| Course | DDHA 8503 Strategic Management and Systems Thinking |
|---|---|
| Week | Week 1 |
| Paper type | Doctoral discussion post with two replies |
| Length | About 650 words, 4 pages |
| Format | Discussion post, APA 7 citations |
| School | Walden University |
| Program | Doctor of Healthcare Administration (DHA) |
| Updated | October 2026 |
Free sample paper for DDHA 8503 Week 1
Week 1 Discussion: When a Fix Stops Working
The Two-Day Reply Rule Worked for One Quarter: How a Portal Message Standard Produced the Messages That Undid It
Brightwater Medical Group, a composite group of fourteen primary care clinics, set a standard two years ago that every patient portal message would receive a reply from the care team within two business days, tracked weekly on a clinic dashboard. For one quarter it worked. The share of messages answered within two days rose from about 60% to 88%. By the third quarter it had slid back to 70%, even though no clinic stopped trying, and by the fourth the inbox backlog was larger than before the rule.
What happened afterward is the interesting part. Clinicians met the standard at first by answering faster, and the fastest reply to a complicated message is a short one: "Please schedule a visit," or "Let's discuss at your next appointment." Those replies closed the message on the dashboard. They did not close the patient's question, so within a few days many patients wrote again, often twice. The arrival rate of messages, which the standard never addressed, began to rise about six weeks after the rule took effect. Meanwhile, medical assistants learned to convert difficult messages into telephone tasks, which removed them from the measured inbox and moved them into a phone queue no dashboard tracked. Each adjustment was sensible for the person making it. Together they formed a compensating response that pushed the backlog back up with a delay long enough to look like slipping discipline.
In the terms Sterman (2000) uses, the standard acted on a flow, replies per day, while the stock that mattered, unresolved patient questions, kept filling through a loop the rule did not see: quick replies generated follow-up messages, which raised arrivals, which raised the backlog the quick replies were meant to clear. Repenning and Sterman (2001) describe a related trap in which pressure to meet a performance target leads people to work faster rather than fix the underlying process, producing short-term gains that erode capability over time. The clinics did exactly that. Sinsky et al. (2016) found that physicians in ambulatory practice already spent nearly half their clinic day on electronic records and desk work, so a rule that asked for faster replies without removing other work could only be met by shortening the replies.
My reading is that the fix did not fail in implementation. It worked as designed on the variable it measured and provoked the system to restore the condition through a variable it ignored. I would like to hear how others would have spotted the second loop before the fourth quarter.
Reply to Adaeze
Adaeze, I read your case of the overtime cap on your surgical unit through the same lens, and I think there is a different loop at work than the one you named. You described the cap as failing because managers stopped enforcing it. Your own account suggests something else: after the cap, nurses who could not stay late left documentation for the next shift, the next shift started behind and incidental overtime moved from evenings to mornings, where the cap's report did not look. That is a shifting-the-burden pattern, where the symptom moves rather than resolves. Would morning overtime data show the rise you would expect if that were true?
Reply to Gareth
Gareth, your triage protocol example interested me because the decay you describe took almost exactly two quarters, like ours. You attributed it to staff turnover. I would add a delay worth checking. If the protocol shortened waits, word may have spread, and walk-in demand from neighboring areas may have grown over the following months until waits returned. Sterman (2000) emphasizes that delays in a feedback loop make its effects look unrelated to the original change. If your arrival data show a gradual rise after the protocol, the decline was partly the protocol's own success.
References
Repenning, N. P., & Sterman, J. D. (2001). Nobody ever gets credit for fixing problems that never happened: Creating and sustaining process improvement. California Management Review, 43(4), 64-88. https://doi.org/10.2307/41166101
Sinsky, C., Colligan, L., Li, L., Prgomet, M., Reynolds, S., Goeders, L., Westbrook, J., Tutty, M., & Blike, G. (2016). Allocation of physician time in ambulatory practice: A time and motion study in 4 specialties. Annals of Internal Medicine, 165(11), 753-760. https://doi.org/10.7326/M16-0961
Sterman, J. D. (2000). Business dynamics: Systems thinking and modeling for a complex world. Irwin/McGraw-Hill.
What the DDHA 8503 Week 1 instructions ask for
The first thread in this course asks for a fix you have seen work and then fade, explained as system behavior rather than as poor follow-through. Choose an ordinary case, such as a staffing rule, a triage change or a reporting requirement. Describe the original problem briefly. Spend most of the post tracing what happened after the change, in order: who adjusted, how and how long the adjustment took to show. Use systems terms such as stock, flow, loop, delay and compensating response to do actual work in your explanation. Support the pattern with one or two sources. In replies, read a classmate's case through the same lens and, where you can, propose a loop they did not name, with the evidence that would tell the two explanations apart.
How the DDHA 8503 Week 1 example is put together
The opening paragraph gives the clinic group, the two-day standard and the figures showing its rise and fall over four quarters. The second paragraph traces the sequence of adjustments: brief replies that closed messages without answering them, repeat messages arriving weeks later and difficult messages converted to phone tasks no dashboard counted. The third paragraph names the stock the standard ignored, unresolved patient questions, and ties the pattern to Repenning and Sterman's account of working harder instead of smarter and to Sinsky and colleagues' finding that desk work already filled half the clinic day. The fourth states the reading in one sentence and asks how classmates would have spotted the second loop sooner. One reply recasts an overtime cap as shifting the burden to morning shifts. The other adds a delayed demand response to a triage case.
Where the marks sit in the DDHA 8503 Week 1 rubric
Markers in this opening thread look for a reversal explained by structure, not by blame. A post that says staff stopped complying, or that leadership lost interest, misses the week's point. Credit grows when the post follows the sequence of adjustments in time and names who changed behavior. Systems vocabulary must carry the explanation; terms dropped into one sentence earn little. A small number of sources that support the named pattern count for more than a long list. Brevity matters, since the thread rewards a sharp argument in a few paragraphs. Replies are judged on whether they apply the same reading to a classmate's case and add a loop or delay the original post missed, and every in-text citation should match an entry in the reference list in APA form.
DDHA 8503 Week 1 help from the desk
The commonest misstep is describing the original problem at length and leaving one paragraph for what happened afterward. Reverse the proportions. Another is calling the reversal an implementation failure, which ends the analysis just where it should begin. Ask who changed their behavior after the fix and why that change made sense to them. Look for a variable the fix did not measure, because the system usually restores itself through one. Be precise about timing, since delays are what make these patterns hard to see. In replies, avoid agreeing; offer a rival loop and say what data would settle it. If you want a post written around a fix from your own workplace, we can draft one to your prompt.
Get a DDHA 8503 Week 1 example written to your instructions
Send the Week 1 thread prompt and the rubric posted in your classroom, and a finished post with replies returns inside 24-48 hours, free the first time, with the peer replies attached and the loop named. Threads reference a made-up health system, since the internal postmortems circulated at a workplace are private and stay that way.
More DDHA 8503 papers and DHA samples
- DDHA 8503 Week 2: System Description
- DDHA 8503 Week 3: Causal Loop Analysis
- DDHA 8503 Week 4: Environmental Scan
- DDHA 8503 Week 5: Stakeholder Analysis
- DDHA 8503 Week 6: System Boundary Post
- DDHA 8503 Week 7: Scenario Set
- DDHA 8503 Week 8: Intervention Design
- DDHA 8503 Week 9: Consequence Review
- DDHA 8503 Week 10: Alignment Audit
- DDHA 8503 Week 11: Strategic Plan
- DDHA 8303 Week 1: Researchable Questions Post
- DDHA 8203 Week 1: Clinic Constraint Post
- DDHA 8113 Week 1: Authority Versus Influence Post
- DDHA 8103 Week 1: Harm Despite Controls Post
DDHA 8503 Week 1 questions, answered
Where can I find a free DDHA 8503 Week 1 sample paper?
This page shows the full post on the faded two-day reply standard, both replies and the references, at no cost.
What fix does the DDHA 8503 Week 1 example examine?
A rule that every patient portal message get a reply within two business days, tracked weekly on a clinic dashboard.
Why did the two-day standard stop working?
Quick replies closed messages without answering them, so patients wrote again and the arrival rate rose about six weeks later.
Which variable did the standard ignore?
The stock of unresolved patient questions, which kept filling even as reply speed improved.
What do the replies add to classmates' cases?
One reframes an overtime cap as moving the problem to morning shifts; the other suggests a delayed rise in walk-in demand.