments together to improve community health. Resources are invested directly in communities through both community organizations and local health departments. Community residents understand what is needed to improve health and well-being because health happens at the community level, where people live. The engagement and investment of community residents in improving their own health is vital to sustaining improvement and building accountability. Public health departments are the only enduring public resource that has the mission and mandate to protect and promote the health and well-being of the public. Looking beyond medical care, public health departments are charged with preventing illness and disease before they happen."
(Section: Mission) "The mission of the Partnership for the Public’s Health is to develop effective, responsive and sustainable public health systems. Effective public health systems require a foundation of institutional infrastructure, policies, and action that address and prevent public health problems while promoting community health. Such systems build upon a broad definition of health and shared accountability among residents, community organizations, and health departments for achieving community health improvement."
(Section: Goals) To strengthen the capacity of communities to engage residents to act on their own and in partnership with health departments and other institutions to protect and improve the community's health and well-being.
To enhance the capacity of health departments to respond to community-based and community-driven priorities, partner with other institutions and provide essential functions in a manner consistent with the cultures, values and needs of communities.
To create sustainable relationships between communities and public health departments and other key institutions that promote and define mutual responsibility for community health.
To develop state and local policies and infrastructure that support and sustain local capacity to improve community health."
external image Pdf.jpgPaton, K., S. Sengupta, et al. (2005). "Settings, systems and organization development: The healthy living and working model." Health Promotion International 20(1): 81-89.
Abstract:
"This paper highlights the importance of understanding management theories to development of the settings approach to health promotion. It then provides an overview of two areas of especial pertinence: organization development and systems thinking. This is followed by the articulation of the Healthy Living and Working Model, which is proposed as a mechanism for applying the principles of the settings approach in practice within organizations. The paper concludes by pointing to future challenges in developing this Model and reiterating that facilitating improvement at the organizational level should be the defining characteristic of the settings approach to health promotion," (pg 81).
external image Pdf.jpgPennisi, E. (2000). "In nature animals that stop and start win the race." Science 288(5463): 83-85.
Notes:
This is essay has no abstract.
From the Plexus Institute: "New research shows that animals in the wild move in cycles-short bursts of movement followed by rest (intermittent locomotion). This article explores the benefits of such a variable approach to movement. This has led physiologists to speculate about the value of intermittent locomotion for humans with compromised physiological functioning. The consonance of these findings with the HeartWaves Program of Dr. Irving Dardik is noteworthy. See Dardik's "The Origin of Disease and Health, Heart Waves: The Single Solution to Heart Rate Variability and Ischemic Preconditioning")."
From Science AAAS: " For decades researchers have emphasized steady-state locomotion, bringing organisms into the laboratory and watching them move at a steady pace. But recent results are showing that animals from aquatic invertebrates to humans move like window shoppers, stopping and starting as they seek out food, mates, or shelter. Probing the fitful nature of locomotion is helping researchers understand how various organisms' bodies and biochemistry are adapted for movement, and it may even have applications in human medicine."
external image Pdf.jpgPhillips, D. F. (1999). ""New Look" Reflects Changing Style of Patient Safety Enhancement." JAMA 281(3): 217-219.
external image Pdf.jpgPinkerton, S. (2004). "Early Bar Code Ruling Helps Reduce Medication Errors." Health Care Management Review 29(2): 89.
external image Pdf.jpgPlsek, P. E. and T. Greenhalgh (2001). "Complexity science - The challenge of complexity in health care." British Medical Journal 323(7313): 625-628.
Notes:
This article has no abstract, instead, it has "summary points":
  1. The science of complex adaptive systems provides important concepts and tools for responding to the challenges of health care in the 21st century
  2. Clinical practice, organisation, information management, research, education, and professional development are interdependent and built around multiple self adjusting and interacting systems
  3. In complex systems, unpredictability and paradox are ever present, and some things will remain unknowable
  4. New conceptual frameworks that incorporate a dynamic, emergent, creative, and intuitive view of the world must replace traditional “reduce and resolve” approaches to clinical care and service organisation
external image Pdf.jpgPlsek, P. E. and T. Wilson (2001). "Complexity science - Complexity, leadership, and management in healthcare organisations." British Medical Journal 323(7315): 746-749.
Notes:
This article has no abstract, instead, it has "summary points":
  1. Management thinking has viewed the organisation as a machine and believed that considering parts in isolation, specifying changes in detail, battling resistance to change, and reducing variation will lead to better performance
  2. In contrast, complexity thinking suggests that relationships between parts are more important than the parts themselves, that minimum specifications yield more creativity than detailed plans
  3. Treating organisations as complex adaptive systems allows a new and more productive management style to emerge in health care"
external image Pdf.jpgPorter, J., J. Johnson, et al. (2002). "The Management Academy for Public Health: A New Paradigm for Public Health Management Development." Journal of Public Health Management & Practice 8(2): 66-78.
Abstract:
"Research has established a need to develop management skills among public health professionals. The University of North Carolina Chapel Hill created the Management Academy for Public Health as a pilot program for this specialized training need. This article describes why a management academy for public health managers was formed, its curriculum and instructional methods, and the evaluation findings from its first year. The program sponsors hope to effect individual and organization level change, eventually leading to improved community health. Results suggest that this innovative program gives public health professionals needed skills and improves their job performance," (pg 66).
external image Pdf.jpgPotter, M. A., G. Barron, et al. (2003). "A Model for Public Health Workforce Development Using the National Public Health Performance Standards Program." Journal of Public Health Management & Practice 9(3): 199-207.
Abstract:
"Workforce development programs in public health should link improvements in workers' performance with improvements in their agencies' performance. The "ten essential services" of public health provide criteria for measuring both individual worker training (as in workforce competency standards) and agency performance (as in the Centers for Disease Control and Prevention's National Public Health Performance Standards Program). This shared foundation was the basis for a model strategic training program developed for use in a 500-employee urban county health department. Full implementation of this model as a foundation for assessment, curriculum development, and evaluation requires careful attention to management issues, confidentiality of employee records, and evaluation methodologies," (pg 199).
external image Pdf.jpgPronk, N. P. and J. Boucher (1999). "Systems approach to childhood and adolescent obesity prevention and treatment in a managed care organization." International Journal Of Obesity 23: S38-S42.
Abstract:
"OBJECTIVE: To outline an intervention approach to childhood and adolescent obesity prevention and treatment, that will systematically facilitate effective communication, provide long-term social support and access to resources, that may be accessed preactively or on demand. Furthermore, this approach operates in an environment that involves all critical parties: child/adolescent, family-unit, physician and allied health professionals.
SYSTEMS THINKING APPROACH: The objective is to bring together all key stakeholders and consider the interrelationships among them as a common process. In a managed care setting, this may be accomplished by optimizing the contributions of care delivery, health promotion and information systems.
SETTING: A not-for-profit, community governed Managed Care Organization (MCO) in the Midwestern United States. Telephone-based, centralized services facilitate a process of access, communication, documentation and intervention implementation.
STUDIES:Two case studies are presented as examples of how access is obtained, the intervention is tailored to individual needs, communication is established, documentation is organized and long-term support is facilitated.
CONCLUSIONS: A systems thinking approach to obesity prevention and treatment in youth has great potential. In a MCO setting, such an approach may be implemented, since integrated health care delivery systems may allow a common process to be established that can bring together all key stakeholders," (pg S38).
external image MIA.jpgPruessner, H. T., W. A. Hensel, et al. (1992). "The Scientific Basis Of Generalist Medicine." Academic Medicine 67(4): 232-235.
Abstract:
"The authors state that one of the reasons medical students favor specialist medicine over generalist medicine (i.e., primary care) is that they see generalist medicine as existing in a nebulous world of non-science. Students often feel that the scope of knowledge in generalist disciplines is so broad and unbounded that these fields cannot be approached with sufficient scientific rigor. Students hold this view in part because they are unable to see the shortcomings of the reductionist thinking that dominates medical education and specialty medical care. But now a new field, chaos science, reveals the intellectual basis for generalist medicine, because it finds patterns and order in the behavior of whole, complex systems (such as human beings) and explains the necessity for the experiential, holistic, and intuitive processes that are essential in generalist care. This intellectual basis is neither greater nor lesser than that of specialist medicine - just different. To explain these contentions, the history, strengths, and limits of reductionist thinking are discussed, and aspects of chaos science, such as the butterfly effect and strange attractors, are described. The authors close by emphasizing the importance of striking a balance between reductionist and whole-systems thinking, and challenge students who "have an eye for pattern and a taste for complexity, jagged edges, and sudden leaps" to consider a career in primary care medicine, where they will be, in effect, the chaos scientists of human beings," (pg 232).
Notes:
This journal is at the Veterinary library.
external image Pdf.jpgPruitt, S. D. and J. E. Epping-Jordan (2005). "Preparing the 21st century global healthcare workforce." BMJ 330(7492): 637-639.
Abstract:
"To meet the growing global demands of caring for the increasing numbers of patients with chronic conditions, we need to develop a new approach to training," (pg 637).
external image Pdf.jpgPukk, K. and D. C. Aron (2005). "The DNA damage response and patient safety: engaging our molecular biology-oriented colleagues." International Journal For Quality In Health Care 17(4): 363-367.
Abstract:
"The imperative to improve patient safety is clear. Biomedical scientists, who account for a large proportion of medical school faculty, and clinicians tend to speak different languages. Biological systems are remarkable for their high robustness, flexibility, and efficiency. Biomedical scientists possess a profound understanding of the complex mechanisms that govern organisms. Their insights may inform the design of safer health care systems. We propose a model to assist in bi-directional communication between these disciplines. We use the principles and mechanisms of the DNA damage response to describe the central concepts of safety science and discuss similarities and differences between the systems of DNA repair and organizational approaches to safety in health care. We suggest that such biomedical scientists can and should be engaged in the effort to bring education about patient safety management into the medical school curriculum and to make patient care safer," (pg 363).

[edit]Authors: R

external image Pdf.jpgRadley, A. (1996). "Social psychology and health: Framing the relationship." Psychology & Health 11(5): 629-633.
Abstract:
"Although the connectionist model makes possible a discussion of links between the individual and the social in health psychology, it needs to be understood alongside theories concerning ritual and discourse. By acknowledging that systems thinking describes forms of relationship, questions can then be asked about such things as 'claims to definition' and 'risks to meaning'. These are important issues in the study of how people sustain health beliefs, negotiate entitlement to care and make their illness situation sensible and bearable," (pg 629).
external image Pdf.jpgRitchie-Dunham, J. L. and J. F. M. Galvan (1999). "Evaluating epidemic intervention policies with systems thinking: A case study of dengue fever in Mexico." System Dynamics Review 15(2): 119-138.
Abstract:
"In developing national epidemiological control strategies, understanding the environment in which an epidemic develops, the complex interrelationships of the relevant variables and their resulting behavior requires responsible health decision makers to develop comprehensive, effective policies. Systemic decision models can help managers understand the impact of alternative strategies for addressing disasters such as national epidemics. This paper discusses an interactive, systemic decision model developed in the Secretariat of Health of Mexico, at the advisory level, highlighting how the change in decision-making perspective provided valuable insight into strategically managing the control of dengue, a potentially catastrophic epidemic," (pg 119).
Notes:
This article was cited in Sterman, J. D. (2006). "Learning from Evidence in a Complex World." American Journal of Public Health 96(3): 1-10 PAGE NUMBERS NOT FINALIZED, part of the AJPH Special Issue on Public Health.
external image Pdf.jpgRodrigues, B. 2002. Health Care Reform: Opportunities for Professional Chaplains to Build Intentional Communities of Learners by Integrating Faith, Science, Quality, and Systems Thinking. Journal of Health Care Chaplaincy 13:195-211.
Abstract excerpted from above:
"Albert Einstein once said, "The significant problems we face cannot be solved at the same level of thinking we were at when we created them" (www.brainyquote.com). Health care reform has brought professional chaplains to a place of chaos-a place that raises many questions about the past, present and future. This chaos presents tremendous opportunities for professional chaplains to increase their capacities in building intentional communities of learners by integrating faith, science, quality and systems thinking. Pastoral care givers must truly understand the pressures from all sides and the new emerging paradigm of integrated health care delivery. Without this understanding, we will not see the opportunities and challenges of integrating pastoral and spiritual care in the emerging structures and systems. The future of chaplaincy largely will depend on the quality of the data, quality of our conversations and our ability to thinking together through dialogue."
external image Pdf.jpgRoss, D. A., A. R. Hinman, et al. (2004). "The Near-Term Future for Child Health Information Systems." Journal of Public Health Management & Practice 10(Suppl.): S99-S104.
Abstract:
"The developmental process in children offers an opportunity to influence their health and well-being as adults. The information infrastructure of the future needs to support the multiple partners responsible for providing elements of the health protection and health care of children. In this partnership, public health plays simultaneously a supportive role and a leadership role. Five tasks need to guide near-term information systems thinking with respect to establishing a basis for building electronic linkages among various child health programs. First, the nation's vital records system must be reengineered to ensure that this key information asset can be integrated into other child health information systems. Second, through an appropriate governance structure, the key stakeholders in child health should endorse standards and requirements that define a longitudinal health record for children. Third, public health agencies should develop a thorough business case/value proposition that drives mutually developed and mutually endorsed requirements for the integration of presently fragmented systems. Fourth, public health should take the lead in ensuring that parents have convenient access to information that can support the coordination of their child's care and development. And fifth, provider groups and public health agencies should join research networks to study how information supports positive changes to children's health," (pg S99).
external image Pdf.jpgRothschild, A. S., L. Dietrich, M. J. Ball, H. Wurtz, H. Farish-Hunt, and N. Cortes-Comerer. 2005. Leveraging systems thinking to design patient-centered clinical documentation systems. International Journal Of Medical Informatics 74:395-398.
Abstract excerpted from above:
"A hospital is a type of system, yet healthcare information technology (IT) has largely failed to view it as such. The failure to view the hospital as a system has contributed to the practice of inefficient and ineffective clinical documentation. This paper seeks to address how current clinical documentation practices reflect and reinforce inefficiency and poor patient care. It also addresses how rethinking clinical documentation and IT together may improve the entire healthcare process by promoting a more integrated and patient-centered healthcare information paradigm. Rethinking IT in support of clinical documentation from a system-oriented perspective may help improve patient care and provider communication."
external image Pdf.jpgRowitz, L. (2004). "Ten tools for practice learning." Journal of Public Health Management & Practice 10(4): 368-370.
Abstract:
"Provides learning toolkits for enhancing public health practice and leadership skills. Use of case studies in learning how public health works in the real world; Popularity of interactive exercises and games in training programs; Demonstration of public health in action through site visits."
external image Pdf.jpgRoyston, G. (1998). "Shifting the balance of health care into the 21st century." European Journal Of Operational Research 105(2): 267-276.
Abstract:
"Some of the present or likely future key shifts in the balance of health care in Europe are set out; shifts in when and where and how carl is delivered, what is delivered and who is cared for. An illustrative assessment is given of ways in which ORMS can help in coping with the uncertainty, complexity and change that underlies many of the observed shifts in the balance of health care," (pg 267).

[edit]Authors: S

external image Pdf.jpgSchmidt, G., M. Malik, et al. (1999). "'Heart-rate turbulence after ventricular premature beats as a predictor of mortality after acute myocardial infarction." Lancet 353(9162): 1390-1396.
Abstract:
"Background Identification of high-risk patients after acute myocardial infarction is essential for successful prophylactic therapy. The predictive accuracy of currently used risk predictors is modest even when several factors are combined. Thus, establishment of a new powerful method for risk prediction independent of the available stratifiers is of considerable practical value,
Methods The study investigated fluctuations of sinus-rhythm cycle length after a single ventricular premature beat recorded in Holter electrocardiograms, and characterised the fluctuations (termed heart-rate turbulence) by two numerical parameters, termed turbulence onset and slope. The method was developed on a population of 100 patients with coronary heart disease and blindly applied to the population of the Multicentre Post-Infarction Program (MPIP; 577 survivors of acute infarction, 75 deaths during a median follow-up of 22 months) and to the placebo population of the European Myocardial Amiodarone Trial (EMIAT; 614 survivors of acute myocardial infarction, 87 deaths during median follow-up of 21 months). Multivariate risk stratification was done with the new parameters and conventional risk factors.
Findings One of the new parameters (turbulence slope) was the most powerful stratifier of follow-up mortality in EMIAT and the second most powerful stratifier in MPIP: MPIP risk ratio 3.5 (95% CI 2.2-5.5, p<0.0001), EMIAT risk ratio 2.7 1.8-4.2, p<0.0001), In the multivariate analysis, low left-ventricular ejection fraction and turbulence slope were the only independent variables for mortality prediction in MPIP (p<0.001), whereas in EMIAT, five variables were independent mortality predictors: abnormal turbulence onset, abnormal turbulence slope, history of previous infarction, low left-ventricular ejection fraction, and high mean heart rate (p<0.001). In both MPIP and EMIAT, the combination of abnormal onset and slope was the most powerful multivariate risk stratifier: MPIP risk ratio 3.2 (1.7-6.0, p<0.0001), EMIAT risk ratio 3.2 (1.8-5.6, p<0.0001).
Interpretation The absence of the heart rate turbulence after ventricular premature beats is a very potent postinfarction risk stratifier that is independent of other known risk factors and which is stronger than other presently available risk predictors," (pg 1390).
Notes:
From the Plexus Institute: "A new risk factor, heart rate turbulence (defined as the acceleration and subsequent deceleration of sinus rhythm after a single ventricular premature beat) has been found to be a better predictor of post-MI mortality as compared to traditional predictive factors. This is an important advance since accurate prediction of risk for repeat infarction is critical in determining which individuals are appropriate for prophylactic intervention. Patients showing an acceleration/deceleration pattern in heart rate after ventricular premature beats are more likely to survive than patients with no such adaptive response. See related articles by Dardik and Goldberger."
external image Pdf.jpgSeely, A. J. E. and N. V. Christou (2000). "Multiple organ dysfunction syndrome: Exploring the paradigm of complex nonlinear systems." Critical Care Medicine 28(7): 2193-2200.
Abstract:
"Objectives: The objectives of this article are to introduce and explore a novel paradigm based on complex nonlinear systems, and to evaluate its application to critical care research regarding the systemic host response and multiple organ dysfunction syndrome (MODS).
Data Sources: Published original work, review articles, scientific abstracts and books, as well as our personal files. Study Selection: Studies were selected for their relevance to the applications of nonlinear complex systems, to critical care medicine, and to the concepts presented. Data Extraction: We extracted all applicable data.
Data Synthesis: Following a brief review of MODS, an introduction to complex nonlinear systems is presented, including clear concepts, definitions, and properties. By examining the multiple, nonlinear, interrelated, and variable interactions between the metabolic, neural, endocrine, immune, and inflammatory systems; data regarding interconnected antibody networks; and the redundant, nonlinear, interdependent nature of the inflammatory response, we present the hypothesis that the systemic host response to trauma, shock, or sepsis must be evaluated as a complex nonlinear system. This model provides a new explanation for the failure of trials using various antimediator therapies in the treatment of patients with sepsis and MODS. Understanding the host response as a complex nonlinear system offers innovative means of studying critical care patients, specifically by suggesting a greater focus on systemic properties. We hypothesize that analysis of variability and connectivity of individual variables offer a novel means of evaluating and differentiating the systemic properties of a complex nonlinear system. current applications of evaluating variability and connectivity are discussed, and insights regarding future research are offered.
Conclusion: The paradigm offered by the study of complex nonlinear systems suggests new insights to pursue research to evaluate, monitor, and treat patients with MOBS," (pg 2193).
Notes:
From the Plexus Institute: "This article proposes that the paradigm of complex nonlinear systems be used in critical care research regarding the systemic host response and multiple organ dysfunction syndrome (MODS). It is suggested that “understanding the host response as a complex nonlinear system offers innovative means of studying critical care patients, specifically by suggesting a greater focus on systemic properties. We hypothesize that analysis of variability and connectivity of individual variables offer a novel means of evaluating and differentiating the systemic properties of complex nonlinear systems."'
external image Pdf.jpgSetliff, R., J. E. Porter, et al. (2003). "Strengthening the Public Health Workforce: Three CDC Programs that Prepare Managers and Leaders for the Challenges of the 21st Century." Journal of Public Health Management & Practice 9(2): 91-102.
Abstract:
"To address the need for management development in public health, the Centers for Disease Control and Prevention (CDC) established three independent workforce development initiatives aimed primarily at strengthening management and leadership capacity: the Sustainable Management Development Program, the Management Academy for Public Health, and the CDC Leadership and Management Institute. Though independently designed and implemented, the programs share similar guiding principles in their approach to management development: interactive (adult) learning, management tools that reinforce evidence-based decision making, individual feedback, continuous improvement of the learning process, posttraining support for networking and life-long learning, and teamwork. This article will discuss important lessons learned regarding best practices in management and leadership development," (pg 91).
external image Pdf.jpgexternal image 20px-Ajphlogo.jpgShah, M. N. (2006). "The Formation of the Emergency Medical Services System." American Journal of Public Health 96(3): PAGE NUMBERS NOT FINALIZED.
Abstract:
"The evolution of the emergency medical services system in the United States accelerated rapidly between 1960 and 1973 as a result of a number of medical, historical, and social forces. Current emergency medical services researchers, policy advocates, and administrators must acknowledge these forces and their limitations and work to modify the system into one that provides uniformly high-quality acute care to all patients, improves the overall public health through injury control and disease prevention programs, participates as a full partner in disease surveillance, and is prepared to address new community needs of all types," (pg PAGE NUMBERS NOT FINALIZED).
Notes:
This is part of the AJPH Special Issue on Systems Thinking.
external image Pdf.jpgShelton, J. D. (2000). "The Harm of "First, Do No Harm"." JAMA 284(21): 2687-2688.
external image 20px-Binder.jpgSinger, M. (1996). "A dose of drugs, a touch of violence, a case of AIDS: conceptualizing the SAVA syndemic." Free Inquiry in Creative Sociology 24(2): 99-110.
Abstract:
"Gang violence, substance abuse and AIDS have been described as parallel epidemics in the U.S. inner city. This paper draws upon findings from a set of ethnographic and survey research projects in the Puerto Rican community of Hartford, CT to develop a conceptualization of the close interconnections between these three health and social problems. Rather than separate conditions, substance abuse, violence, and AIDS, referred to here as SAVA to stress the relationships among these three phenomena, are best thought of forming a single syndemic (a closely interrelated complex of health and social crises) that continues to take a significant toll on the lives and well-being of the urban poor," (pg 99).
external image Pdf.jpgSinger, M. and S. Clair (2003). "Syndemics and public health: Reconceptualizing disease in bio-social context." Medical Anthropology Quarterly 17(4): 423-441.
Abstract:
"The world of public health has undergone dramatic changes since the emergence of AIDS in the early 1980s. The appearance and global spread in recent years of wave after wave of new and renewed infectious diseases and their entwinement with each other and with the social conditions and biopsychological consequences of disparity, discrimination, and structural violence has produced a new significant threat to public health internationally. The term syndemic has been introduced recently by medical anthropologists to label the synergistic interaction of two or more coexistent diseases and resultant excess burden of disease. This article provides the fullest examination of this new concept to date, including a review of relevant new literature and recent research finds concerning coinfection and synergistic interaction of diseases and social conditions at the biological and population levels," (pg 423).
external image 20px-Binder.jpgSinger, M. and C. Snipes (1992). '"Generations of suffering: experiences of a treatment program for substance abuse during pregnancy." Journal of Health Care for the Poor and Underserved 3(1): 222-234.
Notes:
This article has no abstract.
external image Pdf.jpgSmith, R. (2003). "What doctors and managers can learn from each other." BMJ 326(7390): 610-611.
external image Pdf.jpgexternal image 20px-Ajphlogo.jpgSterman, J. D. (2006). "Learning from Evidence in a Complex World." American Journal of Public Health 96(3): 1-10 PAGE NUMBERS NOT FINALIZED.
Abstract:
"Policies to promote public health and welfare often fail or worsen the problems they are intended to solve. Evidence-based learning should prevent such policy resistance, but learning in complex systems is often weak and slow. Complexity hinders our ability to discover the delayed and distal impacts of interventions, generating unintended "side effects." Yet learning often fails even when strong evidence is available: common mental models lead to erroneous but self-confirming inferences, allowing harmful beliefs and behaviors to persist and undermining implementation of beneficial policies.
Here I show how systems thinking and simulation modeling can help expand the boundaries of our mental models, enhance our ability to generate and learn from evidence, and catalyze effective change in public health and beyond," (pg 1 PAGE NUMBERS NOT FINALIZED).
Notes:
This is part of the AJPH Special Issue on Systems Thinking.
external image Pdf.jpgStokols, D., K. R. Pelletier, et al. (1996). "The ecology of work and health: Research and policy directions for the promotion of employee health." Health Education Quarterly 23(2): 137-158.
Abstract:
"This article identifies new research and policy directions for the field of worksite health in the context of the changing American workplace. These directions are viewed from an ecological perspective on worksite health and are organized around three major themes: (1) the joint influence of physical and social environmental factors on occupational health, (2) the effects of nonoccupational settings (e,g., households, the health care system) on employee well-being and the implications of recent changes in these settings for worksite health programs, and (3) methodological issues in the design and evaluation of worksite health programs, Developments in these areas suggest that the field of worksite health may be undergoing a fundamental paradigm shift away from individually oriented wellness programs (provided at the worksite and aimed primarily at changing employees' health behavior) and toward broader formulations emphasizing the joint impact of the physical and social environment at work job-person fit, and work policies on employee well-being," (pg 137).
external image Pdf.jpgStorch, J. L. (1999). "Is practical nursing experience necessary in administration, education, and research?" Western Journal Of Nursing Research 21(1): 83-93.
Abstract:
"Because nursing is a practice discipline involving a relationship between nurse and client based on moral commitments of nurse to client, it is critically important that nurse administrators, educators, and researchers have experienced that relationship in practice. Nurse administrators need that basis to found a vision of nursing required to lead and guide. Nurse educators need to have experienced nursing practice to engage nursing students in praxis, that act of reflection and action. Nurse researchers need to have practiced nursing to identify critical areas of focus in nursing practice and to give meaning to the interpretation of findings. The author urges greater convergence and clarity in identifying the nonnegotiables of nursing's art and science, including the importance of nursing practice as foundational to nursing work," (pg 83).
external image Pdf.jpgexternal image 20px-Ajphlogo.jpgSuba, E. J., S. K. Murphy, et al. (2006). "Systems Analysis of Real-World Obstacles to Successful Cervical Cancer Prevention in Developing Countries." American Journal of Public Health 96(3): PAGE NUMBERS NOT FINALIZED.
Abstract:
"Papanicolaou screening is feasible anywhere that screening for cervical cancer, the leading cause of cancer-related death among women in developing countries, is appropriate. After documenting that the Vietnam War had contributed to the problem of cervical cancer in Vietnam, we participated in a grassroots effort to establish a nationwide cervical cancer prevention program in that country and performed root cause analyses of program deficiencies. We found that real-world obstacles to successful cervical cancer prevention in developing countries involve people far more than technology and that such obstacles can be appropriately managed through a systems approach focused on programmatic quality rather than through ideological commitments to technology. A focus on quality satisfies public health goals, whereas a focus on technology is compatible with market forces," (pg PAGE NUMBERS NOT FINALIZED).
Notes:
This is part of the AJPH Special Issue on Systems Thinking.
external image Pdf.jpgSuchman, A. (2002). "Linearity, Complexity and Well-being." Medical Encounter 16(4): 17-19.
Notes:
This article has no abstract. From the Plexus Institute: "Excessive and inappropriate use of linear thinking contributes to an enormous amount of anxiety and suffering for healthcare professionals. A non-linear perspective helps us embrace paradox and unpredictability; as we let go of expectations of control, there's room for more spontanetity, curious observation, discovery and delight. Complexity reminds us to pay attention to our surroundings and our relationships. It helps us set realistic expectations for ourselves, reducing shame and fear, thus improving well-being."
external image 20px-Binder.jpg Syme, S. L. and J. L. Balfour (1998). Social determinants of disease. Maxey-Rosenau-Last Public Health & Preventive Medicine. R. B. Wallace. Stamford,CT, McGraw-Hill Professional: 795-810.
Notes:
I was unable to find an abstract or summary of this chapter on-line.

[edit]Authors: T

external image Pdf.jpgTilson, H. H. and K. Gebbie (2001). "Public health physicians: An endangered species." American Journal of Preventive Medicine 21(3): 233-240.
Abstract:
"Background: Questions have arisen regarding the competency levels of the various professions within the public health sector, including those of physicians. Protection of the nation’s health requires that physicians on the public health team be competent practitioners of both medicine and public health. Physicians practicing in this arena are required to possess a vast array of knowledge, skills, and attitudes to be effective contributors in the field.
Methods: Using focus groups of key informants in public health, the context of practice, inventory of required competencies, current competencies, and identified gaps in these competencies, measures to address the situation were identified and discussed.
Results: Recommendations from the focus groups include: use of distance-based learning, development of educational materials and programs, use of the American College of Preventive Medicine as a facilitator, improved remuneration, changes to the certification process, utilization of mentoring programs, introduction of new marketing strategies, use of professional publications, and increased governmental/agency support. Contributors to this endeavor are identified.
Conclusions: While we strive to improve the physician workforce entering the field, creative strategies for continued lifelong learning are urgently needed to facilitate ongoing development of physicians in the current public health workforce. This situation presents a major research agenda for public health practice. Identification of the essential knowledge, skills, and attitudes for public health physicians is the first step toward narrowing gaps in required competencies," (pg 233).
external image Pdf.jpgTriolo, P. K., B. J. Pozehl, et al. (1997). "Development of leadership within the university and beyond: Challenges to faculty and their development." Journal Of Professional Nursing 13(3): 149-153.
Abstract:
"Environmental changes in health care are driving changes in academic health centers. Nursing faculty have an opportunity to shape the changes on campus and in future health care delivery systems through participation in campus initiatives, but some may lack the skill set to be active participants. Leadership is defined as the ability to influence behavior and includes the skills of negotiation, facilitation, conflict management, organizational improvement, political savvy, systems thinking, personal mastery, and others. Opportunities for acquiring stronger leadership skills include feedback, partnering, mentoring, formal classes, and 360 degrees feedback," (pg 149).
external image Pdf.jpgexternal image 20px-Ajphlogo.jpgTrochim, W. M., D. A. Cabrera, et al. (2006). "Practical Challenges of Systems Thinking and Modeling in Public Health." American Journal of Public Health 96(3): 538-546.
Abstract:
"Objectives. Awareness of and support for systems thinking and modeling in the public health field are growing, yet there are many practical challenges to implementation. We sought to identify and describe these challenges from the perspectives of practicing public health professionals.
Methods. A systems-based methodology, concept mapping, was used in a study of 133 participants from 2 systems-based public health initiatives (the Initiative for the Study and Implementation of Systems and the Syndemics Prevention Network). This method identified 100 key challenges to implementation of systems thinking and modeling in public health work.
Results. The project resulted in a map identifying 8 categories of challenges and the dynamic interactions among them.
Conclusions. Implementation by public health professionals of the 8 simple rules we derived from the clusters in the map identified here will help to address challenges and improve the organization of systems that protect the public's health," (pg 1 PAGE NUMBERS NOT FINALIZED).
Notes:
This is part of the AJPH Special Issue on Systems Thinking.
external image Pdf.jpgTrochim, W. M. and M. Kane (2005). "Concept mapping: an introduction to structured conceptualization in health care." International Journal For Quality In Health Care 17(3): 187-191.
Abstract:
"Structured conceptualization is a specific form of concept mapping that is a mixed methods participatory approach that combines group processes (brainstorming, sorting, group interpretation) with a sequence of multivariate statistical analyses (multidimensional scaling, hierarchical cluster analysis). Concept mapping’s relevance to health care quality and services is described. The basic steps and analysis sequence in the concept mapping method are outlined and a brief example of the results for a health planning project are presented. Several examples of the use of concept mapping in health are provided," (pg 187).
external image Pdf.jpgTrochim, W. M. K., F. A. Stillman, et al. (2003). "Development of a model of the tobacco industry's interference with tobacco control programmes." Tobacco Control 12(2): 140-147.
Abstract:
"Objective: To construct a conceptual model of tobacco industry tactics to undermine tobacco control programmes for the purposes of: ( 1) developing measures to evaluate industry tactics, ( 2) improving tobacco control planning, and ( 3) supplementing current or future frameworks used to classify and analyse tobacco industry documents.
Design: Web based concept mapping was conducted, including expert brainstorming, sorting, and rating of statements describing industry tactics. Statistical analyses used multidimensional scaling and cluster analysis. Interpretation of the resulting maps was accomplished by an expert panel during a face-to-face meeting. Subjects: 34 experts, selected because of their previous encounters with industry resistance or because of their research into industry tactics, took part in some or all phases of the project.
Results: Maps with eight non-overlapping clusters in two dimensional space were developed, with importance ratings of the statements and clusters. Cluster and quadrant labels were agreed upon by the experts.
Conclusions: The conceptual maps summarise the tactics used by the industry and their relationships to each other, and suggest a possible hierarchy for measures that can be used in statistical modelling of industry tactics and for review of industry documents. Finally, the maps enable hypothesis of a likely progression of industry reactions as public health programmes become more successful, and therefore more threatening to industry profits," (pf 140)
external image Book.jpgexternal image Cabreralib.jpg Turning Point National Program Office (2003). From Silos to Systems: Performance Management to Improve the Public's Health. Seattle, WA, Turning Point Performance Management Collaborative, Public Health Foundation.
Notes:
This booklet is primarily focused on performance management of health care systems. The terminology of "silos to systems" is used on page 30 bulleted list.

[edit]Authors: U

external image Pdf.jpgU.S. Department of Health and Human Services. 2000. Healthy people 2010: Understanding and improving health, 2nd ed. U.S. Government Printing Office, Washington, DC.
Notes:
"Healthy People 2010 is about improving health--the health of each individual, the health of communities, and the health of the Nation. However, the Healthy People 2010 goals and objectives cannot by themselves improve the health status of the Nation. Instead, they need to be recognized as part of a larger, systematic approach to health improvement," (pg. 7). The two goals of the project are to increase life expectancy and quality of life and to eliminate health disparaties between populations. These goals are monitores through 467 more specific objectives.
external image Pdf.jpgU.S. Department of Health and Human Services. 2001. Healthy people in healthy communities: A community planning guide using healthy people 2010. U.S. Government Printing Office, Rockville, MD.
Notes:
This report is essentially what the title suggests: a planning guide aimed at community leaders for implementing Healthy People 2010 initiatives.
external image Pdf.jpgU.S. Department of Health and Human Services. 2003. Creating partnerships, improving health: The role of community-based participatory research. AHRQ Pub. No. 03-0037, U.S. Government Printing Office, Washington, DC.
Notes:
Excerpted from the report: "In CBPR, community-based organizations (CBOs) or groups, such as churches, church members, neighborhood organizations, community residents, and other social organizations, help researchers to recruit subjects. But they do more than that. Community-based organizations play a direct role in the design and conduct of the research study by:
  • Bringing community members into the study as partners, not just subjects
  • Using the knowledge of the community to understand health problems and to design activities to improve health care (interventions).
  • Connecting community members directly with how the research is done and what comes out of it
  • Providing immediate benefits from the results of the research to the community that participated in the study"
external image Pdf.jpgU.S. Department of Health and Human Services. 2005. Healthy people 2010: The cornerstone for prevention. U.S. Government Printing Office, Rockville, MD.
Notes:
This is a pdf version of a tri-fold flyer about the Healthy People 2010 initiative.
external image Cabreralib.jpg U.S. Dept. of HEW (Public Health Service). 1964. Smoking and Health: Report of the Advisory Committee to the Surgeon General of the Public Health Service. 1103, Washington, DC.
Notes:

external image Pdf.jpgUmble, K., S. Shay, et al. (2003). "An Interdisciplinary MPH via Distance Learning: Meeting the Educational Needs of Practitioners." Journal of Public Health Management & Practice 9(2): 123-135.
Abstract:
"This article describes a distance learning master of public health program that prepares students to lead programs and organizations. Evaluation showed that the curriculum, format, and teaching methods were accessible, affordable, acceptable, and appropriate for the working professional, and equivalent to residential master's programs aimed at experienced professionals. Students interacted with professors and other learners using the World Wide Web, weekly videoconferences, and face-to-face meetings. Students, whose main motivations for enrolling included improving job performance in leadership and career advancement, reported strengthening of knowledge, perspective, skill, technical facility, confidence, and job performance. Learner satisfaction was high, with 100% agreeing they would recommend the program to others," (pg 123).
external image Pdf.jpgUmble, K., D. Steffen, et al. (2005). "The National Public Health Leadership Institute: Evaluation of a Team-Based Approach to Developing Collaborative Public Health Leaders." American Journal Of Public Health 95(4): 641-644.
Abstract:
"Recent public health literature contains calls for collaborative public health interventions and for leaders capable of guiding them. The National Public Health Leadership Institute aims to develop collaborative leaders and to strengthen networks of leaders who share knowledge and jointly address public health problems. Evaluation results show that completing the institute training increases collaborative leadership and builds knowledge-sharing and problem-solving networks. These practices and networks strengthen interorganizational relationships, coalitions, services, programs, and policies. Intensive team-and project-based learning are key to the program’s impact," (pg 641).
external image Pdf.jpgexternal image Www.jpgUniversity of Washington. 2005. Community-Campus Partnerships for Health Home Page. Accessed October 3,2005. in. http://depts.washington.edu/ccph/
Notes:
Excerpted from the website: "Community-Campus Partnerships for Health (CCPH) is a nonprofit organization that promotes health through partnerships between communities and higher educational institutions. Founded in 1996, we are a growing network of over 1000 communities and campuses throughout the United States and increasingly the world that are collaborating to promote health through service-learning, community-based participatory research, broad-based coalitions and other partnership strategies. These partnerships are powerful tools for improving health professional education, civic engagement and the overall health of communities."
external image Pdf.jpgexternal image Www.jpgUniversity of Washington. 2005. Community-Campus Partnerships for Health: About Us. Accessed October 3,2005. in. http://depts.washington.edu/ccph/principles.html
Notes:
Excerpted from the website: "At CCPH we hold to the following values and beliefs:
  • The fundamental need for healthier communities and the important role that communities play in their own well-being. We believe that the power of shared ideas, resources, and experiences will help us all create healthier communities.
  • Creating healthier communities and overcoming complex societal problems requires collaborative solutions which bring communities and institutions together as equal partners and build upon the assets, strengths, and capacities of each. As an organization, we strive to develop collaborative relationships with other organizations.
  • Collaboration must be inclusive to succeed. We view inclusion as a strength and a centerpiece of all of our activities. Our language and actions must reflect our commitment to inclusion.
  • The importance of creating learning opportunities which foster the equitable exchange of knowledge and ideas between communities and educational institutions.
We are pursuing several strategies for achieving our goals:
  • Creating and expanding opportunities for individuals and organizations to collaborate and exchange resources and information relevant to community-campus partnerships.
  • Promoting awareness about the benefits of community-campus partnerships.
  • Advocating for policies needed in the public and private sectors that facilitate and support community-campus partnerships.
  • Promoting service-learning as a core component of health professions education.

[edit]Authors: W

external image Pdf.jpgW.K. Kellogg Foundation. 1998. Partnerships: A powerful tool for improving the well-being of families and neighborhoods, Final Review Version. W.K. Kellogg Foundation, Battle Creek, MI.
Notes:
This report looks at ten community-university partnerships to improve family and community development that the W.K. Kellogg Foundation funded.
Excerpted from the Report:
"Refreshing, even primal, values defined the work of all ten partnerships:
  • focusing on the capacities and assets (rather than the deficits) of families and neighborhoods
  • working to build self-determination and responsibility among families and address the collective set of problems they are facing (rather than working primarily with individuals or with only one problem)
  • looking at families in the context of their community
  • actively engaging community residents in change
  • focusing on results rather than following the rules
  • incorporating a multicultural and cross-cultural perspective into services," (pg 4).
"Defining what constitutes a partnership and what determines its success varies considerably depending on the community context, the people and organizations involved, and their goals. The partners come with differences in perceptions, differences in assets, beliefs, and values. They come with different ideas of the important problems and issues in the community and how to address them. They vary in their consciousness of the assets each partner brings. They bring differences in real and perceived power among the parties. In each of the ten sites, the nature of the imbalances in the relationships and contextual factors varied considerably. Just as a gardener balances nutrients and water for the local climate, so too each partnership worked on how, to, achieve a new balance that would support the well-being of families and communities through education... All sites featured a partnership between one or more institutions of higher education and agencies and/or residents of one or more communities. While each site identified its own goals specific to local needs, all focused on some kind of training and operated within the goal statements of the cluster and defining values provided by the W.K. Kellogg Foundation," (pg 7).
external image Pdf.jpgWadsworth, Y. and M. Epstein (1998). "Building in dialogue between consumers and staff in acute mental health services." Systemic Practice And Action Research 11(4): 353-379.
Abstract:
"This paper describes some aspects of the methodology, material, and findings from a lengthy participatory action research engagement by a consumer organization in Australia, which was undertaken in collaboration with staff at a major public psychiatric hospital and then went on to involve "players" throughout the local and national mental health services system. A small first phase established a dialogic methodology for the exchange of experiences and thinking between staff and consumers. The purpose of the second phase of the research was to explore how consumers' voices might be heard, and how staff-consumer communication about that feedback, might be "built in" to ongoing organizational structure and culture. Systems thinking about defensive routines, silences, and voice-as-discourse is reported as offering a possible way of cracking the puzzle of the closed-loop cycle of claim/blame-defense-and-counter-claimiblame-defense that has been characteristic to date," (pg 353).
external image Pdf.jpgWakefield, M. A., Y. M. Terry-McElrath, et al. (2002). "Tobacco industry marketing at point of purchase after the 1998 MSA billboard advertising ban." American Journal Of Public Health 92(6): 937-940.
Notes:
This paper has no abstract. It found that smoking advertisements inside, outside, and in the parking lots of stores where tobacco products are sold all increased following the 1998 ban on marketing tobacco products on billboards.
external image Pdf.jpgWeibel, E. R. (1991). "Fractal Geometry - A Design Principle For Living Organisms." American Journal Of Physiology 261(6): L361-L369.
Abstract:
"Fractal geometry allows structures to be quantitatively characterized in geometric terms even if their form is not even or regular, because fractal geometry deals with the geometry of hierarchies and random processes. The hypothesis is explored that fractal geometry serves as a design principle in biological organisms. The internal membrane surface of cells, or the inner lung surface, are difficult to describe in terms of classical geometry, but they are found to show properties describable by fractal geometry, at least sectionwise and within certain bounds set by deterministic design properties. Concepts of fractal geometry are most useful in characterizing the structure of branching trees, such as those found in pulmonary airways and in blood vessels. This explains how the large internal gas exchange surface of the lung can be homogeneously and efficiently ventilated and perfused at low energetic cost. It is concluded that to consider fractal geometry as a biological design principle is heuristically most productive and provides insights into possibilities of efficient genetic programming of biological form," (pg L361).
Notes:
From the Plexus Institute: "A fascinating article that explores the possibility that fractal geometry is a design principle in biological systems. It calls into question the current view that biological structure is "precisely determined by the genetic program of an organism"."
external image Pdf.jpgWeiner, B., J., L. A. Savitz, et al. (2004). "How Do Integrated Delivery Systems Adopt and Implement Clinical Information Systems?" Health Care Management Review 29(1): 51-66.
Abstract:
"Health care delivery organizations, especially integrated delivery systems (IDS), have significantly increased investment in information technology (IT) in recent years. However, the use of IT in key clinical functions remains low. In this study, how five IDSs make decisions about and implement clinical information systems is examined. Using case study research methods, general themes are identified and how organizational factors and IT characteristics affect adoption and implementation processes is explored. IDSs showed substantial clinical involvement, at both the system level and the local level, in clinical IT adoption decisions and implementation processes. System-level senior managers generally did not provide leadership in terms of setting the agenda for decision-making about clinical information systems. IDSs generally take a phased approach to implementation that involves both sequential installation of across care delivery sites and maintenance of parallel data entry, storage, and retrieval systems," (pg 51).
external image Pdf.jpgWeiner, B. J., J. A. Alexander, et al. (2000). "Strategies for effective management participation in community health partnerships." Health Care Management Review 25(3): 48-66.
Abstract:
"A study develops guidelines for effective health services management participation in community health partnerships. Drawing on a study of Community Care Network (CCN)Demonstration, the strategic alliance literature, and other research six challenges are described that health services managers are likely to face as partnership participants and the strategies are discussed that they might use to deal with them," (pg 48).
external image Pdf.jpgWhite, L. (2003). "The role of systems research and operational research in community involvement: A case study of a health action zone." Systems Research And Behavioral Science 20(2): 133-145.
Abstract:
"In recent years community involvement and increasingly local partnerships with community groups have become central themes in debates and policies surrounding urban regeneration. The paper attempts to explore the contribution that operational research and systems research could make to these debates. The potential contribution will be illustrated by a case study on developing community involvement in the context of a local area health initiative, namely the Health Action Zone Programme. The case study describes work undertaken over a period of two years, ending in April 2001, and reflects on how community involvement as a strategy was formed through paying attention to local relationships, and institutions. A range of participatory techniques was used as well as methods from operational research and the systems field. A framework for community involvement was developed from the work and-will be presented," (pg 133).
external image Pdf.jpgWhyte, D. A. (1992). "A Family Nursing Approach To The Care Of A Child With A Chronic Illness." Journal Of Advanced Nursing 17(3): 317-327.
Abstract:
"Chronic illness in childhood affects family functioning, and professional support is required when the child is being cared for at home. The focus of concern for this study is the nursing contribution to the support of the family. A longitudinal ethnographic study of the experience of four families caring for a child with cystic fibrosis provided data. Analysis of the four case studies provides insight to the effect of cystic fibrosis on family interaction. The genetic aspects and the life-threatening nature of the illness are seen to have a profound effect on the parents' lives. The experience of crisis and the chronic burden of care are described. The context of long-term care requires the nurse to share the illness trajectory with the families and to help family members to travel it together. This is seen to require a high level of interpersonal skill and considerable emotional investment. The issues for nursing are examined. The research arose from practice, and it contributes to theoretical explanation of nursing interaction, and the relationship of systems thinking to understanding of the nursing situation. The case for the development of family nursing practice to meet contemporary health care needs is argued," (pg 317).
external image Pdf.jpgWieman, T. J. and E. A. Wieman (2004). "A systems approach to error prevention in medicine." Journal Of Surgical Oncology 88(3): 115-121.
Abstract:
"Minimization of medical errors is at the core of all clinical medical practices. The first tenet of care is to do no harm. The enormous complexity of modern medical care has made error detection and management extremely difficult. Traditional deterministic methods of solving the "error issue" cannot cope with the huge number of potential errors that are possible. Systems thinking and approach to error reduction provides a different avenue for tackling this challenging dilemma. The intent of this article is to introduce a systems view of medical errors and to explain how it can provide new insights about dealing with massively complex organizations such as the healthcare system. Important features include an understanding of system relationships, sources of error, human components, optimization versus perfection in systems and the interrelationships between human and system processes," (pg 115).
external image Pdf.jpgWilliams, W., D. Lyalin, et al. (2005). "Systems Thinking: What Business Modeling Can Do for Public Health." Journal of Public Health Management Practice 11(6): 550-553.
Abstract:
"Today's public health programs are complex business systems with multiple levels of collaborating federal, state, and local entities. The use of proven systems engineering modeling techniques to analyze, align, and streamline public health operations is in the beginning stages. The authors review the initial business modeling efforts in immunization and cancer registries and present a case to broadly apply business modeling approaches to analyze and improve public health processes," (pg 550).
external image Pdf.jpgWilson, A. and H. Jarman (2002). "Private practice -- An advanced practice option." Contemporary Nurse 13 (2-3): 209-216.
Abstract:
"Currently there is considerable debate on the role and function of nurses in Australia and internationally. This debate stems from developments within the nursing profession itself, from political and economic issues in health platforms, due to restructuring of the health care system, consumer expectations of health care and nurses' expectations of a career. This paper provides the opportunity to reflect on the development of the role of the private practice (independent nurse) and where that role is situated in the nursing profession. This forms the basis for discussion of the development of specialty practice at an advanced level in Australia and to demonstrate its relationship with the nurse practitioner movement in Australia," (pg 209).
external image Pdf.jpgWilson, J. (2002). "Leadership development: Working together to enhance collaboration." Journal of Public Health Management & Practice 8(1): 21-26.
Abstract:
"The Turning Point Leadership Development National Excellence Collaborative has completed the first year of a 4-year effort. This article reports the results of the first year of work, including the formation of the collaborative and its goals, vision, and mission. The article goes on to discuss the primary focus area, collaborative leadership, and some of the challenges of implementing this style of leadership in the public health field and initial implementation activities," (pg 21).
external image Pdf.jpgWorld Health Organization (2000). World Health Report 2000: Health Systems: Improving Performance. World Health Report. Geneva, Switzerland, World Health Organization.
Notes:
This report looks at health systems (which the report defines as all the organizations, institutions, and resources in a particular area that are tasked with improving health) in different countries, talks about the characteristics of effective and ineffective health systems, and discusses ways to improve health systems.
external image Pdf.jpgexternal image Www.jpgWorld Health Organization. 2005. Commission on Social Determinants of Health. Accessed October 3, 2005. in. http://www.who.int/social_determinants/en/.
See also
Notes:
"The Commission aims to lever policy change by turning existing public health knowledge into actionable global and national policy agendas. It will:
  • Compile evidence on successful interventions and formulate policies that address key social determinants, particularly for
low-income countries;
  • Raise societal debate and advocate for implementation by Member States, civil society, and global health actors of policies that address social determinants;
  • Define a medium- and long-term action agenda for incorporating social determinants of health interventions/approaches into planning, policy, and technical work within WHO," (2nd pdf, pg 1).
external image Pdf.jpgWright, K., L. Rowitz, et al. (2000). "Competency Development in Public Health Leadership." American Journal Of Public Health 90(8): 1202-1207.
Abstract:
"The professional development of public health leaders requires competency-based instruction to increase their ability to address complex and changing demands for critical services. This article reviews the development of the Leadership Competency Framework by the National Public Health Leadership Development Network and discusses its significance. After reviewing pertinent literature and existing practice-based competency frameworks, network members developed the framework through sequential use of workgroup assignments and nominal group process. The framework is being used by network members to develop and refine program competency lists and content; to compare programs; to develop needs assessments, baseline measures, and performance standards; and to evaluate educational outcomes. It is a working document, to be continually refined and evaluated to ensure its continued relevance to performance in practice. Understanding both the applications and the limits of competency frameworks is important in individual, program, and organizational assessment. Benefits of using defined competencies in designing leadership programs include the integrated and sustained development of leadership capacity and the use of technology for increased access and quality control," (pg 1202).
external image 20px-Binder.jpg Wynder, E. L. and D. Hoffmann (1994). "Smoking And Lung-Cancer - Scientific Challenges And Opportunities." Cancer Research 54(20): 5284-5295.
Notes:
This article has no abstract.

[edit]Authors: Z

external image Pdf.jpgZiegenfuss, J. T., R. F. Munzenrider, et al. (1998). "Organization change in a university hospital: A six year evaluation report of the HORIZONS project." Systemic Practice And Action Research 11(6): 575-597.
Abstract:
"Many health care organizations are currently engaged in changing the design of their health care services delivery system. The issues of cost containment, quality, and access are prominent. This paper reports on the impact of the implementation of a new organization design at one university hospital. The organization change effort (named HORIZONS) was a five year project funded in part by the Robert Wood Johnson Foundation and the Pew Charitable Trusts. In a changing health care environment, the project was undertaken with three goals in mind: (1) to maintain and enhance quality of patient care; (2) to improve the quality of working life; and (3) to accomplish this in a budget neutral manner. Initiated as a program to strengthen hospital nursing, the project became a patient-focused redesign effort encompassing both clinical and administrative affairs. The core ideas of the project approach included systems thinking, interactive planning and idealized design. This evaluation reports on the project's progress after six years," (pg 575).
external image Book.jpgexternal image Cabreralib.jpg Zimmerman, B., C. Lindberg, et al. (2001). Edgeware: Lessons From Complexity Science for Health Care Leaders. Dallas, TX, VHA, Inc.
Notes: From the Plexus Institute: "Annotation by Tom Petzinger – “At last. Authors who reveal the clarity in complexity. As a journalist and business author myself, I've read virtually every book seeking to apply complexity science to strategy, work, and economics. None, I assure you, comes close to EDGEWARE in terms of sheer clarity and utility. Though solid on the theory of complexity, this book's real breakthrough in its tremendous practicality for leaders. The pages are brimming with case after case--episodes of complexity in action that inspire as well as inform. For leaders (in hospitals and anywhere else) who ask, 'What do I do on Monday morning?' EDGEWARE provides literally dozens of suggestions. Don't get me wrong. Applying complexity is hard work. No book will ever make it easy to abandon command-and-control leadership or to let organizations 'play' their way into the future. But with EDGEWARE as your guide, the work will be joyous.”'
external image Pdf.jpgZylinski, J., G. L. Allan, et al. (1998). "The implementation of an integrated on-line health education system at RMIT." International Journal Of Medical Informatics 50(1-3): 261-265.
Abstract:
"The Faculty of Biomedical and Health Sciences at RMIT has been developing an on-line health education system using a systems thinking approach, to create a learning environment whose basis is supported by Information Technology (IT). The centre-piece of this system is the Faculty Learning Centre, which has been created: both in space and layout, to promote collaborative learning between the students, so that the educator is physically assimilated with the student body. This facility is supplemented by the Faculty WWW server, which has been the main vehicle for course material dissemination to students. To ensure an effective on-line teaching environment, the position of an on-line facilitator has been created, whose responsibilities include both the continual evaluation of the system and the implementation of appropriate system changes. Aspects have included the production of a staff development training program and extensive user documentation. This paper discusses the systems thinking approach used to implement this integrated on-line system, and the establishment of explicit educational rationales in the use of IT to support learning strategies. Some examples of the on-line educational programs are also presented," (pg 261).