An introduction to Systems Thinking, from a public health point of view
- Systems Theory
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Today I had a very interesting, but very abstract lecture, if I may say so myself, that talked about a theory that I have never heard of. Systems Theory, introduced by Karl Ludwig von Bertalanffy and, in its most basic understanding, deals with observing the behaviors of the interconnected parts of a system and how it interacts with other systems. This theory has brought a specific approach into existence which is called Systems Thinking, which is a more practical approach on how to look at processes, within the context of corporate management, and bring about optimizations within these processes. I would like to explain what this is all about from a public health perspective.
A system is any kind entity that is made up of parts that interact. Together these parts and interactions create a whole, which in turn produces some kind of result. Using this systems perspective is important because it helps to better understand the success or hinders of health intervention, project management and so on.
Here’s an example, Suzanne is Regional Senior Manager for a health organization. A high rate in obesity is prevalent in her community and she’s been mandated to address this problem. Her first instinct is to develop a program aiming to get more active. But what is realistic to expect from this approach? Systems Thinkers believe that, viewing a program like this, a part, in isolation of a larger part of a system within witch it operates in, the “whole”, tends to ignore other aspects that might influence potential for impact. Why?
Research tells us that obesity is the result of a combination of many physiological, psychological, social, environmental and economic factors that all interact with one another.
For example, at the individual level, there are issues such as human physiology, exercise habits, food choices and one’s occupation. But beyond the individual, there are other factors at play, such as, the local built environment and quick and easy access to junk food and larger industry food practices, such as, trends in portion sizes, sugar and fat content. The interaction of all these influences make obesity the product of what we call a complex system.
If Suzanne were to use a systems approach, she would realize that relying on simple cause-and-effect solutions effects solution for one program would ignore those interactions and likely fail. While Suzanne’s staff at the program level have a tendency to think only within the bound of their program senior managers and planners like Suzanne are in a unique position to do what system thinkers call, zooming out.
Zooming out considers how other aspects outside of a programs traditional boundaries both within the organization and beyond, might influence the success of the program. By zooming out and looking at the influence of other interventions, policies, structures, patterns and norms, in the broader system, Suzanne is better able to strategically consider other values and perspective and interrelationships among each that may impact obesity rates in her community.
In doing so she can identify more powerful leverage points outside the program that have the potential to facilitate and support changes in obesity, leverage points are places within the system that can be tweaked in way that supports greater impact. For example, are there actions Suzanne and her team might take that could increase the community’s access to opportunities for physical activity. While some leverage points are within Suzanne’s capacity to change, others will be beyond her control, however, it would still be useful to be aware of these as the plans for the program. Adopting a systems view, won’t change the boundaries of the program, but it will expand the boundaries of the evaluation by recognizing the importance of the different perspectives and values of those outside of the program and the interrelationships throughout the system, Suzanne can ensure that the evaluation is framed in a way that captures the key boundaries diverse perspectives and interrelationships that serve as important leverage points in the system course Suzanne’s budget won’t permit an evaluation of the entire system, but she can ensure that any evaluation she commission will provide her with more strategic direction on how to effectively address obesity within her community.
For example, in addition to recommendations for improving the program, the results might indicate opportunities for new partnerships or external policy change. If her community has poor walking and cycling infrastructure, where might she and her team advocate or who could they could collaborate with to make changes. By asking these questions, Suzanne is finding that using a systems approach helps her focus on the broader issue of obesity in her community, instead of a single program in her organization. She gains a better understand of what external factors are influencing the program’s success and can set more reasonably expectation what it can accomplish. She’s also learning, but needs to change both within and outside the program to better maximize her organization’s effectiveness. Many now believe that a systems approach holds the most promise for addressing complex health problems like obesity. Which is not only good for Suzanne, but good for everyone.
So there you have it! Systems thinking. I hope I’ve been able to give a clear explanation what system thinking is. Thanks for reading!