Document Type : Review Article

Authors

Department of Industrial Management, Management and Accounting Faculty, Shahid Beheshti University, G.C.

Abstract

The purpose of this systematic review is to identify and categorize the application of soft operations research methods in healthcare settings. A systematic review was conducted to identify published papers on the application of soft operations research methods in the healthcare setting, using Google Scholar, Scopus, PubMed, Emerald, Elsevier, Web of Science, and ProQuest databases through December 2021. A total of 69 papers met our selection criteria for the systematic review. Soft operations research methods were used in a wide range of healthcare fields, including healthcare management, health informatics, e-health, and medical education, for identifying requirements, problem-solving, system design and implementation, process improvement, policymaking, knowledge management, and managing resilience, and marketing. This study contained restrictions on access to the full text of some articles and dissertations that had little impact on the study’s quality. The present study demonstrates the use of soft operations research methods in various areas of the healthcare system to better understand problematical situations. This paper can help to use soft operations research methods further in the healthcare problems, especially in the design and implementation of e-health and emerging new technology.

Keywords

Plsek PE, Greenhalgh T. The challenge of complexity in health care. Bmj. 2001;323(7313):625-8.
Braithwaite J, Churruca K, Ellis LA, Long J, Clay-Williams R, Damen N, et al. Complexity science in healthcare. Sydney: Australian Institute of Health Innovation, Macquarie University. 2017.
Greenhalgh T, Papoutsi C. Studying complexity in health services research: desperately seeking an overdue paradigm shift. Springer; 2018.
Kannampallil TG, Schauer GF, Cohen T, Patel VL. Considering complexity in healthcare systems. Journal of biomedical informatics. 2011;44(6):943-7.
Cohn S, Clinch M, Bunn C, Stronge P. Entangled complexity: why complex interventions are just not complicated enough. Journal of Health Services Research & Policy. 2013;18(1):40-3.
Augustsson H, Churruca K, Braithwaite J. Change and improvement 50 years in the making: a scoping review of the use of soft systems methodology in healthcare. BMC health services research. 2020;20(1):1-13.
Smith CM, Shaw D. The characteristics of problem structuring methods: A literature review. European Journal of Operational Research. 2019;274(2):403-16.
Mingers J, Rosenhead J. Problem structuring methods in action. European journal of operational research. 2004;152(3):530-54.
Matthee M, Turpin M. Teaching critical thinking, problem solving, and design thinking: Preparing IS students for the future. Journal of Information Systems Education. 2019;30(4):242-52.
Ackoff RL. The Art of Problem Solving Accompanied by Ackoff’s Fables. 1978.
Sepehrirad R, Azar A, Dabestani R. Methodology of Soft Operational Research. The International Journal of Humanities. 2015;22(3):0-.
Ferreira JS. Multimethodology in metaheuristics. Journal of the Operational Research Society. 2013;64(6):873-83.
Masys AJ. Applications of systems thinking and soft operations research in managing complexity. Boston USA. 2015:321.
Heyer R. Understanding Soft Operations Research: The methods, their application and its future in the Defence setting. 2004.
Checkland P, Poulter J. Soft systems methodology.  Systems approaches to managing change: A practical guide: Springer; 2010. p. 191-242.
1Ackermann F, Eden C, Cropper S. Getting started with cognitive mapping: Banxia Software; 1992.
Ackermann F, Eden C. Strategic options development and analysis.  Systems approaches to managing change: A practical guide: Springer; 2010. p. 135-90.
Attri R, Dev N, Sharma V. Interpretive structural modelling (ISM) approach: an overview. Research Journal of Management Sciences. 2013;2319(2):1171.
Thakkar J, Kanda A, Deshmukh S. Interpretive structural modeling (ISM) of IT‐enablers for Indian manufacturing SMEs. Information Management & Computer Security. 2008.
Watson RH. Interpretive structural modeling—A useful tool for technology assessment? Technological Forecasting and Social Change. 1978;11(2):165-85.
El‐Taliawi OG, Hartley K. The COVID‐19 crisis and complexity: A soft systems approach. Journal of Contingencies and Crisis Management. 2021;29(1):104-7.
Pilevari N, Shiva MV. Country-Wide Resilience Model for the Health System: A Case Study on Iran, under Coronavirus Outbreak. Iranian Journal of Public Health. 2021;50(4):806-15.
Sarmiento I, Paredes-Solís S, Loutfi D, Dion A, Cockcroft A, Andersson N. Fuzzy cognitive mapping and soft models of Indigenous knowledge on maternal health in Guerrero, Mexico. BMC medical research methodology. 2020;20:1-16.
Lamé G, Jouini O, Stal-Le Cardinal J. Combining Soft Systems Methodology, ethnographic observation, and discrete-event simulation: A case study in cancer care. Journal of the Operational Research Society. 2020;71(10):1545-62.
Lopes E, Street J, Carter D, Merlin T, Stafinski T. Understanding Canadian Health Technology Assessment through a systems lens. Health Policy. 2020;124(9):952-8.
Abrantes JA, Ferreira FA, Zopounidis C, Pereira LF, Meidutė‐Kavaliauskienė I. Analyzing ethical practices in the public healthcare sector using fuzzy cognitive mapping. Journal of Multi‐Criteria Decision Analysis. 2020.
Khayame HA, Abdeljawad MM. Systems thinking in upstream social marketing: Using soft systems methodology to improve midwifery policy in Jordan. Social Marketing Quarterly. 2020;26(2):167-83.
Martin AC, O’Meara P. Community paramedicine through multiple stakeholder lenses using a modified soft systems methodology. Australasian Journal of Paramedicine. 2020;17.
Rees D, Y. Cavana R, Cumming J. Using cognitive and causal modelling to develop a theoretical framework for implementing innovative practices in primary healthcare management in New Zealand. Health Systems. 2018;7(1):51-65.
Emes M, Smith S, Ward S, Smith A, Ming T. Care and flow: using soft systems methodology to understand tensions in the patient discharge process. Health Systems. 2017;6(3):260-78.
Newell K, Corrigan C, Punshon G, Leary A. Severe asthma: emergency care patient driven solutions. International journal of health care quality assurance. 2017.
Kumar D, Kumar D. Modelling hospital inventory management using interpretive structural modelling approach. International Journal of Logistics Systems and Management. 2015;21(3):319-34.
Pessôa LAM, Lins MPE, da Silva ACM, Fiszman R. Integrating soft and hard operational research to improve surgical centre management at a university hospital. European Journal of Operational Research. 2015;245(3):851-61.
Talib F, Rahman Z. An interpretive structural modelling for sustainable healthcare quality dimensions in hospital services. International Journal of Qualitative Research in Services. 2015;2(1):28-46.
Kotiadis K, Tako AA, Vasilakis C. A participative and facilitative conceptual modelling framework for discrete event simulation studies in healthcare. Journal of the Operational Research Society. 2014;65(2):197-213.
Sinclair E, Radford K, Grant M, Terry J. Developing stroke-specific vocational rehabilitation: a soft systems analysis of current service provision. Disability and rehabilitation. 2014;36(5):409-17.
Pentland D, Forsyth K, Maciver D, Walsh M, Murray R, Irvine L. Enabling integrated knowledge acquisition and management in health care teams. Knowledge Management Research & Practice. 2014;12(4):362-74.
Thomas LH, French B, Burton C, Sutton C, Forshaw D, Dickinson H, et al. Evaluating a systematic voiding programme for patients with urinary incontinence after stroke in secondary care using soft systems analysis and Normalisation Process Theory: findings from the ICONS case study phase. International journal of nursing studies. 2014;51(10):1308-20.
Vandenbroeck P, Dechenne R, Becher K, Eyssen M, Van den Heede K. Recommendations for the organization of mental health services for children and adolescents in Belgium: use of the soft systems methodology. Health policy. 2014;114(2-3):263-8.
Duryan M, Nikolik D, van Merode G, Curfs LM. Using cognitive mapping and qualitative system dynamics to support decision making in intellectual disability care. Journal of Policy and Practice in Intellectual Disabilities. 2014;11(4):245-54.
Price M, Lau FY. Provider connectedness and communication patterns: extending continuity of care in the context of the circle of care. BMC health services research. 2013;13(1):1-10.
Holm LB, Dahl FA, Barra M. Towards a multimethodology in health care–synergies between Soft Systems Methodology and Discrete Event Simulation. Health Systems. 2013;2(1):11-23.
Kotiadis K, Tako AA, Rouwette EA, Vasilakis C, Brennan J, Gandhi P, et al. Using a model of the performance measures in Soft Systems Methodology (SSM) to take action: a case study in health care. Journal of the Operational Research Society. 2013;64(1):125-37.
Heyrani A, Maleki M, Marnani AB, Ravaghi H, Sedaghat M, Jabbari M, et al. Clinical governance implementation in a selected teaching emergency department: a systems approach. Implementation science. 2012;7(1):1-10.
Hodges S, Ferreira K, Israel N. “If we’re going to change things, it has to be systemic:” Systems change in children’s mental health. American journal of community psychology. 2012;49(3-4):526-37.
Dalkin SM, Jones D, Lhussier M, Cunningham B. Understanding integrated care pathways in palliative care using realist evaluation: a mixed methods study protocol. BMJ open. 2012;2(4).
Holm LB, Dahl FA. Using soft systems methodology as a precursor for an emergency department simulation model. OR Insight. 2011;24(3):168-89.
Carr SM, Lhussier M, Reynolds J, Hunter DJ, Hannaway C. Leadership for health improvement–implementation and evaluation. Journal of health organization and management. 2009.
Mukotekwa C, Carson E. Improving the discharge planning process: A systems study. Journal of Research in Nursing. 2007;12(6):667-86.
Sachdeva R, Williams T, Quigley J. Mixing methodologies to enhance the implementation of healthcare operational research. Journal of the Operational Research Society. 2007;58(2):159-67.
Kotiadis K. Using soft systems methodology to determine the simulation study objectives. Journal of simulation. 2007;1(3):215-22.
Reed J, Inglis P, Cook G, Clarke C, Cook M. Specialist nurses for older people: implications from UK development sites. Journal of advanced nursing. 2007;58(4):368-76.
Kalim K, Carson E, Cramp D. An illustration of whole systems thinking. Health Services Management Research. 2006;19(3):174-85.
Kotiadis K, Mingers J. Combining PSMs with hard OR methods: the philosophical and practical challenges. Journal of the Operational Research Society. 2006;57(7):856-67.
Wells J. Hospital‐based industrial therapy units and the people who work within them–an Irish case analysis using a soft‐systems approach. Journal of psychiatric and mental health nursing. 2006;13(2):139-47.
Fahey D, Carson E, Cramp D, Muir Gray J. Applying systems modelling to public health. Systems Research and Behavioral Science: The Official Journal of the International Federation for Systems Research. 2004;21(6):635-49.
Luckett S, Grossenbacher K. A critical systems intervention to improve the implementation of a district health system in KwaZulu–Natal. Systems Research and Behavioral Science: The Official Journal of the International Federation for Systems Research. 2003;20(2):147-62.
O’Meara P. Would a prehospital practitioner model improve patient care in rural Australia? Emergency Medicine Journal. 2003;20(2):199-203.
Adamides E, Maniatis A. A systems study for a European community program on inspection and accreditation of blood collection establishments. Systemic Practice and Action Research. 2001;14(5):575-96.
Clarke CL, Wilcockson J. Professional and organizational learning: analysing the relationship with the development of practice. Journal of Advanced Nursing. 2001;34(2):264-72.
Lehaney B, Clarke S, Paul R. A case of an intervention in an outpatients department. Journal of the Operational Research Society. 1999;50(9):877-91.
Lehaney B, Paul RJ. The use of soft systems methodology in the development of a simulation of out-patient services at Watford General Hospital. Journal of the operational research society. 1996;47(7):864-70.
Wells J. Discontent without focus? An analysis of nurse management and activity on a psychiatric in-patient facility using a’soft systems’ approach. Journal of Advanced Nursing. 1995;21(2):214-21.
Lehaney B, Paul RJ. Using soft systems methodology to develop a simulation of out-patient services. Journal of the Royal Society of Health. 1994;114(5):248-51.
Akinnuwesi BA, Adegbite BA, Adelowo F, Ima-Edomwonyi U, Fashoto G, Amumeji OT. Decision support system for diagnosing Rheumatic-Musculoskeletal disease using fuzzy cognitive MAP technique. Informatics in Medicine Unlocked. 2020;18:100279.
Sharma R, Zhang C, Wingreen SC, Kshetri N, Zahid A. Design of Blockchain-based Precision Health-Care using soft systems methodology. Industrial Management & Data Systems. 2019.
Sandiwarno S. Design Model of Medical Record Information System (Case Study: Clinic Universitas Mercu Buana). 2018.
Salmeron JL, Rahimi SA, Navali AM, Sadeghpour A. Medical diagnosis of Rheumatoid Arthritis using data driven PSO–FCM with scarce datasets. Neurocomputing. 2017;232:104-12.
de Kruijff A. A health information platform for Case Managed Neglected Tropical Diseases-A case study from Mozambique: Faculty of Commerce; 2017.
Milioni K. Hospital Information Systems In Greece: Users’ Perspectives. 2016.
Kononowicz AA, Narracott AJ, Manini S, Bayley MJ, Lawford PV, McCormack K, et al. A framework for different levels of integration of computational models into web-based virtual patients. Journal of medical Internet research. 2014;16(1):e23.
Leonhardt Kjærgaard A, Blegind Jensen T. Using cognitive mapping to represent and share users’ interpretations of technology. Communications of the Association for Information Systems. 2014;34(1):57.
Unertl KM, Weinger MB, Johnson KB, Lorenzi NM. Describing and modeling workflow and information flow in chronic disease care. Journal of the American Medical Informatics Association. 2009;16(6):826-36.
Allaf MS. Pharmacies and medication information system in Jeddah City, Saudi Arabia: Loughborough University; 2009.
Roy A, Kostkova P, Catchpole M, Carson E. Web-based provision of information on infectious diseases: a systems study. Health informatics journal. 2006;12(4):274-92.
Allam O, Gray A, McIntosh S, Morrey D. A systems approach to a deeper understanding of a cancer care domain. Health Informatics Journal. 2004;10(3):205-20.
Macias-Chapula CA. Development of a soft systems model to identify information values, impact and barriers in a health care information system. Journal of Information Science. 1995;21(4):283-8.
Poleto T, Carvalho VDHd, Silva ALBd, Clemente TRN, Silva MM, Gusmão APHd, et al., editors. Fuzzy Cognitive Scenario Mapping for Causes of Cybersecurity in Telehealth Services. Healthcare; 2021: Multidisciplinary Digital Publishing Institute.
Carter B, Whittaker K, Sanders C. Evaluating a telehealth intervention for urinalysis monitoring in children with neurogenic bladder. Journal of Child Health Care. 2019;23(1):45-62.
Rahimi N. Developing a Mixed-Methods Method to Model Elderly Health Technology Adoption with Fuzzy Cognitive Map, and Its Application in Adoption of Remote Health Monitoring Technologies by Elderly Women: Portland State University; 2018.
Prybutok G, Harun A, Prybutok V. eHealth marketing to millennials: a view through a systemigram. International Journal of Electronic Healthcare. 2017;9(4):319-38.
Szwed P, Skrzyński P. A new lightweight method for security risk assessment based on fuzzy cognitive maps. International Journal of Applied Mathematics and Computer Science. 2014;24(1).
Guo X, Zhang X, Li C. Development Strategy of E-health in China.  Innovation in the High-Tech Economy: Springer; 2013. p. 1-11.
Al-Kadi K. Telecare for managing diabetes in Saudi Arabia: City University London; 2012.
Raghupathi W, Umar A. Integrated digital health systems design: A service-oriented soft systems methodology. International Journal of Information Technologies and Systems Approach (IJITSA). 2009;2(2):15-33.
Jones K. The remodelling of patient care pathway for e-health: Brunel University, School of Information Systems, Computing and Mathematics; 2009.
Železnik D, Kokol P, Vošner HB. Adapting nurse competence to future patient needs using Checkland’s Soft Systems Methodology. Nurse education today. 2017;48:106-10.
Por J. The use of soft system methodology (SSM) in a serviced-focussed study on the personal tutor’s role. Nurse education in practice. 2008;8(5):335-42.
Stokes PJ, Lewin D. Information-seeking behaviour of nurse teachers in a school of health studies: a soft systems analysis. Nurse Education Today. 2004;24(1):47-54.
Kahraman C, Topcu YI. Operations research applications in health care management: Springer; 2018.