Complex Systems Thinking?
Complex systems thinking (CST) gives us a different lens through which we can tackle challenging social problems. People who understand CST see that our failure to solve difficult problems is not because we haven't tried hard enough, but because some of our basic assumptions about how to solve complex problems are wrong.
Systems thinking is a different way of thinking about health. While many researchers and practitioners use slightly different definitions of systems thinking, this is how we define it:
Complex Systems Thinking is a perspective and set of tools that helps us to optimize interactions over time, across disciplines and professions, in order to achieve health goals that we as a society want long term.
What would a CST approach to health look like? To begin with, it must include more than just the public health department or hospital administration.
A CST approach would bring our communities together—school teachers, parents, business owners, religious leaders, legislators—to develop a shared vision of the health we want to have. Then we would begin by challenging all previous assumptions and, rather than exerting our effort on independently finding silver-bullet solutions to problems, we focus on working together to create an environment where our community can self-organize over time—maybe over decades— toward producing healthy lives for everyone.
"This powerful tool first decodes the complexity of a health system, and then applies that understanding to design better interventions to strengthen systems, increase coverage, and improve health."
- Dr. Margaret Chan, Director General, W.H.O. 2009
CST principles for
a better approach to health:
Our traditional reductionist approach:
Challenge Mental Models
Examine the lenses through which we interpret and make sense of reality. They include deeply held beliefs, generalizations, and assumptions that we may have never recognized or questioned.
Improve the patterns of interactions between individuals, communities, and organizations over time. All of the properties of a system can't be explained or improved as individual parts in isolation. These patterns of interactions are critical because systems are interconnected and interdependent.
Foster Shared Vision
Develop a common vision owned by all who are part of the community. A shared vision includes a common set of goals, mutual understanding, and shared expectations of all participants, and can take years to form.
Minimize Unintended Consequences
Consider how our efforts to improve health may have unplanned results. We avoid negative unintended consequences by considering diverse perspectives and considering the broader impact of our interventions.
Create an environment that encourages emergence—when larger patterns and regularities emerge as a system's smaller parts interact. These emerging patterns, like the internet and social media, can contribute to improving health in ways we would have never predicted.
Enhance Feedback Loops
Feedback between individuals and organizations is crucial in a health system, allows for self-correction, and can improve outcomes.
Adaptation occurs when individuals or organizations within systems respond to opportunities or challenges by fitting behavior to both internal and environmental changes. By adapting in positive ways, stakeholders respond more effectively to complex challenges and rapid changes.
Non-Linearity, Leverage Points
Relatively small actions in just the right areas can lead to long-term improvements in a health system. Finding and intervening at critical leverage points can transform systems. High-leverage interventions create lasting, rather than fleeting, impact.
Transformational leaders create the conditions under which others and the system as a whole flourishes. They motivate, inspire, empower others to see things differently, advance personally, and work together more effectively. They may not necessarily be in positions of traditional control.
Adapted from "An Introduction to Complex Systems Thinking in Health"
We rarely challenge the basic assumptions behind our health system. For example, who actually produces population health, mothers or doctors?
Work in Siloes
Most of our research and practice is siloed into discrete disciplines and sectors that don't interact enough.
Our health systems are divided into sectors, professions, specialties, departments, and organizations. We too often work as tribes with competing goals rather than for the common good. Because of this, even though some tribes win in the short-term, all of us lose long-term.
Focus On One Problem at a Time
Our current efforts to relieve suffering are plagued by unintended consequences. We fail to consider local context, and how our interventions will impact other parts of the system.
Command from a Central Control
The current health system is based on the principle of command and control, where high-level academics and governing bodies plan and implement interventions. Learning and action are separated.
No News is Good News
Too often, we don't know the impact of what we do, and we just assume it is good. Even when we evaluate programs, we tend to ignore the larger picture of how the program fits in the community context, and we fail to seek feedback from outside of our organization.
Rigidity and Path Dependence
Much of how we think and work is similar to 50 years ago. Our current mode of medical education, including clinical residency, was developed after the second world war.
That was 40 years before the internet emerged.
Expect Large Outputs from Large Inputs
We focus our efforts on interventions that look heroic or politically popular, but don't yield significant influence. We frequently assume the answer is more funding.
We often view leadership as a position of traditional control. Most "leadership" in our current system merely perpetuates the status quo.
How do we currently deliver health interventions?
Most everyone agrees that our current health system is inefficient and could be much better. But how? The answer is not necessarily in the solutions we find, but in how we find them.