@article{Herman2024,

title = {Dynamics of prescribing and accessing medications for opioid use disorder: a community-based systems analysis},

author = {Tianna Herman and Zeynep Hasgul and Tse Yang Lim and Mohammad S. Jalali and Erin J. Stringfellow},

url = {https://mj-lab.mgh.harvard.edu/wp-content/uploads/2024/11/Herman_2024.pdf},

year  = {2024},

date = {2024-11-12},

journal = {Addiction Research & Theory},

abstract = {Background

Although medications for opioid use disorder (MOUD) are effective for treating opioid use disorder (OUD), persistent barriers still prevent patients from accessing this life-saving care. Policies to increase MOUD access have produced suboptimal results. This study presents a qualitative system dynamics model that elucidates the complexities of accessing and staying in MOUD treatment.



Methods

We utilized a community-based system dynamics approach to modeling the MOUD treatment system. We engaged a cohort of system experts/stakeholders, including individuals who had received MOUD, treatment providers, and policymakers, in interviews and group model building to develop and refine a simulation model. We then created a qualitative causal loop diagram based on insights gained while developing the simulation model and a review of interview transcripts.



Results

The causal loop diagram captures four key factors affecting treatment initiation, retention, and leaving: (1) fraught interactions between patients and healthcare providers; (2) stigma-driven regulation of MOUD creating a culture of fear and defensive medicine; (3) a punitive culture in clinics and opioid treatment programs offering MOUD; and (4) the internalization of the abstinence narrative contributing to premature termination of treatment.



Conclusions

Our analysis highlights how interdependent and non-linear feedback processes diminish or counteract the effectiveness and sustainability of MOUD policy interventions. Due to system memory and cultural resistance to change, even rolling back reactionary policies may do little to curb established behavioral patterns. In addition, conflicting and competing strategies among various actors within the system contribute to goal misalignment and a lack of standardization of care.},

keywords = {Participatory modeling, Substance use},

pubstate = {published},

tppubtype = {article}

}

@article{nokey,

title = {How Funding Policy Maintains Structural Inequity Within Indigenous Community-Based Organizations},

author = {Arielle R. Deutsch and Leah Frerichs and Zeynep Hasgul and Foster Murphey and Addie K. Coleman and Annie Y. Bachand and Arlana Bettelyoun and Paul Forney and Gene Tyon and Mohammad S. Jalali},

url = {https://mj-lab.mgh.harvard.edu/wp-content/uploads/2023/10/deutsch-et-al-2023.pdf},

year  = {2023},

date = {2023-10-02},

urldate = {2023-10-02},

journal = {Health Affairs},

volume = {42},

issue = {10},

abstract = {Despite efforts to increase investment in Indigenous health and well-being in the United States, disparities remain. The way in which health-promoting organizations are funded is one key mechanism driving the systemic, long-term health disparities experienced by Indigenous people in the US. Using Indigenous-led community-based organizations (ICBOs) that provide psychosocial care as a case study, we highlight multiple ways in which policies that regulate the external funding that ICBOs depend on must change to promote equity and allow the organizations to flourish and address unmet psychosocial needs for Indigenous community members. We use a system dynamics approach to discuss how “capability traps” arise from a misfit between external funding regulations and organizations’ needs for sustainability and effective care provision. We provide suggestions for reforming funding policies that focus on improving ICBO sustainability.},

keywords = {Disparity and equity, Participatory modeling},

pubstate = {published},

tppubtype = {article}

}

@article{Beaulieu2022,

title = {Health-Related Quality of Life in Cancer Immunotherapy: A Systematic Perspective, Using Causal Loop Diagrams},

author = {Elizabeth Beaulieu and Anne Spanjaart and Ashley Roes and Bernard Rachet and Stéphane Dalle and Marie José Kersten and Delphine Maucort-Boulch and Mohammad S. Jalali},

doi = {10.1007/s11136-022-03110-5},

year  = {2022},

date = {2022-03-19},

urldate = {2022-03-19},

journal = {Quality of Life Research},

volume = {31},

pages = {2357-2366},

abstract = {Purpose: System science offers a unique set of tools, including causal loop diagrams (CLDs), for stakeholders to better grasp the complexity of factors surrounding quality of life. Because the HRQoL of cancer immunotherapy patients exists within an intricate system affected by and affecting many factors across multiple dimensions, the development of a systems-level model can provide a powerful framework to aid the understanding of this complexity. We developed a CLD for quality of life (HRQoL) of cancer immunotherapy patients. Methods: We first apply a literature-based approach to construct a CLD for patients following immunotherapy. We then iteratively review and enhance the CLD through interviews with subject-matter experts. Results: Based on the reviewed literature and subject matter expert input, we produced a CLD representing the system surrounding cancer immunotherapy patients’ HRQoL. Several feedback loops are identified that span clinical experiences, oncology teams’ perceptions about immunotherapy, social support structures, and further research and development in cancer immunotherapy, in addition to other components. The CLD enables visualization of thought experiments regarding how a change anywhere in the system can ultimately worsen or improve patients’ HRQoL. Conclusion: The CLD illustrates the valuable contribution of a systems perspective to quality-of-life research. This systems-based qualitative representation gives insight on strategies to inhibit harmful effects, enhance beneficial effects, and inherent tradeoffs within the system. The CLD identifies gaps in the literature and offers a communication tool for diverse stakeholders. Our research method provides an example for studying the complexities of quality of life in other health domains.  },

keywords = {Cancer, Participatory modeling},

pubstate = {published},

tppubtype = {article}

}

@article{651231,

title = {Community-based System Dynamics Modeling of Sensitive Public Health Issues: Maximizing Diverse Representation of Individuals with Personal Experiences},

author = {Arielle R. Deutsch and Rebecca Lustfield and Mohammad S. Jalali},

url = {https://scholar.harvard.edu/files/jalali/files/community_based_sd_modeling.pdf},

year  = {2021},

date = {2021-01-01},

urldate = {2021-01-01},

abstract = {Community-based system dynamics (CBSD) models enhance our understanding of stigmatized public health issues and related health disparities. The accuracy and usefulness of these models depend upon the individuals who take part in group modeling sessions. Marginalized individuals that are personally impacted by these health issues are critical in the function and development of the models. However, the extent of inclusion varies between studies since such individuals are often hard to recruit. There is substantial diversity in how individuals experience a stigmatized public health issue and with the underrepresentation of individuals with personal experience, research may conclude in biased model development. The purpose of this study was to explore a method that would increase representation for individuals with personal experience of stigmatized issues in model development. We used a case study from a CBSD project on the association between alcohol misuse (AM) and intimate partner violence (IPV) within a Northern Plains American Indian community. Group model building sessions were held at three community organizations: a faith-based re-entry program, a substance use rehabilitation program for pregnant women and mothers, and a domestic violence shelter. Session participants (clients of these organizations) were quick to understand the systems method and were engaged in the modeling process. There were few similarities between the three CBSD models. Each model contributed unique system components, and a consolidated model provided a rich picture of the complex AM-IPV system, as well as the ways in which health disparities are maintained. Coupled with an emphasis on transparency and trust building between researchers and modelers, our approach illuminated the diversity of ways in which individuals with personal experience can perceive AM-IPV systems. Using similar strategies for model building can complement existing efforts to build representative models for stigmatized public health issues within communities.},

keywords = {Disparity and equity, Participatory modeling},

pubstate = {published},

tppubtype = {article}

}

@article{631231,

title = {Dynamics of intervention adoption, implementation, and maintenance inside organizations: The case of an obesity prevention initiative},

author = {Mohammad S. Jalali and Hazhir Rahmandad and Sally Lawrence Bullock and Seung Hee Lee-Kwan and Joel Gittelsohn and Alice Ammerman},

url = {https://scholar.harvard.edu/files/jalali/files/dynamics_of_intervention_adoption.pdf, dynamics of intervention adoption.pdf

https://scholar.harvard.edu/files/jalali/files/vensimfiles.zip, Vensim Files},

year  = {2019},

date = {2019-01-01},

urldate = {2019-01-01},

journal = {Social Science & Medicine},

volume = {224},

pages = {67-76},

abstract = {Overall impact of public health prevention interventions relies not only on the average efficacy of an intervention, but also on the successful adoption, implementation, and maintenance (AIM) of that intervention. In this study, we aim to understand the dynamics that regulate AIM of organizational level intervention programs. We focus on two well-documented obesity prevention interventions, implemented in food carry-outs and stores in low-income urban areas of Baltimore, Maryland, which aimed to improve dietary behaviour for adults by providing access to healthier foods and point-of-purchase promotions. Building on data from field observations, in-depth interviews, and data discussed in previous publications, as well as the strategy and organizational behaviour literature, we developed a system dynamics model of the key processes of AIM. With simulation analysis, we show several reinforcing mechanisms that span stakeholder motivation, communications, and implementation quality and costs can turn small changes in the process of AIM into big difference in the overall impact of the intervention. Specifically, small changes in the allocation of resources to communication with stakeholders of intervention could have a nonlinear long-term impact if those additional resources can turn stakeholders into allies of the intervention, reducing the erosion rates and enhancing sustainability. We present how the dynamics surrounding communication, motivation, and erosion can create significant heterogeneity in the overall impact of otherwise similar interventions. Therefore, careful monitoring of how those dynamics unfold, and timely adjustments to keep the intervention on track are critical for successful implementation and maintenance.},

keywords = {Adoption dynamics, Obesity, Participatory modeling, Simulation modeling},

pubstate = {published},

tppubtype = {article}

}

@article{631227,

title = {Cybersecurity in Hospitals: a Systematic, Organizational Perspective},

author = {Mohammad S. Jalali and Jessica P Kaiser},

url = {https://scholar.harvard.edu/files/jalali/files/cybersecurity_in_hospitals.pdf},

year  = {2018},

date = {2018-01-01},

urldate = {2018-01-01},

journal = {Journal of Medical Internet Research},

volume = {20},

number = {5},

pages = {e10059},

abstract = {Background: Cybersecurity incidents are a growing threat to the health care industry in general and hospitals in particular. The health care industry has lagged behind other industries in protecting its main stakeholder (ie, patients), and now hospitals must invest considerable capital and effort in protecting their systems. However, this is easier said than done because hospitals are extraordinarily technology-saturated, complex organizations with high end point complexity, internal politics, and regulatory pressures.Objective: The purpose of this study was to develop a systematic and organizational perspective for studying (1) the dynamics of cybersecurity capability development at hospitals and (2) how these internal organizational dynamics interact to form a system of hospital cybersecurity in the United States.Methods: We conducted interviews with hospital chief information officers, chief information security officers, and health care cybersecurity experts; analyzed the interview data; and developed a system dynamics model that unravels the mechanisms by which hospitals build cybersecurity capabilities. We then use simulation analysis to examine how changes to variables within the model affect the likelihood of cyberattacks across both individual hospitals and a system of hospitals.Results: We discuss several key mechanisms that hospitals use to reduce the likelihood of cybercriminal activity. The variable that most influences the risk of cyberattack in a hospital is end point complexity, followed by internal stakeholder alignment. Although resource availability is important in fueling efforts to close cybersecurity capability gaps, low levels of resources could be compensated for by setting a high target level of cybersecurity.Conclusions: To enhance cybersecurity capabilities at hospitals, the main focus of chief information officers and chief information security officers should be on reducing end point complexity and improving internal stakeholder alignment. These strategies can solve cybersecurity problems more effectively than blindly pursuing more resources. On a macro level, the cyber vulnerability of a countrytextquoterights hospital infrastructure is affected by the vulnerabilities of all individual hospitals. In this large system, reducing variation in resource availability makes the whole system less vulnerable—a few hospitals with low resources for cybersecurity threaten the entire infrastructure of health care. In other words, hospitals need to move forward together to make the industry less attractive to cybercriminals. Moreover, although compliance is essential, it does not equal security. Hospitals should set their target level of cybersecurity beyond the requirements of current regulations and policies. As of today, policies mostly address data privacy, not data security. Thus, policy makers need to introduce policies that not only raise the target level of cybersecurity capabilities but also reduce the variability in resource availability across the entire health care system.},

keywords = {Cybersecurity, Participatory modeling},

pubstate = {published},

tppubtype = {article}

}

@article{631219,

title = {Dynamics of Implementation and Maintenance of Organizational Health Interventions},

author = {Mohammad S. Jalali and Hazhir Rahmandad and Sally Lawrence Bullock and Alice Ammerman},

url = {https://scholar.harvard.edu/files/jalali/files/dynamics_of_implementation.pdf},

year  = {2017},

date = {2017-01-01},

urldate = {2017-01-01},

journal = {Int. J. Environ. Res. Public Health},

volume = {14},

pages = {917},

abstract = {In this study, we present case studies to explore the dynamics of implementation and maintenance of health interventions. We analyze how specific interventions are built and eroded, how the building and erosion mechanisms are interconnected, and why we can see significantly different erosion rates across otherwise similar organizations. We use multiple comparative obesity prevention case studies to provide empirical information on the mechanisms of interest, and use qualitative systems modeling to integrate our evolving understanding into an internally consistent and transparent theory of the phenomenon. Our preliminary results identify reinforcing feedback mechanisms, including design of organizational processes, motivation of stakeholders, and communication among stakeholders, which influence implementation and maintenance of intervention components. Over time, these feedback mechanisms may drive a wedge between otherwise similar organizations, leading to distinct configurations of implementation and maintenance processes. },

keywords = {Obesity, Participatory modeling},

pubstate = {published},

tppubtype = {article}

}