Grasping the concept of systems thinking is essential to being a social innovator in the health field. i Modelling and simulations are thought to have significant potential for improving decision-making in health … Well-functioning health systems are critical in mounting effective responses to emerging public health emergencies, and addressing burden of disease, ... dynamic complexity and systems thinking. BMI Screening in Schools 2011, Boca Raton Florida: CRC Press, 2. Some see systems thinking as providing a powerful language to communicate and investigate complex issues, while others are confused by the sizable and amorphous body of theories, methods, and tools involved. Article  Strat Manag J. Kickbusch's (Kickbusch, 1989) principles provide a way into theoretical concepts that can inform ecological public health thinking. The term is associated with a wide variety of scientists, including the biologist Ludwig von Bertalanffy who developed General System Theory; psychiatrist Ross Ashby and anthropologist Gregory Bateson who pioneered the field of cybernetics; Jay Forrester, a computer engineer who launched the field of systems dynamics; scientists at the Santa Fe Institute, such as Noble Laureates Murray Gell-Mann and Kenneth Arrow, who have helped define complex adaptive systems [4]; and a wide variety of management thinkers, including Russell Ackoff, a pioneer in operations research, and Peter Senge, who has popularized the learning organization. To illustrate the Ten Steps to Systems patients and the public – a number of Thinking, we use a supply-side financing previously unconsidered issues arise. Cite this article. Many of the challenges in global health are now recognized as complex problems where simple blueprint approaches have limited success [5, 6]. Systems thinking is a core skill in public health and helps health policymakers build programs and policies that are aware of and prepared for unintended consequences. Sterman JD: Business System Dynamics: Systems Thinking and Modeling for a Complex World. In his landmark address on “Why Model?”, which provided inspiration for this essay, Joshua Epstein identified 16 reasons other than prediction on why to model [36]. Health Policy Plan. Poor population health can have detrimental economic impacts, for example. Health Res Policy Syst. PubMed  A systems-approach to population health operates under the notion that community health improvement involves more than just stand-alone disease prevention and treatment programs. In the rapidly changing field of global health, it is hard to know whether the recent attention to systems thinking is just another fad, or something more durable that offers usable insights for understanding and action. Epstein JM, Axtell R: Growing Artificial Societies: Social Science from the Bottom Up. 2014, 12: 44-. The word system is derived from the Greek sunistánai, meaning “to cause to stand together.” If we consider that a system is a perceived whole, made up of parts that interact toward a common purpose, we recognize that the ability to perceive, and the quality of that perception, is also part of what causes a system to stand together. When the aging portion of the population is in better health, there is less stress on health and economic systems. Observing that elements of systems thinking are already common in public health research, the article discusses which of the large body of theories, methods, and tools associated with systems thinking are more useful. Health Res Policy Syst. These support services not only enable population health professionals to focus on what they do best but also ensure population health funds and services reach people in communities that need them most. Apply a Holistic Approach to Solving Problems Difficulties in solving problems often stem from the fact that they do not occur in isola-tion, but rather in relation to each other. California Privacy Statement, While a range of systems methodologies exist (or are in the process of being developed and refined within a public health context), the most advanced systems methodologies seek to model systems and/or subsystems, in order to identify potential points for intervention and change. This can lead to identifying possible policy solutions that may not have been readily apparent, which can be helpful in the realm of using policy to improve the health and wellbeing of populations. If we are addressing community health challenges, it is essential to … expands the range of choices available for solving a problem by broadening our thinking and helping us articulate problems in new and different ways statement and When the older population maintains good health for longer, they are able to be productive workers in society for longer and reduce demand on an already inundated healthcare system. According to the Oxford dictionary, a convivial atmosphere is one that is friendly, lively and enjoyable. how to integrate systems thinking. For example, “systems archetypes” help teams to understand generic patterns of interaction that can be applicable to their “story” [24]. When resources and social services are provided to families in need, the overall health of each household can increase, which can then be scaled to improve the overall health of communities. In this supplement, a number of studies use CLDs that describe relationships between different elements of a health system to explain phenomena such as dual practice of health workers in Uganda [25], provider payment systems in Ghana [26], and childhood vaccination coverage in India [27]. The discipline of systems thinking is useful for seeing and … In this supplement, Rwashana and colleagues use systems dynamics models to examine neonatal mortality in Uganda [28], while other authors use systems dynamics models to examine the effects of policy interventions [29]. The elements of a CLD might also be converted into a quantitative systems dynamics model by classifying the elements as “stocks”, “flows”, or “auxiliary” variables, and using equations to describe the relationships between individual variables in one of many available systems dynamics software environments. 1994, Ann Arbor: University of Michigan Press, Eldredge N, Gould SJ: Punctuated equilibria: an alternative to phyletic gradualism. Systems thinking is defined as a practice that takes a comprehensive approach to complex events or phenomena seemingly caused by a myriad of isolated, independent, and usually unpredictable factors or … map out the network of actors involved in physician’s seeking advice in Pakistan [30]. Springer Nature. It is important for communities and health experts to advocate for equitable access to health services in underserved communities, with a focus on reducing disparities. reform of health care systems in the Republic of Georgia reflecting the importance and usefulness of applying Systems Thinking approaches. There are also other factors involved, such as resources to improve health behaviors, quality of life, and safety. A common thread of all these theories, methods, and tools is the idea that the behavior of systems is governed by common principles that can be discovered and expressed. One of the key diminishing factors of population health is the lack of access to health services and facilities. For example, where individual people interact directly with one another (e.g., transmitting disease) while moving about in an explicit space such as a city, agent-based modeling [1, 2] may be especially powerful. Communities flourish when health services are accessible to all and when systems adapt as community needs change and technology advances. Systems thinking adds to the theories methods and tools we otherwise use in global health, and provides new opportunities to understand and continuously test and revise our understanding of the nature of things, including how to intervene to improve people’s health. A sustainable community is one whose actions don’t diminish the social opportunities and ecosystem health for future generations while being resilient against social and ecological shocks or changes. Health Res Policy Syst. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. Malik AU, Willis CD, Hamid S, Ulikpan A, Hill PS: Advancing the application of systems thinking in health: advice seeking behavior among primary health care physicians in Pakistan. A system is a set of interrelated parts that form a whole. The application of systems thinking in health: why use systems thinking? When people from varying socio-demographic groups are simultaneously accessing different private and public health facilities for different services, it is much more difficult to conclude what the real needs are and where the real gaps lie. Understanding mental health with systems thinking. PubMed Central  Beyond the contributions of any particular theory, method, or tool, the practice of systems thinking can reinforce what Epstein calls a “militant ignorance”, or commitment to the principle that “I don’t know” as a basis for expanding scientific knowledge. 1978, London: Pitman, Ashby WR: An Introduction to Cybernetics. 1. Systems thinking has typically some of the following characteristics: the issue is important; the problem faced is not a one-off event; the problem is familiar and has a well-known history and people have unsuccessfully tried to solve the problem before. I also appreciate the comments received from Josh Epstein. 1993, Cambridge, MA: Pegasus Communication. 2014, 12: 36-10.1186/1478-4505-12-36. Health equity addresses the varying levels of access to opportunities for health improvement among different groups. For example, a woman may choose to go to a private doctor for an annual exam, but then choose to go to a free clinic in order to receive other services. 1993, Chicago, IL: University of Chicago Press, Epstein JM: Generative Social Science Studies in Agent-Based Computational Modeling. How does an aging population impact health systems? Notes that a systems view emphasizes relationships, transcends boundaries, bridges silos, and embraces heterogeneity. But even if you’re intrigued by the possibility of looking at business problems in new ways, you may not know how to … In addition to accessibility, population health measures tend to focus on preventing communicable and chronic diseases. It is to these uses that we now turn. Rwashana Semwanga A, Nakubulwa S, Nakakeeto-Kijjambu M, Adam T: Advancing the application of systems thinking in health: understanding the dynamics of neonatal mortality in Uganda. This paper explores the question of what systems thinking adds to the field of global health. Family health usually includes programs like family planning, nutrition assistance for mothers and children, and pediatric care. A common thread is the idea that the behavior of systems is governed by common principles that can be discovered and expressed. Systems Thinking: A better way of problem-solving (7min read) Published on January 15, 2016 January 15, 2016 • 75 Likes • 14 Comments Conviviality. It is essential to look at determinants of overall health, the people most affected, and what kind of socio-economic impacts they may have. Several papers in this supplement use similar approaches for a variety of situations, including to build leadership capacity for health systems in South Africa [32], to develop sustainable physical rehabilitation programs in Nepal and Somaliland [33], and to build sustainable maternal and child preventive health services in Northern Bangladesh [34]. Public health activists in local communities are lobbying for zoning law requirements on property developers that they include paths for walking and biking in any new housing development, in order to make opportunities for exercise more readily available to residents. systems thinking approach to better deal with complex situations in health, environment, education, etc. This Commentary is part of the Thematic Series entitled: “Advancing the application of systems thinking in health”. Systems thinking is a process of self-awareness in which the nurse knows boundaries specific to clinical reasoning, personal effort, reliance on authority, and awareness of interdependencies. The author also gratefully acknowledges support from the Future Health Systems Research Programme Consortium through a grant provided from the Department for International Development (United Kingdom). It is important to evaluate current health trends and develop effective programs to address the unique health challenges within a community. 10.1002/smj.4250140304. 2010, Stanford, CA: Stanford University Press. We use systems thinking to apply the Baldrige Framework to US population health. Finally, the older and elderly population segments are also important to assess when measuring community health. San Francisco: Freeman Cooper, 1072-, Baumgartner F, Jones BD: Agendas and Instability in American Politics. Google Scholar, Forrester JW: Principles of Systems. Uganda Health Res Pol Syst. Google Scholar, Poston T, Stewart IN: Catastrophe Theory and its Applications. Innovation history (or change management history) is used to compile a history of key events, outcomes, issues that have cropped up along the way, and measures taken to address problems. Bishai D, Paina L, Li Q, Peters DH, Hyder A: Advancing the application of systems thinking in health: why cure crowds out prevention. Rather than attempt to sort out semantic nuances between these terms, the utility of systems thinking can be better appreciated by a brief look at some of its more commonly used theories, methods, and tools (Table 1). Thinking in Systems. Optimizing access to things like family planning, pediatric care, and breastfeeding support can have an immensely positive impact on population health. 2010, Oxford: Oxford University Press. For more introduction, I refer you to Pegasus Communications' What is Systems Thinking. Applying Systems Thinking to Obesity: Given the complexity of many public health problems, systems thinking is increasingly cited as an approach and competency needed to understand these problems. In this supplement, Zhang et al. Typically, feedback loops are identified between the different elements. Overcoming this challenge requires presenting systemic concepts and tools at the right “strategic moment,” when leaders are confronting a performance issue and are ready to learn a different approach. The shift to Whole Systems Thinking – be it through the evolution of the Primary Health Care Model in developing nations or the emergence of the New Public Health within the developed world – constitutes a change in the way that we think about the achievement of health gain that constitutes a paradigmatic shift. 2. 2010, 20 (8): 946-958. Many of these specific reasons relate to being able to explain how things work, and systems thinking is particularly useful to explaining how complex systems work. Constraints to applying systems thinking concepts in health systems: A regional perspective from surveying stakeholders in Eastern Mediterranean countries Fadi El-Jardali 1,23 4 5 *, Taghreed Adam6, Nour Ataya1, Diana Jamal , Maha Jaafar Abstract Background: Systems Thinking (ST) has recently been promoted as an important approach to health systems Thinking in Systems (TiS) can help public health professionals think more effectively, and systemically, about the issues they face. For these reasons, systems thinking is more a strategic than operational tool. The most challenging areas for population health improvement are within the urban populations where there is a broad range of economic, ethnic, cultural, and racial diversity. Systems thinking is way to make sense of a complex system that gives attention to exploring the relationships, boundaries and perspectives in a system. Privacy 1956, London: Chapman & Hall Ltd., [http://pespmc1.vub.ac.be/books/IntroCyb.pdf], Strogatz SH: Nonlinear Dynamics and Chaos. Agyepong IA, Aryeetey GC, Nonvignon J, Asenso-Boadi F, Dzikunu H, Antwi E, Ankrah D, Adjei-Acquah C, Esena R, Aikins M, Arhinful DK: Advancing the application of systems thinking in health: provider payment and service supply behaviour and incentives in the Ghana National Health Insurance Scheme - a systems approach. Paina L, Peters DH: Understanding pathways for scaling up health services through the lens of complex adaptive systems. If we are addressing community health challenges, it is essential to understand the connections across other social systems. Health Res Policy Syst. Importance and role of Systems Thinking The external and internal environments within which organisations, health systems and the society operate have become very dynamic and complex. Network mapping, social network analyses, and process mapping involve a range of tools to illustrate and analyze connections between people, organizations, or processes in both qualitative and quantitative ways. This usually results in cases of disease and sometimes death that may have been preventable. The paper reviews the origins of systems thinking, describing a range of the theories, methods, and tools. The real key to overcoming the population health challenges is increasing opportunities for collaboration among local health service providers, public health departments, and community partners. Managing population health means more than just focusing on disease prevention and research; it also aims to increase equitable access to health care and initiatives that address the overall health and well-being of a community. present a very simple systems dynamics model to illustrate the trade-offs and unintended consequences of policy choices related to allocation to preventive and curative services [29]. PubMed  Systems thinking is the most important discipline in Peter Senge’s Learning Organization Theory. They each address problems of complexity, which is a frequent challenge in global health. Article  The field of obesity in particular has benefited from systems thinking, methods and modeling, however, the application of these methods remains in an inchoate stage. Addresses the questions of what systems thinking and modeling are and why they are important with respect to public health. Manage cookies/Do not sell my data we use in the preference centre. Heluna Health is working to improve population health outcomes by providing fiscal sponsorship and other support services to organizations, helping to bridge gaps across systems and revitalize community health. Apply a Holistic Approach to Solving Problems Difficulties in solving problems often stem from the fact that they do not occur in isola-tion, but rather in relation to each other. It is much more challenging to discern what health services are truly lacking because the needs are less clear. Using a systems perspective to understand how health system building blocks, contexts, and actors act, react and interact with each other is an essential approach in designing and evaluating interventions. 2014, 12: 47-. Health Research Policy and Systems (2014) 12 (1) 51. We often make connections when conducting and interpreting research, or in our professional practice when we make an intervention with an expectation of a result. The objectives were to: (1) explore how systems methodologies are being applied within public health and (2) identify fruitful areas of activity. Peters, D.H. In addition, it may be difficult to isolate factors that may be contributing to poor health outcomes within a specific group and across groups. several recent projects have adopted systems thinking to tackle complex health problems and risk factors. Peters, D.H. Naturally, population health is optimized when people live longer with a higher quality of life. However, rather than relying on implicit models, with hidden assumptions and no clear link to data, systems thinking deploys explicit models, with assumptions laid out that can be calibrated to data and repeated by others. In their paper Six Steps to Thinking Systemically, Michael Goodman and Richard Karash introduced six steps to apply systems thinking principles while solving complex problems. 3. 1993, 14: 193-213. The real question is not whether we should be using systems thinking, as broadly described here, but rather, which of the many theories, methods, and tools currently associated with the field of systems thinking are most useful in particular settings. By empowering population health practitioners to innovate, Heluna Health is helping to improve access to care, prevent disease, and bring systematic change to communities. SYSTEMS THINKING Systems Thinking is a powerful set of problem solving tools and techniques based on system analysis and design, explained by Peter Senge in The Fifth Discipline, that helps us avoid unintended consequences and find optimal solutions to complex problems. For example, population health can be improved through things like anti-tobacco campaigns, clean air regulations, and child car seat voucher programs. Grasping the concept of systems thinking is essential to being a social innovator in the health field. Health Res Policy Sys 12, 51 (2014). Discussions around population health focus on the root causes of health problems, and the resulting outcomes from these issues. The entire foundation of this thinking style began in 1956 with Professor Jay Forrester at the Massachusetts Institute of … The benefit of systems thinking is that you can see problems caused by how the parts of your business fit together. Read more about the Prevention Centre’s approach to systems thinking Public health programmes can be designed to use these leverage points to push or pull a system in a different direction with the intent to change the behaviour of that system and improve health outcomes. Founded by Peter Senge, Innovation Associates brought the Systems Thinking approach into many Fortune 100 level businesses. 7 “Systems thinking is an approach to thinking about how things interact with one another,” he said. Population health is a field that has grown with increasing interest in recent years as professionals seek to improve public health systems and access to health resources. To find out how your organization can get involved in this type of change making, get in touch with Heluna Health, the new Public Health Foundation Enterprises. The author declares that he has no competing interests. Methods like Soft Systems Methodology provide a … And for those who value thinking and doing in global health, that can only be a good thing. In global health, we are concerned with both theory and practice, and are in need of models that match the complex conditions in which we work. © 2020 BioMed Central Ltd unless otherwise stated. By supporting health experts and community leaders to work together more effectively, Heluna Health supports communities to improve health outcomes. In much of public health and medicine, we use research evidence on the efficacy of interventions to inform decisions with an expectation about their future effect. Notes that a systems view emphasizes relationships, transcends boundaries, bridges silos, and embraces heterogeneity. At the core of this ecological public health thinking is the concept of conviviality. Systems thinking is a core skill in public health and helps health policymakers build programs and policies that are aware of and prepared for unintended consequences. This new way of thinking permits us to see things we didn’t see before. With systems thinking, you can use diagrams, graphs, and computer simulations to illustrate and model systems behavior. The Report offers practical explanations for complex issues ranging from the design of system-oriented interventions to evaluating their effects. The paper reviews the origins of systems thinking, describing a range of the theories, methods, and tools. 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