The necessity of a comprehensive response to the number and composition of oral healthcare teams in Iran using the system dynamics approach

Document Type : Letter to Editor


1 Dental Research Center, Research Institute of Dental Sciences, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran

2 Department of Community Dentistry, Faculty of Dentistry, Kerman University of Medical Sciences, Kerman, Iran

3 Institute of Biochemistry and Biophysics, University of Tehran, Tehran, Iran


Background: Considering the limitations of analytical models, it is recommended that modelling methods be used to solve complex social issues. Dynamic modelling helps policymakers to have a better understanding of system behavior. In health systems, considering the available resources and impact of decisions plays a key role in improving health. The lack of a dynamic and systematic attitude sometimes ignores the impacts, and the results are not desirable despite the cost. Considering the current situation, in this article, it is strongly recommended that a system dynamics approach be adopted to improve the health of society.
Methods: Using different articles, the use of modelling with a system dynamics approach has been introduced and emphasized.
Results: Studies indicate the promising role of modelling with a system dynamics approach in the cost-effective improvement of oral health.
Conclusion: It is suggested that oral health decision-makers should focus on applying existing data and using them in system dynamics modelling to forecast and predict new policies before implementing them at the community level.


Main Subjects

  1. Ahn J, Back KJ. Integrated resort: a review of research and directions for future study. Int J Hosp Manag. 2018;69:94-101. doi: 10.1016/j.ijhm.2017.10.017.
  2. Cave S, Willis G. System dynamics and workforce planning. In: Dangerfield B, ed. System Dynamics: Theory and Applications. New York, NY: Springer; 2020. p. 431-57. doi: 10.1007/978-1-4939-8790-0_659.
  3. Kirkwood CW. System Dynamics Methods. USA: College of Business Arizona State University; 1998.
  4. Krustrup U, Petersen PE. Dental caries prevalence among adults in Denmark--the impact of socio-demographic factors and use of oral health services. Community Dent Health. 2007;24(4):225-32.
  5. Sachan D. India looks to a new course to fix rural doctor shortage. Lancet. 2013;382(9899):e10. doi: 10.1016/s0140-6736(13)62058-9.
  6. O’Malley L, Macey R, Allen T, Brocklehurst P, Thomson F, Rigby J, et al. Workforce planning models for oral health care: a scoping review. JDR Clin Trans Res. 2022;7(1):16-24. doi: 10.1177/2380084420979585.
  7. Gallagher JE, Wilson NH. The future dental workforce? Br Dent J. 2009;206(4):195-9. doi: 10.1038/sj.bdj.2009.114.
  8. Radzicki MJ, Taylor RA. Origin of system dynamics: Jay W. Forrester and the history of system dynamics. In: US Department of Energy’s Introduction to System Dynamics. System Dynamics Society; 2008.
  9. Homer JB, Hirsch GB. System dynamics modeling for public health: background and opportunities. Am J Public Health. 2006;96(3):452-8. doi: 10.2105/ajph.2005.062059.
  10. Sadeghipour M, Khoshnevisan MH, Jafari A, Shariatpanahi SP. Friendship network and dental brushing behavior among middle school students: an agent based modeling approach. PLoS One. 2017;12(1):e0169236. doi: 10.1371/journal.pone.0169236.
  11. Sadeghipour Roudsari M, Shariatpanahi SP, Ebn Ahmady A, Khoshnevisan MH. Agent-based modeling: an innovative opportunity for population-based oral health promotion. J Dent (Tehran). 2016;13(2):73-6.
  12. Leerapan B, Teekasap P, Urwannachotima N, Jaichuen W, Chiangchaisakulthai K, Udomaksorn K, et al. System dynamics modelling of health workforce planning to address future challenges of Thailand’s universal health coverage. Hum Resour Health. 2021;19(1):31. doi: 10.1186/s12960-021-00572-5.
  13. Guynn I, Simon J, Anderson S, Klaman SL, Mullenix A, Cilenti D, et al. Tools for supporting the MCH workforce in addressing complex challenges: a scoping review of system dynamics modeling in maternal and child health. Matern Child Health J. 2022;26(Suppl 1):176-203. doi: 10.1007/s10995-022-03376-8.
  14. Atkinson JA, Wells R, Page A, Dominello A, Haines M, Wilson A. Applications of system dynamics modelling to support health policy. Public Health Res Pract. 2015;25(3):e2531531. doi: 10.17061/phrp2531531.
  15. Barber P, López-Valcárcel BG. Forecasting the need for medical specialists in Spain: application of a system dynamics model. Hum Resour Health. 2010;8:24. doi: 10.1186/1478-4491-8-24.
  16. Ishikawa T, Ohba H, Yokooka Y, Nakamura K, Ogasawara K. Forecasting the absolute and relative shortage of physicians in Japan using a system dynamics model approach. Hum Resour Health. 2013;11:41. doi: 10.1186/1478-4491-11-41.
  17. Vanderby SA, Carter MW, Latham T, Feindel C. Modelling the future of the Canadian cardiac surgery workforce using system dynamics. J Oper Res Soc. 2014;65(9):1325-35. doi: 10.1057/jors.2013.77.
  18. Wu MH, Yu JY, Huang CH. Theoretical system dynamics modeling for Taiwan pediatric workforce in an era of national health insurance and low birth rates. Pediatr Neonatol. 2013;54(6):389-96. doi: 10.1016/j.pedneo.2013.04.010.
  19. Royston G, Dost A, Townshend J, Turner H. Using system dynamics to help develop and implement policies and programmes in health care in England. Syst Dyn Rev. 1999;15(3):293-313. doi: 10.1002/(sici)1099-1727(199923)15:3 < 293::aid-sdr169 >;2-1.
  20. Koichubekov B, Kharin A, Sorokina M, Korshukov I, Omarkulov B. System dynamics modeling for general practitioner workforce forecasting in Kazakhstan. Ann Ig. 2021;33(3):242-53. doi: 10.7416/ai.2020.2391.
  21. Cave S, Willis G. Applying system dynamics and systems thinking methods to the development of robust workforce policies for the health and social care system in England. Int J Appl Syst Stud. 2016;6(3):239-57. doi: 10.1504/ijass.2016.079093.
  22. Rashwan W, Abo-Hamad W, Arisha A. A system dynamics view of the acute bed blockage problem in the Irish healthcare system. Eur J Oper Res. 2015;247(1):276-93. doi: 10.1016/j.ejor.2015.05.043.
  23. Semwanga AR, Nakubulwa S, Adam T. Applying a system dynamics modelling approach to explore policy options for improving neonatal health in Uganda. Health Res Policy Syst. 2016;14(1):35. doi: 10.1186/s12961-016-0101-8.
  24. Auping WL, Pruyt E, Kwakkel JH. Societal ageing in the Netherlands: a robust system dynamics approach. Syst Res Behav Sci. 2015;32(4):485-501. doi: 10.1002/sres.2340.
  25. Lee GM, Yoo KB. Development of a demand model for physician workforce projection on regional inequity problem in Korea using system dynamics. Health Policy Manag. 2022;32(1):73-93. doi: 10.4332/kjhpa.2022.32.1.73.
  26. Abas ZA, Ramli MR, Desa MI, Saleh N, Hanafiah AN, Aziz N, et al. A supply model for nurse workforce projection in Malaysia. Health Care Manag Sci. 2018;21(4):573-86. doi: 10.1007/s10729-017-9413-7.
  27. de Carvalho MN, Gil CRR, Costa E, Sakai MH, Leite SN. Needs and dynamics of the primary healthcare workforce in Brazil. Cien Saude Colet. 2018;23(1):295-302. doi: 10.1590/1413-81232018231.08702015.