Using Cognitive Mapping and Qualitative System Dynamics to Support Decision Making in Intellectual Disability Care

Abstract

Provider organizations specializing in supporting people with intellectual disabilities (ID) are under pressure because of public policy reforms, changes in society, and increased customer expectations. The combination of all these factors makes long‐term decision making a challenge for the managers of such organizations. The majority of research examining decision making in ID service organizations has commonly studied the issue from the perspective of healthcare providers. The authors contend that the degree of success of ID support providers depends on their ability to appreciate the views and interests of service receivers and frontline workers, the most important components in the system. Having a comprehensive picture of key stakeholders' overall perspectives on problem situations can enhance managers' understanding of the behavior of a complex system they manage. The authors suggest that the combination of qualitative system dynamics modeling and cognitive mapping techniques can facilitate collaborative representation of the stakeholders' views in a way that can support decision making in complex healthcare systems. The authors illustrate the application of this combined method through a case study in one ID supports provider in the Netherlands and demonstrated the possibilities of using structured stakeholders' perspectives related to flexible pool schedule shifts, one of the key resource allocation dilemmas in the organization, for organizational decision making.

Senior manager decision‐making and interactions with frontline staff in intellectual disability organisations: A Delphi study

“…Round 1 provided three responses suggesting that panel were interested in using informal interactions with staff to better understand their organisations. Round 2 responses supported this emerging theme and round 3 showed consensus for (Green, 2013). Close attention to informal cultural aspects represents one way to avoid such abusive care and potential gaps developing between policy and actual practice McDonnell, Breen, Deveau, Goulding, & Smyth, 2014).…”

“…It has been suggested that intellectual disability organisations should be analysed and managed as complex adaptive systems, characterised by non‐linear responses to interventions (e.g. government and organisational policy and decision‐making) leading to unpredictable emerging patterns of behaviour (see Deveau, ; Duryan, Nikolik, Merode, & Curfs, ). Duryan et al () analyse ‘decision‐making’ in intellectual disability organisations using a complex adaptive system perspective and suggest that organisational decision‐making should take account of service user and FLS perspectives to be effective in meeting policy and individual service user goals.…”

“…government and organisational policy and decision‐making) leading to unpredictable emerging patterns of behaviour (see Deveau, ; Duryan, Nikolik, Merode, & Curfs, ). Duryan et al () analyse ‘decision‐making’ in intellectual disability organisations using a complex adaptive system perspective and suggest that organisational decision‐making should take account of service user and FLS perspectives to be effective in meeting policy and individual service user goals. This study showed that SM may employ behaviours and thinking that, whether consciously or not, take account of this complex system thinking.…”

The Development of Food Security Behavior Model through Environmental-Based Learning: A System Dynamics Approach

“…Feedback loops are represented in causal loop diagrams. In system dynamics, the design of the causal loop diagram is an iterative and qualitative process (Duryan et al, 2014). Causal loop diagram illustrates the relationship between two reciprocal variables.…”

The Use of a Context‐Based Change Model to Unfreeze the Status Quo and Drive Valued Outcomes

“…The context‐change model depicted in Figure integrates elements of the existing change models discussed in the literature: (1) system dynamics models that focus on the presence of feedback loops that have a critical impact on behavior across systems (Duryan, Nikolik, van Merode, & Curfs, ; Morecroft, ; Senge, ); (2) structured inquiry methods that involve mapping the strategic context, discovering the drivers, and building the road map (Albrecht, ; Schalock & Verdugo, ); (3) problem structuring methods that focus on a shared understanding of the problems in the organization or system and fostering commitment and enrollment of stakeholders (Duryan, Nikolik, van Merode, & Curfs, ; Rosenhead & Mingers, ); and (4) quality improvement strategies that typically focus on sequential action steps involving assessment, planning, doing, and evaluating (Deming, ; Lee, ; Schalock et al, ). Integrating elements from these existing models (Shogren et al, 2014; 2015) and applying them to the disability field builds on our previous work and provides direction for efforts to systematically apply a methodology to understand and change contextual factors in such a way that promotes, over time, enhanced valued outcomes that do not currently exist in the field.…”