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) a n expanded definition of health care to include health improvement and prev ention 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 hav e created a number of learning consortia to develop microworld learning env ironments that illuminate strategic choices and their consequences. This ar ticle presents the advantages of microworld learning environments to meet t hese needs and describes two system dynamics-based microworld learning envi ronments and their use by health care providers as they navigate through co mplexity and uncertainty. In particular, the paper focuses on how system ar chetypes (or generic structures) are used as a device to capture what is le arned about the dynamics of these three changes and to help microworld user s apply what is learned to similar situations in their own organizations. C opyright (C) 1999 John Wiley & Sons, Ltd.