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Systems thinking in healthcare

In this step, we look at systems thinking in healthcare.

In this video, we introduce you to Amanda Royston – an Associate Professor in Healthcare, Leadership and Management at Coventry University.

Amanda talks about the need for leaders to adopt a systems thinking approach to navigate the challenges and increasing complexity of health systems across the world.

In 2008 the World Health Organization (WHO) observed the following about health systems:

The responses of many health systems so far have been generally considered inadequate and naive… a system’s failure requires a system’s solution – not a temporary remedy.
(Savigny and Adam 2009: 39)
As we discussed in the previous step, systems thinking is an approach to problem-solving that views ‘problems’ as part of a wider, dynamic system. Through an increased understanding of a system’s fundamental characteristics, systems thinking allows us to see, with greater precision, how systems work.
The characteristics described in the rest of this step – especially when taken together – influence how systems, including health systems, respond to external factors or to intervention. The application of systems thinking in the health sector is accelerating a more realistic understanding of what works, for whom, and under what circumstances.
In 2009, the WHO stated that strengthening health systems was a core principle for itself, its member states and the global health community. Systems thinking was identified as a key enabler within this:
Systems thinking works to decode the complexity of a health system, then applies this understanding to design and evaluate interventions that maximize health and health equity.
(Savigny and Adam 2009: 30)
The WHO report highlights that in the constantly changing world of healthcare, where elements of the system are always acting, reacting and interacting in an often counter-intuitive process, it is crucial to understand how system-level interventions and policy directives might affect the reality of healthcare experienced at ground-level.
The WHO works to advance the principles of equity, universal coverage, and people-centred approaches – and within the complexity of this are advocating that policy-makers and funders must focus on system-strengthening initiatives that really work.
The WHO Health Systems Framework identifies six building blocks that must be in the place to deliver the overall goals of any health system.
Adapted from Savigny and Adam (2009: 31) – click on image to expand size.
In summary, the WHO emphasises three important points relating to systems thinking in healthcare:
  • Using a systems perspective to understand how health system building blocks, contexts and actors act, react and interact with each other is an essential approach in designing and evaluating interventions
  • Mainstreaming a stronger systems perspective in the health sector will assist this understanding and accelerate health system strengthening
  • Systems thinking offers a comprehensive way of anticipating synergies and mitigating negative emergent behaviours, with direct relevance for creating policies that are more system-ready

Your task

Consider the following quote:
‘… health services can be characterised as modern society’s most complex knowledge system’ (Saltman, Calltorp and de Roo 2011: 150).
Do you agree with this statement? Discuss your position in the comments area.

Further reading

Savigny, D., and Adam, T. (2009) Systems Thinking for Health Systems Strengthening [online] Alliance for Health Policy and Systems Research, World Health Organization. available from [21 April 2020]


Saltman, R., Calltorp, J., and de Roo, A. (2011) ‘Health Sector Innovation and Partnership’. in OECD Health Reform: Meeting the Challenge of Ageing and Multiple Morbidities. OECD Publishing, 143-168

Savigny, D., and Adam, T. (2009) Systems Thinking for Health Systems Strengthening [online] Alliance for Health Policy and Systems Research, World Health Organization. available from [21 April 2020]

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Understanding Systems Thinking in Healthcare

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