Blip-Zip Executive Summary
Tired of fragmented health systems? Unleash the Power of Systems Thinking for Health Leaders! This 2-Part article explores how a systems thinking approach can revolutionize health leadership across preventive health, healthcare, mental health, and social services. Discover how to break down silos, address root causes, and create sustainable solutions for healthier individuals and communities.
Blip-Zip Takeaways
- Break Down Silos: Systems thinking fosters collaboration between health and human services sectors, leading to more comprehensive solutions.
- Address Root Causes: Go beyond symptoms! Systems thinking helps identify the underlying factors that contribute to health issues.
- Achieve Lasting Health Improvements: This approach focuses on sustainable solutions that create healthier communities for everyone.
Key Words and Themes (#Hashtags)
#SystemsThinking #SystemsThinkingInHealth #HealthLeadership #HealthEquity #PopulationHealth #SDOH #Collaboration #RootCauses #SustainableSolutions #CommunityHealth #PublicHealth #PreventiveHealth #MentalHealth #AlliedHealth #SocialServices #CollaborationInHealth #StrategicHealthLeaders
Table of Contents
An Overview of Systems Thinking With an Offer You Can’t Refuse
Welcome to the health and human services workforce! Systems thinking examines system components and their relationships holistically. It has helped health systems. While there is plenty of theory about systems thinking, its application to health issues needs to be improved. This chapter provides an overview of systems thinking and a value proposition on why systems thinking in health improvement is paramount to creating healthier individuals, families, and communities. Systems thinking competencies will assist you in reaching leadership positions.
What is systems thinking? In the book Health Systems Thinking: A Primer, The World Health Organization (WHO) describes systems thinking as “an approach to problem-solving that views ‘problems’ as opportunities and part of a wider, chaotic and dynamic system. Systems thinking involves much more than a reaction. It demands a deeper understanding of the linkages, relationships, interactions, and behaviors among the elements to characterize the entire system.”
David Peter Stroh, an applied systems thinking expert who previously worked on projects for the Center for Disease Control and Prevention (CDC), draws on the work of award-winning systems thinker Donella Meadows, who defined a system as “an interconnected set of elements coherently organized in a way to achieve something.” Stroh builds on her definition of systems thinking: “ability to understand the interdependencies and interconnections in a way as to achieve a desired purpose or endstate.”1
HHS is a complex mix of social determinants of health sectors. Unfortunately, siloed approaches rarely address health issues’ root causes. Strategic health leaders (SHELDR) need sophisticated thinking. Systems thinking and critical, strategic, and design design design thinking emerge as powerful strategic health leadership approaches, fostering collaboration, innovation, and improved outcomes. Critical thinking underpins rigorous analysis, while design thinking creates user-centered solutions.
Systems thinking elevates leadership. Systems thinking helps leaders see how seemingly unrelated factors affect health outcomes. Systems thinking views the world as interconnected systems. It examines component relationships, feedback loops, and system behavior. A systems thinker would recognize how unstable housing affects health in affordable housing. They may examine housing insecurity, stress, and chronic disease risk.
Systems thinking promotes cross-boundary leadership, which breaks down silos and promotes sectoral collaboration. Navigating a fragmented healthcare system and making it more integrated and efficient for population health requires this competency.
This 2-Part article explains why health and human services leaders need systems thinking. See how this approach can change your perspective and improve preventive, primary, public, mental, and other health sectors.
What Exactly is Systems Thinking?
Systems thinking uses new language and tools. A system is a group of complex interconnected elements—the human body, department, organization, community, region—that work together to achieve a common goal. Imagine the human body: The heart pumps blood, which delivers oxygen to muscles, allowing for movement. Each organ plays a role and influences the others. To navigate complexity effectively, leaders need a robust approach toolkit.
Imagine a bustling hospital. Doctors, nurses, social workers—everyone plays a crucial role. But what if a patient’s frequent readmissions stem from social determinants of health, like a lack of affordable housing? A traditional, siloed approach might not capture this bigger picture. It’s not just the sum of its parts but the complex interdependencies and interactions between them.
Unlike linear thinking, which is reactive, systems thinking is proactive, open, and circular. Systems thinking helps us see the bigger picture. It’s a problem-solving approach that recognizes the interconnectedness of parts within a whole system. The system could be a hospital, a community, or even the entire health and human services sector.
Fundamentals of Systems Thinking
Systems thinking provides a set of fundamentals–recognizing system dynamics, understanding interdependencies and interconnections within a system structure, feedback loops, leverage points, dynamic behavior, mental models to suggest sustainable solutions, and simulation models to test policies. For example, feedback loops can boost or lower system performance at any level. Spiral up or down. Teams, organizations, and communities rarely have them alone. Figure 1 provides a health system performance model.
Figure 1: Health System Performance
Systems thinking challenges health professionals, leaders, and policymakers to identify root causes, bottlenecks, and constraints for sustainable solutions. By doing so, leaders avoid blame and focus on results. Some growth and decline limits can become dysfunctional, especially if organizations have the wrong goals.
Reinforcing loops can generate an organization’s daily patient visit schedule, and financial incentives limit growth. A loop can move positively or negatively depending on capacity, system interactions, care experience, and policies that promote health versus episodic visits or the desired goal. Table 1 provides examples of the critical fundamentals in action with examples related to the social determinants of health:
Table 1: Systems Thinking Fundamentals and Examples
| Systems Thinking Fundamental | Example: Social Determinants of Health | |
| Mental Models: Improve communication and collaboration by challenging assumptions and creating shared mental models within your team. | Education: Imagine a school district struggling with absenteeism. Teachers might assume absenteeism is due to a lack of parental involvement. However, using systems thinking, they could challenge this assumption and explore social determinants of health, like inadequate housing or food insecurity, that might lead to student absences. Open communication with parents and community organizations could reveal these underlying issues, facilitating a more holistic approach to addressing attendance. | |
| Interdependence and Interconnections: All system elements affect and are affected by each other. Consider a person with diabetes. Diet affects blood sugar, which affects medication needs and well-being. | Income and Food Insecurity: Consider a low-income family struggling to afford healthy food. Their diet might contribute to chronic health issues, leading to increased healthcare utilization and potentially job loss due to illness. This cycle highlights the interconnectedness between income, nutrition, health outcomes, and employment. Addressing income inequality becomes crucial to breaking the cycle and improving overall well-being. | |
| Boundaries: Systems have boundaries that define their scope. For example, the social services system may support the community while the mental health system treats hospital patients. | Housing: The housing system provides shelter, while the healthcare system focuses on medical care. However, these systems are interdependent. Unsafe or unstable housing can exacerbate existing health conditions and increase healthcare needs. Collaboration between housing authorities and healthcare providers is essential to address the combined impact of these determinants on health. | |
| Dynamic Behavior and Emergence: The whole is greater than its parts. A well-functioning healthcare system requires seamless collaboration between providers, insurers, and community support services, not just great doctors. | Social Support: Social connections can provide emotional support and a sense of belonging, influencing mental and physical health. A robust social support system can help individuals manage stress, cope with illness, and make healthy lifestyle choices. However, social isolation can lead to depression, substance abuse, and other health problems. A healthy community requires the collective effort of social services, faith-based organizations, and community centers to foster a strong social support network. | |
| Feedback Loops: System actions can create balancing or reinforcing cycles. A successful smoking cessation program can reduce lung disease and hospital admissions (balancing cycle). However, more chronic conditions could strain hospitals, limiting preventive care (reinforcing cycle). | Transportation: A new public transportation system might improve access to healthier food options in underserved communities (balancing cycle). However, increased access to processed foods could increase obesity rates (reinforcing cycle). Ongoing data analysis and monitoring are crucial to identify and address unintended consequences of interventions related to transportation and its impact on dietary choices. | |
| Leverage Points and Causal Loop Diagrams: Visualize cause-and-effect relationships between system components to identify unintended consequences. | Income Inequality and Health Disparities: Causal loop diagrams can visualize the interconnected factors contributing to health disparities. By mapping out how low income can limit access to healthy food, quality healthcare, and safe housing, leaders can identify potential points for intervention and develop more equitable solutions. | |
| Agents: Conduct gatekeeper and stakeholder analysis to engage all affected parties and create inclusive solutions. | Environmental Justice: Systems thinking encourages stakeholder analysis to identify all parties affected by environmental hazards. The approach could involve engaging community residents, environmental protection agencies, and healthcare providers to understand the impact of pollution on respiratory health. A team can develop solutions that address the root causes of environmental injustice and improve health outcomes by including all relevant agents. | |
| Simulation, Testing, and Planning: Develop adaptable and resilient systems by considering various future possibilities. | Climate Change: Systems thinking encourages considering future possibilities. Public health leaders can anticipate the impact of climate change on heat-related illnesses, vector-borne diseases, and mental health by conducting scenario planning. This proactive approach allows for the development of adaptable health systems that can effectively address future challenges. | |
Systems thinking gives leaders and policymakers a holistic view of the system. They are no longer reductionist and linear; they think expansively. Looking at the big picture helps leaders see interrelationships and patterns. They realize problems may indicate more profound issues in a system or system of systems.
Contrasting Systems Thinking with Critical, Strategic, and Systems Thinking
Understanding systems thinking fundamentals helps you see how interconnected health and human services challenges and solutions are. Critical, strategic, and design thinking enhance systems thinking.
Critical thinking—the ability to reason, think, and judge—underpins good decision-making. It requires objective data analysis, bias identification, and argument accuracy assessment. A critical-thinking therapist would evaluate a client’s symptoms, history, and social factors before diagnosing mental illness. Critical thinking can help therapists diagnose depression. Systems thinking should encourage managers and the workforce to consider their social environment, healthcare access, and economic factors affecting their mental health.
Strategic thinking considers long-term plans. It involves predicting trends, identifying threats and opportunities, and allocating resources. Public health officials may consider population demographics, vaccine availability, and community resistance when planning a vaccination campaign. Strategic thinking, as illustrated in the book The Critical Public Health Value of Vaccines: Tackling Issues of Access and Hesitancy: Proceedings of a Workshop by the
National Academies of Sciences may include a five-year vaccination plan. Systems thinking considers how vaccine hesitancy, underserved community access, and community outreach strategies affect success.
Design thinking promotes patient- or client-centered design innovation. Iterative steps include empathizing with users, defining problems, brainstorming solutions, prototyping, and testing. For example, a dementia care program may be designed using design thinking in long-term care. Before implementing the program, designers would interview residents, caregivers, and staff to hear their needs, prototype activity formats, and get feedback.
Strategic thinking focuses on long-term goals, while systems thinking studies system dynamics. A nutrition program’s strategic planning may include community fruit and vegetable consumption goals. Systems thinking would investigate food deserts, fresh produce availability, and cultural preferences that affect diet.
Design thinking creates innovative solutions for specific users, while systems thinking understands the context. Providers could use design thinking to develop a mobile app for medication adherence. Systems thinking would examine the app’s role in the healthcare ecosystem, including patient health literacy, technology access, and EHR integration. Critical thinking may be good at analyzing parts and arguments. Consider the obesity epidemic. On the other hand, systems thinking considers the system’s relationships and leverage or intervention points. A critical thinker might weigh the pros and cons of a new medication and dietary needs for a patient, but a systems thinker would consider how it interacts with the patient’s lifestyle, health, and support services.
Understanding these distinctions makes systems thinking easier for health and human services leaders. These leaders can collaborate across sectors, address health disparities, and provide a more holistic approach to well-being.
Part 1 Summary
Health organizations and systems operate in an increasingly dynamic, uncertain, complex, and ambiguous environment. There is a dire need to increase and integrate these organization’s capabilities so communities at any level can make effective decisions and engage in behaviors to promulgate the healthiest populations in the world. A good starting point in this discussion is briefly exploring the distinction between a system and systems thinking.
Systems thinking is a practical approach to help organizations, communities, and nations make sense of the fragile interconnectedness and interdependencies of today’s health systems. Systems thinking has the potential to produce sustainable solutions to many of the most daunting health challenges we are facing in the world today. Unfortunately, systems thinking as a competency is not sufficiently known nor embraced in health settings and across communities.
Learn more about systems thinking as a competency
To Be Continued …
In the meantime, are you ready to transform your leadership and tackle health challenges from a systems perspective? Explore the questions and activities below to get started!
Deep Dive Discussion Questions
- How can you leverage systems thinking to identify the root causes of health disparities within your community?
- Think of a current health challenge you’re facing. How could collaboration across sectors, fostered by systems thinking, contribute to a more comprehensive solution?
- Imagine you’re designing a new health program. How would a systems thinking approach help you consider factors beyond the immediate intervention?
- How can you identify and map the interconnected aspects of a health challenge you’re facing?
- Consider a health disparity in your community. How might a systems thinking approach help address its root causes?
- Imagine collaborating with leaders from different sectors using systems thinking. What challenges and opportunities might arise?
- How can you leverage systems thinking to break down silos within your organization and foster cross-sectoral collaboration?
- Reflect on your leadership style. How can you integrate systems thinking to become a more holistic and effective leader?
Professional Development and Learning Activities
- Conduct a systems mapping exercise to visualize the components and interactions within a health issue you’re passionate about.
- Identify a siloed approach within your organization and brainstorm solutions to foster cross-sectoral collaboration for a specific health initiative.
- Research a successful public health program that exemplifies systems thinking in action. Analyze the program’s design and impact.
- Partner with a colleague from a different health or human services sector. Brainstorm innovative solutions using a systems thinking approach.
- · Attend a workshop on systems thinking in health leadership. Network with professionals and share best practices.
Resources
- The World Health Organization (WHO) Center for Health Development http://extranet.who.int/kobe_centre/en/who-we-are
- “Thinking in Systems Overview” by the Centers for Disease Control and Prevention (CDC) https://www.cdc.gov/policy/polaris/tis/index.html
- “Development and application of ‘systems thinking’ principles for quality improvement” (BMJ Open Quality, 2020)
- The Critical Public Health Value of Vaccines: Tackling Issues of Access and Hesitancy: Proceedings of a Workshop by the National Academies of Sciences, Engineering, and Medicine (2021). National Academies Press. https://nap.nationalacademies.org/catalog/26134/the-critical-public-health-value-of-vaccines-tackling-issues-of
- The Systems Thinking Institute—Mental Model Musing. https://www.systems-thinking.org/
- Donella Meadows. (2008). Thinking in Systems: A Primer (3rd Edition). Chelsea Green Publishing.
- Why Systems Thinking Matters for Population Health https://www.helunahealth.org/news/systems-thinking-population-health/
- The application of systems thinking in health: why use systems thinking? NIH, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4245196/
Citations
1. Stroh D. Systems Thinking For Social Change: A Practical Guide to Solving Complex Problems, Avoiding Unintended Consequences, and Achieving Lasting Results. 85 N Main St, #120, White River Junction, VT 05001-7059: Chelsea Green Publishing; 2015.
