Systems thinking in health systems

Systems thinking is easier for some people than others – and some people who work in health systems naturally think in non-linear, complex ways, even if they don’t give formal names like ‘feedback loops’ to the patterns they identify.

In the next few weeks you’ll keep coming back to this idea as we look at case studies of situations where appreciation of complexity helped (or might have helped) in developing health systems strengthening actions.

Think of the last time you attempted to explain a health systems problem to someone else (or to yourself). For example:

Health workers in the public system provide poor quality of care.

Was it a rather linear explanation? For example:

They don’t make the required effort because they are over-worked and underpaid. They are over-worked and underpaid because there are not enough resources in the public health system. There are not enough resources in the public health system because there is a lack of political commitment.

Did you trace the roots of the problem back to just one or two causes? Or did you think about all the aspects of the system that might be contributing to the problem (and might need to change if the problem was to be addressed). Did you think of contributing factors there were ‘outside’ the formal health system (for example, secondary education quality or workplace politics and culture). Did you think about how the different factors might interact in unexpected or unpredictable ways, or did your explanation assume that one factor always led consistently to another?

Learning to be a systems thinker is hard work, particularly in the context of limited time and information that are common for people working with health systems.

Before moving on, think about the health system problem again. Can you think of at least one feature of complex systems (for example, feedback loops) that might have been part of the complex nature of this problem?