Abstract for: Modeling and improving integrated healthcare pathways through Systems Thinking and System Dynamics: a case study

Integrated healthcare pathways are becoming increasingly fundamental to address fragmentation in complex clinical conditions, yet their design remains challenging and partially underanalyzed. Traditional approaches rely on static representations that overlook system dynamics. Healthcare pathways instead exhibit feedback loops, delays, and resource constraints, thereby suggesting the need to conceptualize them as complex adaptive systems and to adopt Systems Thinking and System Dynamics approaches. This study adopts an action research approach combining Systems Thinking, System Dynamics, and participatory modelling. It is based on an exploratory case study of a femur fracture pathway in an Italian healthcare setting. The research integrates co-creation and public service ecosystem perspectives, using system mapping to analyze patient flows, resource allocation, and feedback structures across hospital and territorial care. Preliminary results include the development of a system map representing the integrated care pathway, highlighting patient flows, delays, and resource allocation dynamics. The analysis reveals critical rework processes, such as re-hospitalizations and complications. Key intervention areas have been identified as leverage points where co-creation processes can support system improvement and reduce inefficiencies across care transitions. Preliminary findings suggest that improving integrated healthcare pathways requires a systemic perspective that accounts for feedback, delays, and cross-boundary coordination. The integration of System Dynamics with co-creation and ecosystem thinking supports shared understanding and more effective intervention design. The research is still in progress. Ongoing work will further formalize the model and explore how participatory approaches influence system change and policy effectiveness. Refinement of the text to improve clarity and fluency.