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When ‘solutions of yesterday become problems of today': crisis-ridden decision making in a complex adaptive system (CAS)—the Additional Duty Hours Allowance in Ghana

Agyepong, Irene Akua ; Kodua, Augustina ; Adjei, Sam ; Adam, Taghreed

In: Health Policy and Planning, 2012, vol. 27, p. iv20-iv31

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    Titre
    • When ‘solutions of yesterday become problems of today': crisis-ridden decision making in a complex adaptive system (CAS)—the Additional Duty Hours Allowance in Ghana
    Auteur
    • Agyepong, Irene Akua. Ghana Health Service, Greater Accra Regional Health Directorate, Accra, Ghana, University of Ghana School of Public Health, Legon, Ghana, Ministry of Health, Accra, Ghana, Center for Health and Social Services (CHeSS), Accra, Ghana and Alliance for Health Policy and Systems Research, World Health Organization, Geneva, Switzerland
    • Kodua, Augustina. Ghana Health Service, Greater Accra Regional Health Directorate, Accra, Ghana, University of Ghana School of Public Health, Legon, Ghana, Ministry of Health, Accra, Ghana, Center for Health and Social Services (CHeSS), Accra, Ghana and Alliance for Health Policy and Systems Research, World Health Organization, Geneva, Switzerland
    • Adjei, Sam. Ghana Health Service, Greater Accra Regional Health Directorate, Accra, Ghana, University of Ghana School of Public Health, Legon, Ghana, Ministry of Health, Accra, Ghana, Center for Health and Social Services (CHeSS), Accra, Ghana and Alliance for Health Policy and Systems Research, World Health Organization, Geneva, Switzerland
    • Adam, Taghreed. Ghana Health Service, Greater Accra Regional Health Directorate, Accra, Ghana, University of Ghana School of Public Health, Legon, Ghana, Ministry of Health, Accra, Ghana, Center for Health and Social Services (CHeSS), Accra, Ghana and Alliance for Health Policy and Systems Research, World Health Organization, Geneva, Switzerland
    Type de document
    • Postprint
    Langue
    • Anglais
    Publié dans
    • Health Policy and Planning, 2012, vol. 27, p. iv20-iv31. Oxford University Press
    Autre version électronique
    Identifiant OAI-PMH
    • oai:doc.rero.ch:296584
    Summary
    Implementation of policies (decisions) in the health sector is sometimes defeated by the system's response to the policy itself. This can lead to counter-intuitive, unanticipated, or more modest effects than expected by those who designed the policy. The health sector fits the characteristics of complex adaptive systems (CAS) and complexity is at the heart of this phenomenon. Anticipating both positive and negative effects of policy decisions, understanding the interests, power and interaction between multiple actors; and planning for the delayed and distal impact of policy decisions are essential for effective decision making in CAS. Failure to appreciate these elements often leads to a series of reductionist approach interventions or ‘fixes'. This in turn can initiate a series of negative feedback loops that further complicates the situation over time. In this paper we use a case study of the Additional Duty Hours Allowance (ADHA) policy in Ghana to illustrate these points. Using causal loop diagrams, we unpack the intended and unintended effects of the policy and how these effects evolved over time. The overall goal is to advance our understanding of decision making in complex adaptive systems; and through this process identify some essential elements in formulating, updating and implementing health policy that can help to improve attainment of desired outcomes and minimize negative unintended effects