Complex Societal Issues



Global Safety & Sustainable Development & Healthcare


EURO XXII in Prague Czech Republic , Europe

July 8-11 2007


22 European Conference on Operational Research


Volume 16


Dorien DeTombe


Complex Societal Issues: Global Safety & Sustainable Development & Healthcare

EURO XXII in Prague , Czech Republic , Europe

July 8-11, 2007  

22 European Conference on Operational Research

Volume 16


Dorien DeTombe

ã Greenhill & Waterfront, Dorien J. DeTombe

Publisher: Greenhill & Waterfront,

Europe: Amsterdam , The Netherlands ; Guilford , UK

North-America: Montreal , Canada

Contact us:

ISBN  978-90-77171-21-9

Version 001,  21 pages, May 2007

Nugi 661, 652, 654

Language English

10 Euro


EURO XXII in Prague

July 8-11, 2007

22 European Conference
on Operational Research


Methodology of Societal Complexity

Chair: Dorien J. DeTombe,

International Research Society on Methodology of Societal Complexity

Euro working Group on Methodology of Societal Complexity

P.O. Box. 3286, 1001 AB Amsterdam,

The Netherlands , Europe Tel: +31 20 6927526



The subject of Methodology Handling Complex Societal Issues:


Methodology of Handling Societal Complexity focuses on methods and tools for analyzing, structuring, guiding and evaluating complex societal problems.

Complex societal problems are often policy problems that can occur in many fields, like in the Agro-industry (Mad-Cow disease, BSE; Foot- and Mouth disease; Fowl Plague), in the transportation sector, in healthcare (Malaria, HIV/Aids, Sars, Flu), in Water affairs. It focuses on handling local safety problems like large city issues and natural disasters as flood and hurricanes and global safety problems like war, terrorism. Although many of these issues have a different cause, they have so much in comment that they can be approached in the same way.

Complex societal problems are unstructured, dynamical and constantly changing problems. Each problem has knowledge, power and emotional aspects and has a large impact on macro, meso and on micro level of the society.

Handling complex societal problems needs a multidisciplinary approach. The content knowledge comes from content experts. The process knowledge for handling the problem comes from facilitators. The attention of the research group is on the methods and tools facilitators need for supporting these kinds of problems. The facilitators use methods specially created for the field of societal problems combined with methods and insights derived from their original field like medicine, law, economics, societal sciences, methodology, mathematics, computer sciences, technology, engineering sciences, chaos theory and operational research. Often a combination of methods is needed. In this way the field uses all kind of methods from social sciences and operational research. An often-used approach is simulation. A simulation model is one of the powerful tools to describe societal complexity. With simulation models one cannot only understand the causal relations between the phenomena but also see what effect changes have.

The set of lectures focuses on methodology for handling real life complexity with an extra attention to the subject of global safety, sustainable development and healthcare


Keywords: Methodology, complex societal issues, decisions, sustainable development, global safety, healthcare

Stream: Methodology of Societal Complexity

Session I:           Societal Complexity and Safety

Chair session: Prof. Dr. Cathal M. Brugha
Department of Management Information Systems,
University College Dublin
, Belfield, Dublin 4, Ireland .,


Session II:     Societal Complexity and Sustainable Development

Chair session: Dr. Cor van Dijkum

Utrecht University , Faculty of Social

Sciences, Utrecht, Netherlands,


Session III:         Societal Complexity and Healthcare

Chair session: Dr. Dorien J. DeTombe

International Research Society on Methodology of Societal Complexity

Chair Euro Working Group on Methodology of Societal Complexity

P.O. Box. 3286, 1001 AB Amsterdam,

The Netherlands , Europe Tel: +31 20 6927526




Session IV: Prof. Dr Ken Bowen session

Chair session: Dr. Dorien J. DeTombe

International Research Society on Methodology of Societal Complexity

Chair Euro Working Group on Methodology of Societal Complexity

P.O. Box. 3286, 1001 AB Amsterdam,

The Netherlands , Europe Tel: +31 20 6927526




Session I:           Societal Complexity and Safety

Stream: Methodology of Societal Complexity

Chair session Prof. Dr. Cathal M. Brugha
Department of Management Information Systems,
University College
, Dublin 4, Ireland .


I-1 Multidisciplinary cooperation in handling patient safety

Dr. Dorien J. DeTombe

International Research Society on Methodology of Societal Complexity

Chair Euro Working Group on Methodology of Societal Complexity

P.O. Box. 3286, 1001 AB Amsterdam,

The Netherlands , Europe Tel: +31 20 6927526



In System Dynamic and Operational Research scientists model parts of reality to better understand societal complexity. For modeling a complex societal issue a multi disciplinary team of experts is needed to understand the complexity of the phenomenon. A system dynamic model, as part of the seven layer model (DeTombe,1994) made by a multidisciplinary team of experts expresses the knowledge about the issue, and in this way defines the phenomenon. The definition of the phenomenon includes an analysis of the actors and their power. The quality of the model improves by the multidisciplinarity of the team. Too often scientists make models of societal issues by their own. For a complex societal issue this is not fruitful and not even possible. One person or a few persons from the same discipline cannot comprehend all the phenomena that play a role in the complexity. This is step one of the COMPRAM methodology.

In step two each actor group is invited to give their definition of the problem in the same way as the experts do. In step three of the COMPRAM methodology a multidisciplinary team of experts (knowledge) and actors (power) is needed for decision making in order to come to an agreement. The quality of the model and decisions approves by a smoothly cooperation of people of different disciplines. These are the first three steps of the COMPRAM methodology*.

    The key word is multidisciplinarity for knowledge exchange and multidisciplinarity for communication among the actors. The insights of the problem and the sustainability of the decisions increase by working in multidisciplinary teams. However, working with multidisciplinary teams is very difficult. It is often hard to understand each other and accept each others expertise. The COMPRAM methodology provides means of establishing communication among experts and actors. The methodology COMPRAM uses a seven layer modeling scheme for modeling by a multidisciplinary team of experts a problem in different ways using different languages in such a way that the languages within one layer compensate the weak points of the languages in the other layers. In the seventh layer a simulation model of the problem is constructed. This system dynamic simulation model is the result of the insights in the problem developed by modeling the previous layers. In making this model communication tools such as interview techniques, lectures and brainstorming by groupware are used.

    Analysis of disasters, such as the terrorist attack on the World Trade Center , and the damage to New Orleans by Hurricane Katrina, shows the effects of a lack of multidisciplinary communication as a major source of unnecessary casualties. This phenomenon can also be seen in the field of healthcare and within hospitals.

    Within the field of healthcare there is too less communication between the vertical and horizontal chain in the healthcare system. The healthcare system includes aspects as prevention, curing, follow-up afterwards. For instance, the family doctor-patient relation is not the only relation, it is a knot in a chain of relations. A family doctor is imbedded in a chain of professional assistance. There is the horizontal medical chain on the level of the family doctor: the health visitor, the dentist, the pharmacist, and psychiatric. The vertical medical chain on the level of the family doctor is: the medical specialist, hospital, medical research medical industry and insurance companies.

The medical world is imbedded in the social world, where medical professionals and non medical professionals on micro, meso and macro level meet. The medical world has relations with law, education, psychology, sociology, policy on local, state and international level, such as drugs policy, euthanasia and abortion.

The patient is a person imbedded in a societal relation as daughter, mother, grandmother, employee and citizen. The illness of a patient can be related with work, family, partner, children living circumstances and food. It includes aspects of sociology, psychology and sustainable development. Improving patient safety includes deliberation, discussion and exchanging knowledge with all the actors in the field in a multidisciplinary way.

    Within large organizations as hospitals, research shows that due to lack of multidisciplinary communication the patient’s safety is seriously threatened**. Due to a lack of standardized procedures multidisciplinary communication and team work many unnecessary accidents happen. Patient documents are insufficient, a clear caretaker process is missing and the information to the patient is unclear. This is recognized by the Dutch healthcare field and must be improved. This is a clear example of a complex societal issue where the COMPRAM methodology with its emphasize on multidisciplinarity should be used.



DeTombe, D.J. 1994. Defining Complex Interdisciplinary Societal Problems: A theoretical study for constructing a co-operative problem analyzing method. Amsterdam : Thesis Publishers.

DeTombe, Dorien (2003) Handling Complex Societal Problems. International Handbook of Social Impact Assessment. Conceptual and Methodological Advances H. Becker & F. Vanclay. Australia: Edward Elgar Publishers.

*The Compram methodology is selected by the OECD to handle global safety as one of the three methodologies for handling this complex societal issues, based on its ideas on multidisciplinary handling of a global safety issues by experts and actors.

(,2546,en_2649_34269_37163752_119666_1_1_1,00.html ).

** Dutch report 2007-02 Rapport Preoperatief traject on patient safety in the pre-operation phase, by the Dutch Inspection of Healthcare February 2007

Keywords: COMPRAM methodology, methodology societal complexity, healthcare, multidisciplinarity


I-2 Can we build bridges between liberal democracy and global safety?

Dr. Stephen Taylor, Biology, Champlain Regional College , 900

Riverside Drive, J4P 3P2 , Saint-Lambert , Quebec , Canada ,


Rooted in Greek and Roman philosophy, the features of a liberal democracy were nicely summarized in the American Declaration of Independence in 1776:

“We hold these truths to be self-evident:

That all men are created equal; that they are endowed by their Creator with certain unalienable rights; that among these are life, liberty, and the pursuit of happiness.  That, to secure these rights, governments are instituted among men, deriving their just powers from the consent of the governed.”

The philosophy embodied here was then extended through the development of the American Constitution and it subsequent amendments including the Bill of Rights.  These principles have spread widely across the globe and are today found in the constitutions of many nations and the various charters of rights, including that of the United Nations.

    A consequence of the spread has been an increase in the number of choices available to individuals.  The actual number and scope of these choices are too broad to be listed here.  However, just consider for a moment the number of possible options available for spending a free day: stay home and work on one’s house; go out to shop where there are innumerable things to look at and purchase; go to a museum or a library, read a book; or, equally important, just do nothing.  Then there is the number of things to occupy the mind.  The political choices one can make and the opinions one can form about a particular subject.  There are the religious choices available including the right to reject all of them.  In the world of education and research, we value our academic freedom, which again is about the choices that we can make as we look into how things work or why they don’t.  In recent times, these rights have been extended to more and more individuals and groups as the notion of freedom to choose one’s way of life is regarded very highly in the democratic societies.  The general outcome of the extension of choice to individuals has meant an improvement of the quality of life for the many and has provided for a rich, diverse, and dynamic society, which extends across the borders of many countries to much of the world.

    Thus we have built many bridges to connect, individuals and societies to the good life.  The freedom of the individual in this society is limited at the point where the rights of one person limit the rights of another person.  We have empowered our governments as the mediators between individuals and groups, to assure that the choices of some do not impinge on those of others.  Governments have made laws or rejected laws for this purpose.  Public funds have been used to protect rights and to provide services, such as education, transport, and health care to the many.  In general, most of the people living in these open societies are now enjoying a better life than ever before in history.

    However, at the present time our concepts of democracy face a challenge.  We are told that we are living in a new age.  Our world has at the same time grown smaller, while our populations have grown larger.  Our societies are more complex and more diverse.  Unfortunately certain individuals and groups use the liberty that is accorded them by the open society to organize schemes which then limit the choices of others.  These range from the common criminal pursuits that have always been with us, theft, fraud and outright murder, through various forms of violence, to more subtle forms of limits by the imposition of particular political and/or religious philosophies on a society.  A paradox of democracy is that it provides the means for a few to gather the resources to impose limits on the many through perfectly legal channels.  These choices then can have the effect of altering the choices of the majority and then actually bringing on the demise of the democratic society itself.

    Today, we must address the issues of both individual and global safety, in the context of an open and democratic society.  Perhaps, we should think first of some of the global dangers.  All people face major challenges as a consequence of global warming and climate change.  Major health problems can be imposed on individuals as a consequence of their choices.  The risk of being exposed to a virus infection while travelling is more frightening to most of us than the worry of HIV/AIDS.  It has been a long time since the nuclear bombings of Hiroshima and Nagasaki , and most of the world’s people are unaware of the horrors that will result from even a limited deployment of these weapons.  The use of biological and biochemical weapons have even more frightening consequences.  The clash of cultures and religions forebodes doom.  We are living in a global culture of fear, and we must be afraid of that fear itself.  That fear can drive us to accept limits on our freedoms to the long term the detriment of the society as a whole.  In fact, the concepts on which our open societies are based are at risk and this may be the greater danger.

    Discussion of this paradox provides us with examples of several complex societal problems where many different voices must be heard and no simple or immediate solutions are apparent.  The question remains: how can we build and maintain bridges to the good life while protecting our cherished rights, and our individual and collective security?  While it is timely to discuss these issues in an academic forum, it is also necessary to consider how that conversation can take place in the greater society.  It is imperative that we who value the rights, freedoms, and choices available in the democratic societies encourage our neighbours to appreciate our situations.  We have never before had the opportunity to provide widespread education to all people on a global level.  The modern means of communication, satellite transmission of television and radio, internet, and cellular phones, are a few examples of technologies that can be deployed to protect our democratic freedoms through education.  The power of the new technologies resides in their use of interactivity to encourage conversation across great distances.  We should encourage the use of the weapons of mass education to inoculate people with the spirit of liberal democracy.

    The COMPRAM methodology developed by Dr Dorien deTombe may be used as an approach to encouraging this type of conversation.  The strength of this methodology is that it brings people from many different backgrounds and interests together in a conversation.  The participants are able to express their definitions, views and opinions, as well as suggestions for problem resolution in a non-threatening atmosphere.  As a result the people often realize the common aspects among these differences and can consequently begin moving towards satisfactory solutions.  Applying the methodology to the development of a program of education for citizenship would open a conversation among participants with a goal of establishing objectives, topics, and content for particular lessons.  As well they would be encouraged to propose a variety of ways of conveying these lessons across the society.  Analysis of the participants’ responses and conversation can help to develop such a program.

    Can small groups of people make a difference?  Before we describe ourselves as powerless, we should consider the damage being wreaked upon our earth and its inhabitants by relatively small groups of people who are very determined to implement their agendas.  It is important to our long term global safety that we find ways of protecting democracy and our freedom to choose our ways of life.  Let us try to maintain our bridges of choices and build new ones through educational programs for citizenship.


I-3 Modelling the Comprehensive National Threat Assessment:

Example of Computer Analytic Tool – Integro

Dr. Iztok Prezelj, Faculty of Social Sciences, University of

Ljubljana , Kardeljeva ploscad 16, 1000, Ljubljana ,

Slovenia ,


Contemporary terrorist groups use a variety of operational methods that need to be accounted for. Groups carry out attacks, have an organisational structure, organise educational and training activities, move across the border, recruit new members, break into computer systems, express threats to specific subjects, gather intelligence information, finance their operations and activities, deal with smuggling, carry out information and propaganda campaigns, etc. Terrorism is an example of a complex security threat. However, terrorism is only one of the dimensions in the threat spectrum. Health, environmental, economic, military, criminal, information and other dimensions need to be addressed in the process of threat assessment. First goal of my presentation is to identify and diagnose the broad spectrum threats to our societies with special attention to terrorism.

     Every responsible country needs to assess direct and indirect threats. First step in addressing such a complex threat is threat assessment. The process of threat assessment needs to be structured according to the charactherictics of the threats, and several qualitative and quantitative analytical tools and methods, including computer-aided tools, can be used. Many state actors need to be involved, such as police, intelligence services, military and ministry of defence, foreign ministry, ministry of finances, health, interior, environment, etc. Complexity of threat spectrum determines the complexity of the assessment process. Second goal of presentation is to present some results of multidisciplinary and interdisciplinary research project, coordinated by the Faculty of Social Sciences from Ljubljana, which finished in summer 2006. Project “Modelling the national threat assessment” produced a methodology for comprehensive national threat assessment in terrorist, health, information, military, economic, environmental and criminal dimension. The interdisciplinary research group, together with experts from various ministries, produced a big set of indicators, which reflect the threat intensity with their nominal, ordinal or numerical value. Complexity of the threat spectrum was reduced down to many indicators according to the SMART principle (Specific, Measurable, Agreed, Reliable and Timely). The final product is a web-based computer-aided tool – INTEGRO – for inputting, analysing, integrating and presenting threat indicators to the mutisectoral bodies, such as the government, National security council and other multisectoral groups.

    INTEGRO consists of three modules. First module (DATA INPUT) is a tool for gathering and entering the data on indicators by the relevant national actors. Indicators are inserted into the data base on the basis of triple key, containing value of indicator (numeric, ordinal, nominal), level of attributed threat (scale 0-3) and qualitative (textual) interpretation of the indicator or attributed threat level. Second module (DATA ANALYSIS/AGGREGATION/INTEGRATION) is a tool for analyzing the individual indicators, groups of indicators in particular security dimensions or within them. The module shows intensity of the threat by average standardized value for (set of) indicators or whole dimension (Z data bases), threat levels, maximum threat levels and correlation matrices (R data bases). At the joint level (multidimensional level), the module shows average standardized values of indicators for all dimensions, average threat levels in all dimensions, maximal threat levels in all dimensions and correlation matrix among all dimensions. The third module (OUTPUT) is a tool for graphical presentation of the threat situation by showing one indicator, a set of indicators or integral values for all indicators.  This module helps in acquiring a complex overview of the security situation in specific dimensions, identifying interdimensional connections (interdimensional analysis), extracting trends (trend analysis), identifying duplications and inconsistencies in threat assessment among different national actors, etc.

    In this presentation, the operation of program INTEGRO, based on imaginary data base, will be shown for the terrorist threat dimension. Also integral results for all dimensions will be shown. The intention of presentation is to show some of the latest results in developing integral and comprehensive analytical methods in the field of threat assessment. Naturally, INTEGRO has some limitations, which will be discussed as well.


I-4 Conflict Decision Processes: With Illustrations from Ireland

Prof. Dr. Cathal Brugha, Management Information Systems,

University College Dublin , Quinn School of Business,

Befield, 4, Dublin 4, Ireland,


At this session in previous EURO conferences Professor Ken Bowen discussed how to help managers make decisions in practice by providing frameworks and maps to elucidate issues and resolve situations.  He proposed an extension of ideas about Drama Theory, and Confrontation and Collaboration Analysis, which both evolved out of Game Theory. 

This presentation refers to the second of two papers about political decision processes, based on Nomology, a decision science approach to structuring qualitative decisions.  The first, see described a Development nomological process, which follows a generic structure based on a Convincing process embedded within a Committing process, which is implemented using an Adjusting process.  It applied this three-layer system to the situation of ongoing dispute between a stronger and a weaker country to give a formal explanation of eight conflict dilemmas.  This paper first looks at the broader context of how a society can be reduced to having to deal with political disputes, despite being motivated towards higher levels of its development. 

It then extends the first paper by considering the consequences of political conflicts on personal behaviour, and how atrocities can lead to a conflict spiral.  It reveals three additional dilemmas, and focuses on one, whether to rely on the more aggressive (clockwise) Adjusting direction, or the more conciliatory (anticlockwise) Adapting direction, which corresponds with Conflict Resolution. 

It explores Conflict Resolution, and shows that it brings the focus onto a fourth layer of decision-making, which also follows an Adjusting process.  This leads to two different kinds of Adjusting and corresponding names for the third layer “How I Adjust My World” and the fourth layer “How I Adjust Myself”.  Aspects of adjusting oneself are Body, Mind, Soul and Spirit.  Corresponding feelings are Fear, Anxiety, Guilt and Resentment.  The paper then considers the situation of ongoing political conflict where neither side is winning.  It shows that Conflict Resolution requires both sides to see it is a win-win solution to move out of conflict.  This starts first with Adjusting Oneself and involves moving from Conflict to Confrontation, to Cooperation, and finally to Collaboration.  It uses the Adjusting structure described in the first part, but in reverse, as an Adapting process.  To succeed both sides must Adapt within themselves, and then mutually Adapt together.  Lessons from how South Africa applied this process to change their divided society into one living under one constitution lead to suggestions about how the parties in Northern Ireland could make steps towards Conflict Resolution. 


Keywords: systems methodology, Nomology, decision science, philosophy


Session II:     Societal complexity and Sustainable Development

Stream: Methodology of Societal Complexity

Cor van Dijkum, Utrecht University , Faculty of Social

Sciences, Utrecht, Netherlands,


II-1  Two Technical Multi-Criteria to Evaluate Projects of Social Development

Dr.José G. Hernández R., ,

(1)Universidad Metropolitana, Departamento de Gestión de la Tecnología. Caracas Venezuela.

Distribuidor universidad, autopista, Guarenas, 78239, Caracas, 1074 Miranda,Venezuela

Dr. María J. García G., Consultora. Gerencia General. Apartado 78239. Caracas 1074  Venezuela .


The contribution of this work is to demonstrate like two technical multi-criteria, of the extreme simplicity, Matrix Of Weighing (MOW) and the Multiattribute Models (MM) with multiplicative factors, can be used to facilitate the decision making that must make the communities with respect to the projects be executed in favour of them.

    Although when speaking of technical multi-criteria the one that most frequently is mentioned in Literature it is Analytical Hierarchic Process (AHP), in this work will not become use of it, because the AHP requires that all the projects must to compare to construct the evaluation vector. In the case analyzed here, the projects in general arise in isolated form, thus is needed to valuation them of independent way, and Matrix Of Weighing, like the Multiattribute Models with multiplicative factors they allow it, whereas the AHP no.

    The objective of this work is centred in evaluating projects of social development through the MOW and MM with multiplicative factors. This type of projects arises very frequently in the developing countries, when the communities more destitute, receives resource of the state or the international organisms to undertake projects that improve their quality of life. But the financial resources, by very abundant that are, always will be few and it will never be possible simultaneously to undertake all the wished projects, from which it is necessary to make a valuation of them to choose as it is due to implement first.

    Through a hypothetical case one will be as the MOW and MM with multiplicative factors take part to obtain an objective hierarchical structuring of the projects that must be undertaken by a community.

    In order to construct to the hypothetical case to do one interviews to a small group of people inhabitants of different “barrios” [district] from the zone east of the capital, Caracas (in Venezuela “barrios” talks about to centres populated by people of low economic resources). They mentioned that the problems that affect their respective communities, in sequence of more importance are: 1) Safety, 2) Potable water shortage, 3) Infrastructure (stairs), 4) Black waters, 5) Light (electrical service), 6) Transport, 7) Sweepings and 8) Gas.

    As the two problems of greater relevance were the safety and the water the proposed projects would be: A) To construct a police module in a central point of the district from which all the sector can be covered without greater efforts and B) to place or to construct a great water tank (minimum 200,000 litters), at the top of the district with the idea to serve as reservoir for the moments of shortage in the sector.

    As far as the techniques multi-criteria that are going away to use it can say that the MOW are a numerical adjustment of rows and columns, where the usual thing is that in the first column the alternatives to be evaluated appear and in the following columns the criteria, leaving the first row to identify the respective criteria and the ranks of their weights and the remaining squares of the matrix to make the valuation itself, the Pij, that would be the weight that assigns alternative i according to criteria j, and the last column is reserved to complete the evaluation of each alternative, adding the accumulated points by the same one, in his respective row.

    On the other hand the models MM with multiplicative factors, respond to the general expression:

Pts = ∏k fgk * (∑ih fih * pci * (∑j pajci * vajci))                                                                                                                                            (1)

    Where, in (1): subscript i represents the criteria and subscript j the attribute, therefore pci will be the weight assigned to criteria i, pajci will be the weight to attribute j of criteria i, vajci will correspond to the value assigned to attribute j of criteria i, fih will represent the correction factors that operate for criteria i, fgk, the multiplicative factors general, where k enters the number of these factors, that operate for all the model, and Pts will be the total value reached about the project in study.

    Known as the techniques work multi-criterion to use and the case hypothetical the pair of models was created, on the one hand a MOW, that through seven criteria allowed the simple and fast evaluation of the two alternatives. On the other hand MM with multiplicative factors, which worked with five criteria, twelve (2 +2 +4 +2 +2) attributes altogether, a multiplicative factor, Perpetually, for each one of the five multiplicative criteria and two general factors Perpetually and Cost. Just as the MDP, the MM with multiplicative factors, also of fast and simple form managed to choose which the project was more indicated to be undertaken.

    As conclusion could be seen, that more important that the results of the hypothetical example, were the construction of both models, that are very simple and easy to construct and that they allow a clear selection between social projects that they can be undertaken by a community, aspect this one that do not allow other technical multi-criteria as they could be AHP.


Keywords: Multi-criteria, Matrix Of Weighing, Multiattribute Models, Social problems, Multiplicative factors.


II-2 Fuzzy-Based Models and Hierarchy Procedures as a Tool for Suburban Area Classfication

Prof. Dr. Ludmilla Koshlai, Glushkov Institute of Cybernetics

Department of Mathematical Cybernetics


Prof. Dr. Mikhail Mikhalevich, Ukrainian Academy of Foreign Trade,

Department of Systems Analysis



    The interaction of urbanization processes and inadequate development of infrastructure in post-socialist countries has been generated a number of interrelated economic, social, ecological and technical problems. Many of them concentrate within the suburban area of large cities, when intensive labour migrations, both legal and illegal, take place. In essence, these problems are typical examples of complex societal problems and Compram method could be applied for their solution. We consider the situation arisen in suburbs of Kiev (the largest city of Ukraine and its capital) as typical for Compram. The establishment of legal provision for the relations between city and regional authorities was determined as a mental idea at the first sub-cycle of the mentioned method. Geographical limits of suburban area were defined using fuzzy-based models; the choice of alternatives for legislation development was made on the basis of analytical hierarchy procedures. The further discussion demonstrated the necessity of classification of suburban area into several sub areas with different decision-making rules and interaction procedures for local, regional and city authorities in each of them. Such classification also has been made using methods of fuzzy set theory, ordinary regression and hierarchy analysis. An important advantage of this approach is the possibility to take into account imperfect, weakly structured information, in particular the ordinal expert estimations.  The generalization of “gravitation” model was constructed for these purposes. Its analysis demonstrated the existence of the following suburban sub areas:

            a) “compact” agglomeration, i.e. the populated areas located around the large city at the distance between borders from each other which is not more than 1 km ;

            - area with strong gravity to the large city; the value of membership function for the fuzzy set of areas with strong gravitation is greater than 0.9;

            - area with moderated gravity to the large city; the value of the mentioned membership function laying between 0.8 and 0.9;

            -  periphery of suburban area; the value of  membership function changes between 0.6 and 0.8.

    Proposals for legislation development were elaborated using the hierarchy decision-making model. The establishment of consultive-advisory body, which would coordinate the activities of city, local and regional authorities, related to the suburban area, and would take into account the interest of local governing institutions of the suburban area is considered as the main direction for legislation improvement. Functions of this body will be differ for different parts of suburban areas. Practically all kinds of activity of city, regional and local authorities must be coordinated for “compact” agglomeration and such coordination is necessary only for strategic decision concerning the periphery of suburban area.

    Obtained results are compared with conclusions received by alternative approaches. It allows us to elaborate semantic and casual models for suburban area.  These results create the basis for next Compram sub-cycles; taxation, ecological and emergency problems, infrastructure development will be their subject. The approach suggested is universal enough. It could be applied towards the research of interaction processes of a big city and a suburban area for both transition and developed market economy countries.


Keywords: urbanization, complex societal problems, Compram, fuzzy set theory, hierarchy analysis.


II-3 From Participatory Budgets To E-participatory

Budgets: Models, Methods And Systems

Roman Efremov a, Alexander Lotov b, David Ríos Insua a

a Statistics and Decision Sciences Group, Rey Juan Carlos University, Tulipan s/n, 28933, Madrid, Spain

Rey Juan Carlos University , c/ Tulipan,

s/n, Dpto II, Desp 259, 28933, Mostoles , Madrid , ,

b Department of System Analysis, Lomonosov Moscow State University, GSP-2, Leninskie Gory, Moscow, 119992, Russian Federation

From participatory budgets to e-participatory budgets: models, methods and systems


    Due to the increasing demand for citizen participation in public decision processes, Participatory Budgets (PB) are becoming increasingly popular all over the world, see e.g. Ríos et al. (2005) for more information and references. They are an attempt to allow citizen to have a word and aid in deciding and approving how public budgets are spent. However, no formal modelling or quantification of citizen preferences is usually undertaken and no formal negotiation or group decision support tools are used, there being little methodology available in this field and Information Technology are scarcely used in them.

    Information Technology opens up many possibilities to support stakeholders. Indeed, many authors have dwelt on how Internet is changing the way people interact with governments. However, so far, most ideas relating Internet and politics, have been directed towards facilitating traditional political methods through IT, as with voting instead of voting with a piece of paper. The most challenging goal is to actually transform public decision-making processes.

    There are already several examples of systems used or about to be used for public decision support. From the analysis of such tools, a number of features that we should demand from them can be formulated. First of all, as the system will be used by the general public, we should not expect much sophistication from users. Therefore, emphasis should be placed on user-friendliness in interfaces. This does not entail, however, neglecting rigorousness of the implemented methods.

    Given these prerequisites, we describe here a framework for participatory budget elaboration support. The aim of our study is to develop user-friendly procedures implementable on the web that can collect information about the stakeholders’ preferences and help to transform this information into a group decision in a fair and transparent manner. The procedure should be simple enough for lay stakeholders who are not quantitatively sophisticated decision makers.

    The two procedures we propose could be divided into two stages, once the problem has been formulated. First, the stakeholders express their preferences in some form. Then, the preference information is used to help stakeholders in constructing the group decision.

    A successful framework for the second stage comes from bargaining theory, introduced by Nash (1953). In particular, the balanced increment method (BIM), a method based on the discrete version of Raiffa’s solution of balanced increments, see Raiffa (2002), is used to offer interactively to participants reasonable group solutions. Together with the general architecture for PB support, it constitutes PARBUD - a system for PB support, see Ríos (2005). We then discuss the experiment run with PARBUD, which showed, on the whole, its appropriateness for PB support but also difficulties in some preference modelling concepts used there.

    The model based on balanced increments arbitration and the probability equivalent method for preference modelling is theoretically well defined but may be too sophisticated for some users. Another approach was aimed at solving this problem through goal identification and regret analysis, see Efremov et al. (2006). It was shown that the model based on goal programming may be used for preference modelling, the experiment has showed that this approach can be implemented in an intelligible way for stakeholders. Technically it permits constructing a surrogate value function that can be used, particularly, in the BIM negotiation scheme.  We then discuss an experiment run with the preference modelling tool based on this approach, see Efremov and Ríos-Insua (2006), that showed us its suitability for preference modelling and the need of further experiments currently on its way.



Efremov R., Ríos Insua D., Lotov A.(2006) A framework for participatory group decision support over the web based on Pareto frontier visualization, goal identification and arbitration: Rey Juan Carlos University Technical Reports on Statistics and Decision Sciences.

Efremov R., Rios-Insua D. (2006) An experimental study of a web-based framework for group decision support with applications to participatory budget elaboration: Rey Juan Carlos University Technical Reports on Statistics and Decision Sciences.

Ríos J., Ríos-Insua D., Fernandez E., Rivero J. A.(2005) Participatory Budget Formation Through the Web: Lecture Notes in Computer Science, Springer, 268-276.

Nash J. F. (1950). The bargaining problem. Econometrica 18: 155-162

Raiffa, H. (2002) Negotiation Analysis, Harvard University Press.

Session III:         Societal complexity and Healthcare

Stream: Methodology of Societal Complexity

Chair session: Dr. Dorien J. DeTombe

International Research Society on Methodology of Societal Complexity

Chair Euro Working Group on Methodology of Societal Complexity

P.O. Box. 3286, 1001 AB Amsterdam,

The Netherlands , Europe Tel: +31 20 6927526



III-1  E-health in the Netherlands

Cor van Dijkum, Utrecht University , Faculty of Social

Sciences, -, Utrecht, Netherlands,


    In our modern society democratization, computer science and globalization changes the structure and functioning of healthcare. In the  Netherlands the base of healthcare was completed after the second world by the state using law regulations. With a rising economy in the seventies of 20th century  the luxury of democratization took it’s shape, also in the domain of healthcare. From an object of treatment of professionals, patients became a participant in the process of recovery. Patients and their relatives, stimulated by the state, got involved in healthcare policy making.  Professionals at first were surprised and seem to get  out of power. However soon they retained  and by using technologies of computer science they strengthened their instruments of administration and control. With  the state at the end of the 20th century leaving healthcare to the free market, patients became thereupon weak actors in a complex free market system that operated businesslike and was mostly controlled by professionals and insurance companies. The globalization of this system made it more complex for patients. In principle introducing more possibilities and choices but in practice slippery because of lack of adequate information and unknown financial interests of globalizing professionals.

    However like in other domains of society citizens began to organize themselves as consumers of services. In a free market consumers of healthcare could ask the best quality for the lowest price.  In the beginning of the 21th century unions of consumers used public information (collected by  state inspectors of healthcare) and results of own survey research questioning patients to articulate quality of somatic healthcare. It was published on Internet what hospitals were the best,  for instance concerning  mortality and failure rates. Specialized groups of patients, for example focusing at rheumatism, made their own website publishing facts, personal experiences and opinions of patients.  Also for the mental healthcare a rich collection of patient oriented sites can be found in the Netherlands .

    Those patient sites somewhat counter-balanced the sometimes the unilateral  information professionals gave on Internet. However for both actors the free market introduced ambivalence between competition and cooperation. The challenge both for professionals and patients in our modern hectic society is to overcome this  tricky ambivalence and to realize a genuine partnership.

Internet is a new medium to shape this partnership by giving balanced information for (potential) clients of healthcare. When it is leaded by professionals by giving relevant information of the side of patients. When it is made by patients by using adequate information of professionals. In this way information is given with which the demand of a (potential) client can be matched with an adequate supply of a professional.

With a case-study from mental healthcare it is illustrated how ‘a patient site’ try to give this information. The site aims at (potential) clients of mental healthcare that have  a problem, for example in the identification of the mental problem they have, or  concerning a search for a matching professional, or what to do with a job that seems to cause the problem. The site presents results of investigation of patient experiences with such problems in the shape of a decision support system. Adequate information from professionals is included, as  well as results of research of professionals about this problem. All is viewed from the patient perspective.


Keywords: Complex Societal Problems , Health Care, Internet, Decision support, Patient’s perspective


III-2 Assessing Probable Risks in Hospital Medical Record Department

Mohammad H. Yarmohammadian, Health Services

Administration, Isfahan University of Medical Sciences, Hezar Jarib St. Azadi Square,, Medical Management School,, 81745-164, Isfahan, Isfahan, Iran, Islamic Republic Of,


Hospital CEOs and Health Managers have great responsibility to assure safety and maintenance of patients data,and legal usage and processing of data,as well as defying and preventing probable risks that might be occurred in medical records depts. This study aim to indentifying probable risks in Medical records department with taking advantages of Risk assessment and management techniques. Alzahra Great Hospital as one of largest special hospital in Iran has choosen as the field of study, and data gathered by RPN, and FMEA Model used to assess, and reduce risks in Medical record depts.


III-3 Systems Approaches to Solving Practical Problems

Prof. Dr. Slavica P. Petrovic, Faculty of Economics, University of Kragujevac,

D. Pucara 3, 34000, Kragujevac , Serbia , Serbia ,


According to its interdisciplinary nature, systems thinking, through suitable theories, methodologies and models, can significantly help to enhance dealing with complexity. Applied systems thinking, represented by the systems methodologies for structuring problem situations, is aimed at creative intervening in the real world, i.e. solving practical management problems. In comparison with the management .fads., high status ought to be granted to applied systems thinking due to theoretical, methodological and practical capacities of the systems approaches to solving complex problems.


III-4 Using Complex Adaptive Systems Theory to Examine the Internal Supply Chain of a U.S. Hospital’s Peri-operative Services System

Dr. Lawrence D. Frendendall

Department of Management, Clemson University ,123 B. Sirrine Hall Clemson , SC 29634 , 864-656-2016

Dr. Janet B. Craig, School of Nursing , Clemson University

#530 Edwards Hall, Clemson , SC 29634 , 864-422-8302


In 2000 the National Academy of Sciences published the first of multiple monographs that focus attention on errors in healthcare (IOM, 2000).  Healthcare in general, and acute care hospitals specifically are under intense scrutiny and increasing environmental pressure to improve patient safety and reliable outcomes while constraining costs to the payers and maximizing their own margins.  Within hospitals, the Perioperative Service can be viewed as a scaled down model of challenges that face the entire hospital e.g. increased demand from an aging population, advances in costly medical technology, shrinking reimbursement, and logistically complex operations (Friedman, et al., 2006).  This paper examines the perioperative service of a medium sized hospital (280 beds) using a prospective, hypothesis generating approach through the lens of complex adaptive system theory to identify the sources and types of complexity in the system. It then examines the barriers and opportunities for application of lean principles to reduce complexity and increase the reliability of the supply chain flow.

    Many researchers report that the structures, incentives, and forces at work in healthcare have produced highly variable patterns of care delivered by a poorly coordinated system that results in excessive costs and risk.  Hospitals often fail to implement best practices and standards, and do not achieve substantive improvements (Coyle, p.10).  However, sources of the failure to adopt proven practices on a widespread basis is not well understood. 

    The peri-operative unit of a hospital has three primary external customer groups: 1) surgeons who often influence where patients have surgery based on their own preferences for performing operations; 2) patients who receive services and may pay all or part of the charges based on third party pay benefit plans; and 3) private insurers who competitively negotiate reimbursement rates with the hospital.   Internally in the hospital, surgical inpatient nursing units receive and provide postoperative care for patients’ whose procedures are serious enough to qualify for inpatient status, while the remaining patients are discharged and referred back for follow-up to their surgeon.  

        Medical researchers argue that healthcare and perioperative services can best be understood as complex adaptive systems (CAS), but there is little empirical research supporting this assertion (Hoff et al., 2004).  Plsek (2003) used CAS to explain the diffusion of innovation in health care. Tucker (2004) and Tucker and Spear (2006) support the notion that healthcare organizations and their operational units, e.g. nursing and pharmacy, are examples of CAS, but they do not provide a theoretical model of complexity or make explicit the impact of flow within the internal supply chain.  Christian, Gustafson, Roth, et al. (2006) suggest that the operating room is one of the most complex work environments in healthcare due to patient variability, treatment protocols, technology, and the coordination necessary to achieve reliable outcomes.  

    Others have argued that the application of lean principles to healthcare will increase reliability along with quality and safety. But, there are many unanswered research questions about the application of lean management to the service industry.

    It is possible that a systems view, which requires managers to view outcomes as the result of an interconnected set of processes, as well as standardized work practices will result in improvements (Hoff, 2004). 

    We analyze the flow of information, materials, task, and roles in the perioperative service, identify sources of random and artificial variation that contribute to complexity, and propose strategies to reduce complexity.


Session IV: : Prof. Dr Ken Bowen memorial session

Stream: Methodology of Societal Complexity

Chair session: Dr. Dorien J. DeTombe

International Research Society on Methodology of Societal Complexity

Chair Euro Working Group on Methodology of Societal Complexity

P.O. Box. 3286, 1001 AB Amsterdam,

The Netherlands , Europe Tel: +31 20 6927526


On behalf of the Euro Operation Research Society , the Irish Operation Research Society and the International Research Society on Methodology of Societal Complexity we are very sad to announce that Professor Dr Ken Bowen passed away last Friday the 16th of March, 2007 at age 87. He died suddenly after working in his garden at his lovely home in Guilford , England .

Prof. Dr Ken Bowen was a good and enthusiastic scientist who’s knowledge exceeded the boundaries of his own field by large. He is an example for all of us of the qualities of a real scientist: able to do good and thorough resarch on his own and in cooperation with others; able to stimulate new comers and youngsters in the field; open to new ideas, yet critical where needed and positively supporting the good ideas of others. He was always willing to reflect different points of view and was able to comunicate carefully. Many beginning scientists benefited from his supportive comments, broad knowledge and guidance. Bringing people together from quite different fields was another one of his strengths. After participating in Operational Research for so many years he became a well known and very respected scientist in the field, he was aquainted with many people, had a good overview of the current state of the subject and became a good friend of many of us. Prof. Dr Ken Bowen worked until the last day of his long life on his science.

After a long career dedicated to the Royal Navy of Great Britain, which provided him with extensive experience and the opportunity to see the world, he completed his doctoral dissertation and dedicated the last 25 years to science, emphasizing that complex societal problems can best be handled in scientific and practical ways, as opposed to waging wars. In this regard, one of his last publications is very interesting to read. See: Volume 8 Global Safety and Terrorism

Prof. Dr Ken Bowen was an active and an enthusiast member of the Euro working group on Societal Complexity. We are happy to have had the opportunity to work closely together with him and are grateful to have had his continued support for our work through enthusiastic discussions. We are sure that we speak for many when we say that we will miss Ken, as a scientist, but most of all as a human being, a good friend, a good companion. We know that being able to participate in scientific inquiry to the end of his life, and being able to go to conferences, as well as supporting youngsters gave Ken a lot of pleasure. Ken and his lovely wife Barbra were also very hospitable and invited many of us to their wonderful home at the top of the hill in Guilford , were we enjoyed many discussions on science, gardening, raising children, politics, ceremonies and poetry while listening to lovely music. He also enjoyed accompanying us on visits to the local museum.

Ken Bowen was a great man, a great personality, and an independent thinker. We want to extend our sincere condolences to his lovely wife Barbara, their children and grandchildren who have lost a great husband, father and grandfather.

Dear Ken, thank you for the change to know you. We will miss you and Barbara at our future conferences. We will not forget you and will stay in contact with Barbara.


©Dorien J. DeTombe, All rights reserved, first published May 2007 , updated May 2008