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Steps to systems thinking

In this step, we explore the steps to systems thinking.

A systems thinking approach requires us to consider organisations (such as HEE) as more than physical entities with clear boundaries, structures and functions, as defined by early management literature.

That linear approach suggests that system efficiency is achieved through the re-engineering and coordination of technical functions, and does not take account of the cultural aspects of an organisation: the emotion, conflict, and politics of organisational life.

The concept of Soft Systems Methodology (Checkland 1981) advocates an interpretive approach to systems thinking that considers the social rules and practices of participants within a system. It recognises that problems are not isolated or confined to a technical system but are part of a wider cultural and political one.

This approach is particularly useful when facing soft, ill-structured problems that include social practice, politics and culture – all of which are important characteristics of healthcare organisations.

Thinking approaches

Leaders and managers working in complex and dynamic systems need to develop a dynamic approach to problem-solving and decision-making. They need to understand how to navigate through the cultural aspects of organisational life, including the conflict, politics and power structures that exist across healthcare systems.

A new interpretive approach to systems thinking needs to be developed in which the social rules and practices of participants in the system are considered. Savigny and Adam (2009: 43) provides examples of the differences between traditional static ways of thinking and dynamic approaches.

Usual approach Systems thinking approach
Static thinking: focusing on particular events Dynamic thinking: framing a problem in terms of a pattern of behaviour over time.
Systems-as-effect thinking: viewing behaviour generated by a system, as driven by external forces. System-as-cause thinking: Placing responsibility for behaviour on internal actors who manage the policies and ‘plumbing’ of the system.
Tree-by-tree thinking: believing that really knowing something means focusing on the details. Forest thinking: believing that to know something requires understanding the context of relationships.
Factors thinking: listing factors that influence or correlate with some result. Operational thinking: Concentrating on causality and understanding how behaviour is generated.
Straight-line thinking: viewing causality as running in one direction, ignoring (either deliberately or not) the interdependence and interaction between and among causes. Loop thinking: viewing causality as an ongoing process, not a one-time event, with effect feeding back to influence the causes and the causes affecting each other.

CATWOE analysis

Building on the above, the CATWOE analysis – developed as part of Checkland’s Soft Systems Methodology – is designed to help understand multiple stakeholder perspectives within a single system. It aims to highlight the differences of view that could be the root cause of a problem or conflict so that stakeholders can work to establish common ground and find solutions.

Business analysts use CATWOE to identify what organisations are trying to achieve, the associated problem areas, and how the solutions could affect those involved. The analysis achieves this by getting each stakeholder or stakeholder group to examine their perspective of six system elements:

  • Customer(s): who are they? These are the people who are at the receiving end of whatever the system does. They are the ones who will benefit or suffer from changes in the system/process.

  • Actors: who does the work? These are the people involved in the implementation of the changes in the system/process.

  • Transformation: what does the system do? This is the system’s main process; the change it brings about by converting inputs into outputs.

  • Worldview: what’s the big picture? This puts the system into a wider context to establish why it exists, which can help highlight the consequences of success or failure.

  • Owner(s): who’s in charge? This is the person or group that has the authority to make changes to a system or stop it altogether.

  • Environmental constraints: what is the system bound by? These are the external constraints and limitations that affect the system, such as ethical limits, regulations, financial constraints, resources limitations, limitations of project scope, limits set by terms of reference and others.

Your task

Consider the example of a hospital emergency department being overused by non-emergency patients when their GP practice is closed.
Use CATWOE to examine this problem from the perspective of the hospital team and the perspective of the GP practice.
Which dynamic approaches do you think would be acceptable to all stakeholders to address the problem? Discuss your thoughts in the comments.


Checkland, P. (1981) Systems Thinking, Systems Practice: Includes a 30-Year Retrospective. Chichester: Wiley

© Coventry University. CC BY-NC 4.0
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Understanding Systems Thinking in Healthcare

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