From Blind Chaos to Clarity: Master 5 Systems Thinking Tools

Search site

Blip-Zip Summary

Master systems thinking tools to navigate the next pandemic’s complexity. Explore how systems thinking and collaboration across sectors and data-driven insights can inform effective pandemic response strategies, building resilience for the future This case study unveils the power of systemic data analysis, collaboration, and modeling in mitigating the next pandemic’s impact.

Blip-Zip Takeaways

Harness systems thinking: Understand the interconnectedness of the pandemic.
Collaborate across sectors: Work together with diverse stakeholders to implement effective solutions.
Actionable insights: Use data to guide effective interventions
Embrace adaptability: Continuously learn, adapt, and improve based on ongoing feedback.

Key Words and Themes

Systems thinking in public health, COVID-19 response strategies, Complex adaptive systems (CAS), Social determinants of health (SDOH), Collaboration in healthcare

Table of Contents

Case Study: Systems Thinking For the Next Pandemic

The 2019–20 coronavirus (COVID-19) pandemic was ongoing. The pandemic began in Wuhan, China, and spread rapidly, with cases confirmed in almost every country.^1,2 This case study summarizes the importance of applying systems thinking tools and coordination between individuals, communities, and institutions at all levels to defeat a complex slow-moving invisible virus.

Part 1 describes the nature of emerging environments and the application of systems thinking principles and tools. Part 2 summarizes how data and trends provide the foundation for aspirational goals followed by interventions. Finally, Part 3 challenges leaders to work collaboratively and laterally across boundaries at all levels of society and the world to systematically mitigate the virus.

Part 1: Unstructured and Unfamiliar Environment

A Complex Adaptive System (CAS), Figure 1, exhibits stable or ambiguous behaviors such as the COVID-19 outbreak. Parts of the system do not convey a perfect understanding of the whole system. Instead, they may provide early indicators or signals.

The outbreak was first identified in December 2019. The World Health Organization (WHO) declared the outbreak to be a Public Health Emergency of International Concern on 30 January 2020 and recognized it as a pandemic on 11 March.^3,4

While CASs represent the whole, they are more complex than their parts.

Emerging patterns (i.e., symptoms, disease onset, supply chain breakage, or travel patterns) of outbreak behavior (i.e., speed, frequency, and reach of spread), risks (i.e., prioritization of response assets such as PPE allocation and available vaccines), constraints (i.e., surge capacity, staffing, infrastructure, and fear), and impacts (i.e., front line health workers, deaths, mental health, and economics) begin to form patterns.

CASs too, are adaptive. Based on feedback loops, they are constantly forming and reforming. Most never return to their original form.^5,6

Feedback loops are important features of CASs, especially when data begins to drive options for overall protection (i.e., equipment, vaccines), response (i.e., healthcare infrastructure), and recovery (i.e., beds, ventilators) given the surge projections and healthcare capacity.⁵

The emergence of a new reality is formed as a result of interactions, signals, and patterns in the environment. As systems evolve, social networks become activated.

As the COVID-19 outbreak social networks, their agents and actors forge relationships between nodes or social determinants of health (SDOH): public health, healthcare, social services, transportation, economic, public safety, food, schools and communication systems, etc. These networks constantly seek equilibrium.

Through the interactions of social networks and assessment of patterns, agents, and actors attain greater situation awareness.⁵ They begin to crystallize an unstructured environment.

As illustrated in the diagram below, a causal loop diagram (CLD) aids in visualizing how different variables in a system are interrelated—actions, information, and results. The CLD diagram consists of a set of nodes and edges. Nodes represent the variables such as number of test kits, stations, and processes to acquire results.

Edges are the links representing connections or relations between variables such as the availability of inventory of masks, gloves, and gowns.⁵

Stocks and flows add a higher level of analysis. Unlike CLDs, stock and flow diagrams as illustrated in the adjacent diagram, differentiate between the parts of the system such as patient flow, equipment optimization, and bed availability.

They include more details about the elements of the system than do CLDs.⁵ It must address the root causes or underlying sources of problems and provide a vision for the future.⁶

Figure 2, connection circles help teams understand the complexity and interdependence of pandemics. For example, teams generate ideas about changing conditions and actions within a system. To become more informed through the application of analytic tools.

As systems are modeled, simulated, and analyzed, co-evolution drives new systems and subsystems to interact and influence each other.5 In the current fight against COVID-19, healthcare, public health, and economic systems and respective policies and interventions the systems evolve and adapt to each other oftentimes with intended and unintended consequences.

Asking “what if” questions using data helps leadership teams develop the best policies and interventions such as self-isolation, social distancing, economic aid, and travel restrictions.

Part 2: Crystallizing an Unstructured Environment

A Behavior over Time Graph (or BOTG) is a simple graphic such as a line graph to show patterns of change over time. A BOTG as illustrated in Figure 3 shows how something increases and decreases as time passes or correlates with other variables over time.⁵ From the emerging situation, initial ideas, diagramming analysis, and BOTGs, collective insight adds value to the team process.

However, insight alone is not enough. Evidence provides an “AS-IS” foundation and should drive an aspirational “TO-BE” state.⁶

Then, insights and aspirational goals are translated into measurable policies and interventions (Figure 4). For example, efforts to prevent the virus from spreading include travel restrictions, quarantines, curfews, workplace hazard controls, event postponements and cancellations, and facility closures.

To be effective, an intervention must be unbiased, self-sustaining, self-correcting when needed, and measurable.

Part 3: “Whole-of-a-World” Approach

Using the Social Ecological Model in Figure 5, we can assess factors, barriers, and health communication strategies and challenges of prevention, protection, response, and recovery at several levels including the individual (intrapersonal), interpersonal, organizational, community, society and the ways they interact.^6,7

Figure 5 challenges systems-minded leaders to engage and mobilize partners across sectors and levels.5 Each must leverage the SDOH in accordance with the interventions and policies. The outcomes are evidence-driven results. For example, results of the COVID-19 interventions can be acquired through further data collection and dashboards such as the Johns Hopkins University COVID-19 Resource Center.⁸

Finally, constant intelligent inquiry should follow results to assess the progress, make adjustments as necessary, improvise when required, and seek out opportunities to improve.^5,6 To maximize feedback and good ideas, leaders should encourage inquiry and feedback in “psychologically safe” environments.

Beyond Leader Development: Insights to Igniting and Revolutionizing Strategic-Minded Leader Development for a Healthier Tomorrow

Summary and Conclusion

Readers should compare and contrast the current state affairs then, and today and ask: would a disciplined system think leadership at all levels have made a difference in today’s current fight against the pandemic?

As of this writing, COVID-19 has infected 770, 563⁸ people worldwide. 36,946⁸ have died. The COVID-19 pandemic has led to severe global socioeconomic disruption such as postponement or cancellation of sporting, religious, and cultural events. It may break or alter health-care or educational systems and crash economies.

Through systems thinking and the application of systems thinking tools, leadership at all levels could have prevented or slowed the spread of COVID-19. By doing so, development of specific antiviral medications approved for COVID-19 can be developed and the lessons from this experience can be applied in the future.

Are you prepared to take your knowledge to the next level and lead with a systems-thinking approach? If you want to learn more about the topics covered and be prepared to face future problems, check out the questions, learning activities, and resources provided.

8 Gutwrenching Questions Every Strategic Health Leaders Must Answer to Catapult Upward As A Coach

Deep Dive Discussion Questions

To apply the principles of systems thinking to your leadership journey, consider the following questions:

In your field of expertise, how can you tackle complex challenges by utilizing systems thinking tools?
Consider a recent experience you had to deal with. In retrospect, how might you have benefited from applying a systems thinking framework to your analysis and problem-solving?
Find an organization with whom you haven’t worked on a project before. In what ways could working with this team improve your capacity to tackle difficult problems?

Professional Development and Learning Activities

Participating in these learning will help you develop your systems thinking abilities:

Get down to the business of mapping systems: Find a complicated problem that your company is facing and draw a diagram showing all the parts and how they work together.
Think about potential outcomes: Create backup plans for each possible future situation that could arise at work.
Look for ways to work together across industries: For a more well-rounded view, branch out from your usual network and form connections with other groups and individuals.

Resources and References

The World Health Organization (WHO) – Coronavirus Disease (COVID-19) Advice for the Public: https://www.who.int/emergencies/diseases/novel-coronavirus-2019
The Centers for Disease Control and Prevention (CDC) – Coronavirus (COVID-19): https://www.cdc.gov/coronavirus/2019-ncov/index.html
The Institute for Healthcare Improvement (IHI) – How Can A System Get Organized for Improvement: https://m.youtube.com/watch?v=lcqrnjblYh4
“Thinking in Systems: A Primer” by Donella Meadows (2008)
“The Fifth Discipline: The Art and Practice of the Learning Organization” by Peter M. Senge (2006)
Systems Thinking For Social Change: A Practical Guide to Solving Complex Problems, Avoiding Unintended Consequences, and Achieving Lasting Results Illustrated Edition by David Peter Stroh

Citations

1. Holshue ML, DeBolt, Chas DeBolt, Lindquist, Scott, Lofy, Kathy H.,Wiesman, John, Bruce, Hollianne, Spitters, Christopher, Ericosn, Keith, Wilkerson, Sara, Tural, Diaz, George, Cohn, Amanda. First Case of 2019 Novel Coronavirus in the United States. N Engl J Med 2019(382):929-936.

2. n.a. Coronavirus disease (COVID-19) Pandemic. 2019; https://www.who.int/emergencies/diseases/novel-coronavirus-2019.

3. Statement on the second meeting of the International Health Regulations (2005) Emergency Committee regarding the outbreak of novel coronavirus (2019-nCoV) [press release]. Geneva, Switzerland: World Health Organization (WHO)2020.

4. Director-General’s opening remarks at the media briefing on COVID-19 – 11 March 2020 [press release]. Geneva, Switzerland: World Health Organization (WHO)2020.

5. Johnson J, Anderson, D, Rossow, C. Systems Thinking: A Primer for Health Administration, Public Health, and Clinical Practice. Burlington, MA: Jones and Bartlett; 2018.

6. Johnson J, Anderson D. Systems Thinking for Health Organizations, Leadership, and Policy: Think Globally, Act Locally. Austin, TX: Sentia Publishing; 2017.

7. McLeroy KR, Steckler, A. and Bibeau, D. (Eds.) The social ecology of health promotion interventions. Health Education Quarterly. 1988;15(4):351-377.

8. n.a. Johns Hopkins Resource Center: Coronavirus COVID-19 Global Cases, Coronavirus Resource Center: Johns Hopkins experts in global public health, infectious disease, and emergency preparedness have been at the forefront of the international response to COVID-19. Available at: https://coronavirus.jhu.edu/map.html. Accessed 30 March, 2020.

Other SHELDR Articles You Might Like

VUCA! VUCA! The 10-Fold Healthcare Crisis Hits Turning Point! Why Strategic Health Leaders Must Save America’s Healthcare System

SHELDR Archives

About the Author

Douglas E. Anderson, DHA, MSS, MBA, FACHE(LinkedIn) is a successful experienced senior-level health administrator, strategist, consultant, coach, educator, facilitator, and author. He is passionate about making health a national strategic imperative, transforming the healthcare system, and integrating health and human services sectors to be more effective. Today, his focus is on helping health and human services leaders leverage the social drivers and determinants of health (SDOH) to create healthier and more resilient and prosperous individuals, families, and communities. He specializes in coaching managers and leaders to improve their organizational strategies and develop or sustain their Strategic Health Leadership (SHELDR) competencies to thrive in an era of complexity and artificial intelligence (AI).

He is coauthor of Health Systems Thinking: A Primer and Systems Thinking for Health Organizations, Leadership, and Policy: Think Globally, Act Locally. You can follow his thoughts on LinkedIn and X: @Doug_Anderson57 and Flipboard E-Mag: Strategic Health Leadership (SHELDR). Disclaimers: Opinions are my own and do not represent any organization or entity. Not responsible for broken links. References to commercial products do not reflect endorsement. References and citations used in this publication will be provided upon request. Copyright: Strategic Health Leadership (SHELDR) ©

Leave the first comment (Cancel Reply)