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Skip to 0 minutes and 9 seconds If we’re going to try to do systems thinking, so appreciation of systems is a fundamental part of the science of improvement, and if I’m helping somebody, and so I need to appreciate the system. Well I have to be able to see that system, I remember when I would do work in auto organisations, they actually designed the big production plants there, where you could go up to the very top of it, and stand in the scaffolding, and actually see the system working and how it’s flowing and so forth to do that. In healthcare sometimes it’s very difficult to see the system. You know, hey the system’s a problem here, well where’s the system?

Skip to 0 minutes and 42 seconds I can’t see it, what do we look at? So what tools do we have? So tools like flow charting, process mapping and so forth, that allows us to see the system, it’s a pretty important tool. On the other hand, as I see people, if I tell people you need to have a flowchart, they get bogged down in that tool. So doing flowcharting, drawing systems maps is not improvement, it allows us to see the system to make that happen. So I’m always careful about ever overemphasising any tool there to do that. Probably if there’s one, that I wouldn’t do without on any improvement work or projects, is a time series chart, a run chart, show heart control chart over time there.

Skip to 1 minute and 19 seconds I always want to see that improvement’s temporal, we have a past, we have the current, and we have a future, and I want a picture that helps everybody see that the same way, and so run chart, a show heart chart, I’ll always have that on improvement project.

Tools for healthcare system mapping

Let’s now consider some evidence-based tools that can support healthcare system mapping.

The video, produced by the Institute for Healthcare Improvement, explains how visual tools can help in the improvement process.

One of the tools mentioned in the video was a process map – let’s look at an example, below:

An example of a process map. This example relates to the process mapping of impatient medication administration at Mulagi Hospital. The process map is linear in nature; each block of the process map leads onto another block with the use of arrows. In this example, the map starts with medication (Rx) form in chart, followed by MD writes Rx order, followed by attendant to pharmacy with form, followed by pharmacy open/staffed, followed by Rx available as written, followed by attendant brings Rx to bedside, followed by nurses round on ward, followed by attendant provides medication to nurse, followed by nurse has supplies to administer Rx, followed by burse administers Rx, followed by nurse documents Rx administration.

Adapted from Alupo et al. (2017: 588) – click on image to expand size.

Other visual tools include the following:

  • Agent-based modelling
  • A causal loop diagram
  • Innovation/change management history
  • Participatory Impact Pathways Analysis (PIPA)
  • Run chart and flowchart
  • Social network analysis
  • Soft system methodology
  • System dynamics modelling

Your task

Undertake some research online relating to the other tools listed in this step. Then, in the comments, share your responses to the following questions:

  • Have you used any of these tools to map out a system or create a project plan for improvement? If so, how? If you haven’t, how do you think they could help you in the future?

  • Which system mapping tool do you find most relevant and applicable to the healthcare system and why?


Alupo, P., Ssekitoleko, R., Rabin, T., Kalyesubula, R., Kimuli, I., and Bodnar, B. (2017) ‘Improving Inpatient Medication Adherence Using Attendant Education in a Tertiary Care Hospital in Uganda’. International Journal for Quality in Health Care 29 (4), 587-592

Littlejohns, L. B., Baum, F., Lawless, A., and Freeman, T. (2018) ‘The Value of a Causal Loop Diagram in Exploring the Complex Interplay of Factors that Influence Health Promotion in a Multisectoral Health System in Australia’. Health Research Policy and Systems 16 (1), 126

Silverman, B. G., Hanrahan, N., Bharathy, G., Gordon, K., and Johnson, D. (2015) ‘A Systems Approach to Healthcare: Agent-based Modelling, Community Mental Health, and Population Well-being’. Artificial Intelligence in Medicine 63 (2), 61-71

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This video is from the free online course:

Understanding Systems Thinking in Healthcare

Coventry University