a pragmatic and systemic approach to advance research in health policy and management; comment on “insights gained from a re-analysis of five improvement cases in healthcare integrating system dynamics into action research”

“healthcare is complex” - or similar sentences – is a statement that introduces a wide number of scientific articles dealing with health policy and management issues. we all agree that healthcare is complex, but most studies, although using this kind of sentence to introduce their background, do little to effectively deal with such complexity in their analyses. holmström et al proposed a methodological approach to tackle healthcare complexity by integrating system dynamics (sd) into action research (ar). this commentary highlights three touch points that makes the combination of ar and sd feasible, namely the epistemological ground, the use of experimentation and the collaborative approach. the proposed approach addresses some of the key sources of the complexity characterizing healthcare settings.