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A Systems Approach to Modelling Services for People with Dementia

Keen, J. (1998). A Systems Approach to Modelling Services for People with Dementia. (Unpublished Doctoral thesis, City, University of London)


Dementia is a condition whose causes are poorly understood, which cannot be cured and for which current treatments have marginal effects. It is estimated that some half a million people in the United Kingdom have it. There are important implications for the health and social care services that support them, and care of people with dementia has moved rapidly up the health and personal social services policy agenda in recent years.

The thesis has three objectives. The first objective is to understand the extent to which systems science approaches are appropriate and useful in a 'soft' domain, using the organisation of formal services for people with dementia as an example. The second objective is to assess the extent to which systems science approaches can be used to provide insights into the chosen domain. Although there have been some excellent studies the domain has not been extensively investigated, and the thesis provides an opportunity to develop understanding of the nature of service delivery. A case study approach, employing both qualitative (eg. influence diagrams, qualitative System Dynamics) and quantitative (Markov Cohort analysis) methods, is used to achieve the first two objectives.

The third objective is to understand the influence of two important elements of government community care policies, namely the flexibility and coordination of services, on the organisation of services for people with dementia. While the first two objectives focus on the detail of methods and patterns of service delivery, the focus here is on wider sytemic issues. Taking these three objectives together, the thesis hypothesis is: Can a systems science approach be applied in this apparently 'soft' domain, to produce new insights and knowledge?

It is concluded that both 'hard' and 'soft' approaches can provide useful insights into the nature of the domain. In contrast with some authors, it is argued that there is no simple relationship between research problems and systems science methods. Rather, thorough understanding of a domain is required, so that any one problem 'induces' the use of some methods rather than others.

The case study results confirm some of the observations made by other commentators about the domain, particularly in relation to the poor coordination of key aspects of service delivery for people with dementia. The results provide additional insights into the behaviour and attitudes of key decision-makers, which help to explain some of the observed problems in implementing successful community care policies on the ground. The policy analysis highlights the limits to the flexibility and co-ordination of services that can be achieved in the domain, given the current professional and organisational divisions between the services provided to people with dementia.

Publication Type: Thesis (Doctoral)
Subjects: R Medicine > RA Public aspects of medicine
Departments: School of Policy & Global Affairs > Sociology & Criminology
School of Health & Psychological Sciences > Healthcare Services Research & Management
School of Health & Psychological Sciences > School of Health & Psychological Sciences Doctoral Theses
Doctoral Theses
[thumbnail of Keen Thesis 1998 PDF-A.pdf]
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