Microworlds and generic structures as resources for integrating care and improving health

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. Copyright (C) 1999 John Wiley & Sons, Ltd.