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The stipulation‐stimulation spiral: A model of system change

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  • Sara A. Kreindler

Abstract

This paper proposes a general model, based on what is known about the nature of (complex) systems, of how systems—in particular, health care systems—respond to attempted change. Inferences are drawn from a critical literature review and reinterpretation of two primary studies. The two fundamental system‐change approaches are “stipulation” and “stimulation”: stip(ulation) attempts to elicit a specific response from the system; stim(ulation) encourages the system to generate diverse responses. Each has a unique strength: stip's is precision, the ability to directly impact the desired outcome and only that outcome; stim's is resonance, the ability to take advantage of behavior already present within the system. Each approach's inherent strength is its complement's inherent weakness; thus, stip and stim often clash if attempted simultaneously but can reinforce each other if applied in alternation. Opposite patterns (the “stip‐stim spiral” vs “stip‐stim stalemate”) are observed to underpin successful vs failed system change: The crucial difference is whether decision‐makers respond to a need for precision/resonance by strengthening the appropriate approach (stipulation/stimulation, respectively), or merely by weakening its complement. With further validation, the model has the potential to yield a more fundamental understanding of why system‐change efforts fail and how they can succeed.

Suggested Citation

  • Sara A. Kreindler, 2019. "The stipulation‐stimulation spiral: A model of system change," International Journal of Health Planning and Management, Wiley Blackwell, vol. 34(4), pages 1464-1477, October.
  • Handle: RePEc:bla:ijhplm:v:34:y:2019:i:4:p:e1464-e1477
    DOI: 10.1002/hpm.2811
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    References listed on IDEAS

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    1. O'Reilly, Charles A., III & Tushman, Michael L., 2013. "Organizational Ambidexterity: Past, Present and Future," Research Papers 2130, Stanford University, Graduate School of Business.
    2. Trenholm, Susan & Ferlie, Ewan, 2013. "Using complexity theory to analyse the organisational response to resurgent tuberculosis across London," Social Science & Medicine, Elsevier, vol. 93(C), pages 229-237.
    3. Essén, Anna & Lindblad, Staffan, 2013. "Innovation as emergence in healthcare: Unpacking change from within," Social Science & Medicine, Elsevier, vol. 93(C), pages 203-211.
    4. Paul C. Nutt, 2008. "Investigating the Success of Decision Making Processes," Journal of Management Studies, Wiley Blackwell, vol. 45(2), pages 425-455, March.
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    Cited by:

    1. Tim Tenbensel & Pushkar Raj Silwal, 2023. "Cultivating health policy capacity through network governance in New Zealand: learning from divergent stories of policy implementation," Policy and Society, Darryl S. Jarvis and M. Ramesh, vol. 42(1), pages 49-63.

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