Systems Thinking in Public Health and Learning from ISIS. Dr. James A. Johnson is a medical social scientist and health policy analyst who has published 18 books and over 100 journal articles on a wide range of health related issues and topics. Systems thinking is an approach to analysis that zeros in on how the different parts of a system interrelate and how systems work within the context of other, larger systems. as midgley observes, "the whole concept of public health is founded on the insight that health and illness have causes or conditions that go beyond the biology and behavior of the individual human being." 1(p466) animated by this systemic insight, public health leaders have worked for more than a century to identify and transform the processes 832 Words. By helping produce good health effectively, health systems also contribute to economic growth (McKee et al. However, linking good health and successful health systems, in particular how health systems might be distinguished from other determinants of health, or ultimately how health systems are linked to good health, has proved challenging (Chen 2012). An effectiveness analysis of healthcare systems using a systems theoretic approach. Increasingly, we also see its embrace in clinical practice, public policy, and health professions education. 2011)deaths that are mostly preventable. Despite the promise that systems approaches hold for improved understanding of the complex factors that contribute to health and disease, few systems initiatives have been developed at one of the premier U.S. center for health researchthe NIHto address chronic disease or its causal . This paper explores the question of what systems thinking adds to the field of global health. This concise primer focuses on systems thinking as it spans the domains of health administration, public health, and clinical practice. Systems thinking adds to the theories methods and tools we otherwise use in global health, and provides new opportunities to understand and continuously test and revise our understanding of the nature of things, including how to intervene to improve people's health. If we are addressing community health challenges, it is essential to understand the connections across other social systems. To gain insight over time and across conditions and settings will require a shift towards coordinated, country-led efforts. To replace crude indicators such as childbirth in a health facility, assessment must not stop at the step of asking how many women delivered at a facility that might be capable of providing appropriate care but must fundamentally shift towards determining whether women were treated with respect, had complications identified quickly and managed appropriately, and returned home with a healthy newborn and the confidence to seek care for herself and her child in the future. Systems Thinking to Improve the Public's Health - PMC. 1996-2022, Amazon.com, Inc. or its affiliates. Systems thinking can be applied in business and healthcare settings. This leads to simplistic analyses of situations, with the most important sources of the problem either missed or overlooked, with misperception of feedback, so that even when information is available, consequences of interactions cannot rapidly and correctly be deducedwith the interventions aimed at eliminating these problems leading to unforeseen consequences and policy resistance (Sterman 1994; Diehl and Sterman 1995). There is a wide application for thinking in this type of holistic way. The site is secure. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide, This PDF is available to Subscribers Only. By Scott Kanagy, DO, system chief medical officer, Upper Valley Medical Center. Epub 2013 Sep 13. PMC eCollection 2022. 2007b; Lebcir et al. Health systems perform multiple functions in society - they do not merely deliver healthcare services and other interventions aimed at maintaining or improving health. Every effective hospital administrator knows that a well-run hospital has multiple service lines . Full content visible, double tap to read brief content. This wide perspective of systems thinking promotes it to solve complex problems that are dependent on external factors. Dr. Johnson has also been an active researcher and health science writer, with more than 100 journal articles and 15 books published. If you are having trouble accessing this website or parts of it, please call 1-800-832-0034 or email. 2010). While many health innovations have been adopted and successfully diffused in low- and middle-income countries to save many lives, there are many instances where innovations of varied complexity are poorly adopted. Health systems are complex adaptive systems with multiple interconnected levels and overlapping sectors [13,14]. By Marice Ashe, Dora Barilla, Eileen Barsi and Stephanie Cihon. 2010). In practice, systems thinking means careful consideration of possible consequences of policies and actions, generating scenarios through group working and joint thinking: taking into account the interactions between health system elements and the context, and when possible combined with systems dynamics modelling (Lane and Oliva 1998) to simulate system behaviour under explicit assumptions (Sterman 1989a; Sterman 2001). Yet, weak health systems, socio-cultural stigma and weak political leadership meant by the end of 2010 ART coverage in sub-Saharan Africa was only 49%, with only 14% of patients with AIDS in the Democratic Republic of Congo receiving ART, 23% in Europe and Central Asia, and 10% in North Africa and the Middle East (WHO 2011). For instance, provision of quality mental healthcare depends on a system capable of screening and detection, integration, and continuous care [19]. A further challenge relates to understanding how innovations (such as new policies, new knowledge and novel technologies) can be effectively introduced in health systems and how these innovations interact with health system variables to influence health outcomes. 2015 May;11(3):176-9. doi: 10.1200/JOP.2015.003749. Kruk M, Gage A, Arsenault C, Jordan K, Leslie H, Roder-DeWan S, et al. doi:10.1371/journal.pmed.1002682. This typically follows a systematic analysis of root causes of problems and inefficiencies. Professor of International Health Management, Imperial College Business School and Faculty of Medicine, Imperial College, London, UK. 2010a; Atun et al. 2010). Health promoting initiatives, such as those operationalized under the whole school approach, include several interconnected components that are coordinated to . Svetlana V. Doubova, Findings from the recent Lancet Global Health Commission for High Quality Health Systems suggest that increasing the scope and reach of health systems without attention to improving quality has the potential to worsen health [1]: individuals can be harmed by unsafe procedures or unnecessary treatment, communities may lose faith in health systems, and already limited resources will be misdirected. HHS Vulnerability Disclosure, Help Highlight, take notes, and search in the book, In this edition, page numbers are just like the physical edition. 2011). This. This typically follows a systematic analysis of root causes of problems and inefficiencies. 10.1377/hlthaff.2018.0151 . Margaret E. Kruk, Affiliation: Currently, the accrediting commissions within public health, health administration, and nursing are including systems thinking as part of the core competencies in their respective fields and professions. This Primer addresses the void by empowering its readers with a greater understanding of this important and timely topic while increasing appreciation for the tremendous potential and the urgent necessity of systems thinking. High coverage of LLINs in the most affected malarial burden countries has prevented thousands of deaths in children aged under 5 years (Akachi 2011). - Exercises help students gain experience in the use of systems thinking to analyze and solve problems. The breadth of this quality deficitspanning long-standing global health priorities such as maternal [11] and child health [4], as well as understudied needs such as mental healthcare [12]demands a new generation of research to compel change. As global and national pursuit of universal health coverage (UHC) accelerates, health system quality has emerged as a critical concern, a weakness that could blunt the promise of UHC. . In system thinking, the health promotion of people four components namely knowledge, models, organization and networks have been used by stakeholders (Rosas, 2015). Read our Cookie Policy to learn more. Please enable it to take advantage of the complete set of features! Though I will admit, I am sometimes the person who says it. Health systems thinking: A new generation of research to improve healthcare quality PLoS Med. 2022 Sep 9;17(9):e0274242. Book reviews, interviews, editors' picks, and more. An official website of the United States government. Copyright: 2018 Leslie et al. Past failure of single discipline programs . Many interconnected and interdependent elements within health systems and their contexts create extensive networks of feedback loops with variable time lags between the cause and effect of an action and non-linear relationships between system elements, collectively creating a dynamic complexity. Writing in the 1970s, Russell Ackoff1 offered two key ideas of relevance here. Bull World Health Organ. Need to improve public health's approach as the workd changes. For full functionality of this site, please enable JavaScript. Examining perspectives on the adoption and use of computer-based patient-reported outcomes among clinicians and health professionals: a Q methodology study. Systems thinking can help address the linear and reductionist approaches which prevail in health systems, by enabling testing of new ideas in social systems (Forrester 1961). The perception of the problem which the innovation is addressing, by the innovation, by the adopting individuals, adoption systems and institutions, also influences the adoption and diffusion of innovations (Figure 1). Global uptake of internationally recommended tuberculosis treatment for drug-sensitive tuberculosis and the directly observed treatment short course (DOTS) strategy, a complex innovation with multiple elements, has steadily increased between 1995 and 2009, with 49 million tuberculosis patients treated globally, 41 million of them successfully (Glaziou et al. 10.2471/BLT.17.191916 Key Features: - Demonstrations of how systems thinking is used in an organization or practice is shown through examples, case studies, and interviews with leaders. 2010). As described in our book, Health Systems Thinking: A Primer, systems thinking has gained wide acceptance in management, medical, and social sciences, including the domains of healthcare and public health. -, Moucheraud C. Service Readiness For Noncommunicable Diseases Was Low In Five Countries In 201315. Measuring Quality of Maternal, Neonatal, Child, Reproductive Health and Nutrition Care with tools developed by the RADAR project and tested in Sub Saharan Africa. official website and that any information you provide is encrypted Importance and role of Systems Thinking The external and internal environments within which organisations, health systems and the society operate have become very dynamic and complex. Combining technological innovations with other innovations in health systems (such as innovative approaches to governance, financing, service delivery, awareness creation and demand mobilization) enables effective adoption of innovations in health systems. 2011). Health Systems Thinking: A Primer is designed to meet that void and serve as a supplemental reading for this important and timely topic. Combining Design Thinking with Systems Thinking to Address Health Care Workforce Well-Being. Health systems are open systems, with interlinked components that interact within the context within which the health system is situated (Atun et al. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine The Author 2012; all rights reserved. Often, the reasons for slow adoption and diffusion of health innovations are less to do with the perceived benefits of the innovation, but the way the problem, which the innovation is designed to address, is perceived by the individuals and the adoption system within health institutions, the health system and the broad context. Without adequate quality of care, access to care and financial protection will be insufficient to improve population health. PLoS ONE. E-mail: Search for other works by this author on: Effect of investment in malaria control on child mortality in sub-Saharan Africa in 20022008, Resistance to implementing policy change: the case of Ukraine, Bulletin of the World Health Organization, Impact of an effective multidrug resistant tuberculosis control programmes in the setting of an immature HIV epidemic: system dynamics simulation model, Analysis of how health system context influences HIV control: case studies from the Russian Federation, Barriers to sustainable tuberculosis control in the Russian Federation health system, Implementing complex health innovationsprimary health care reforms in Estonia: multimethod evaluation, High coverage with HAART is required to substantially reduce the number of deaths from tuberculosis: system dynamics simulation in the setting of explosive HIV epidemic and tuberculosis, Impact of joined-up HIV harm reduction and multidrug resistant tuberculosis control programmes in Estonia: system dynamics simulation model, Diffusion of complex health innovationsimplementation of primary care reforms in Bosnia and Herzegovina: a qualitative study, A systematic review of the evidence on integration of targeted health interventions into health systems, Integration of targeted health interventions into health systems: a conceptual framework for analysis, Health-system strengthening and tuberculosis control. Demonstrations of how systems thinking is used in an organization or practice is shown through examples, case studies, and interviews with leaders. Medical Ethics Leadership Value-Based Care Team-Based Care More on HSS About Health Systems Science, 2nd Edition Teaching HSS More . This can lead to identifying possible policy solutions that may not have been readily apparent, which can be helpful in the realm of using policy to improve the health and wellbeing of populations. 2007a; Atun et al. In Russia, poor uptake of ART and harm reduction interventions was due to: the perception of the HIV/AIDS problem being a problem of injecting drug users and sex workers (Tkatchenko et al. Observing that elements of systems thinking are already common in public health research, the article discusses which of the large body of theories, methods, and tools associated with systems thinking are more useful. ons based on a deeper understanding of a given system. 2009). Current research is inadequate to meet this need. Oxford University Press is a department of the University of Oxford. Health system functions, such as resource generation and service delivery, are not performed in isolation and, thus, should not be analysed independently. SYSTAC aims to increase the field of applied systems thinking in low- and middle-income country (LMIC) health system strengthening efforts; to provide a platform for exchange experiences and knowledge to take the field forward and capture health system challenges from front liners . universal health coverage. Thinking in Systems has 3,358 ratings and 294 reviews. A cross-sectional study in Nairobi City County, Kenya. Systems thinking challenges health leaders and clinicians to assess the interactionsand interdependencies among elements in a system and seek out opportunities to generate sustainable solutions based on a deeper understanding of a given system. The aim of this paper is to share our experiences in applying learning health systems (LHS) thinking to the codevelopment of an intervention improving an integrated response to COVID-19 and tuberculosis in a South African . 2022 Aug;31(8):599-608. doi: 10.1136/bmjqs-2021-014095. The theories, concepts, and methods of systems thinking are suited to a myriad of health settings and professions, organizational cultures, and policy challenges. Clauser SB, Gayer C, Murphy E, Majhail NS, Baker KS. Each of these chapters includes essential concepts along with interviews of systems thinkers and illustrations of various systems thinking tools and processes. Amidst these complexities, decision-makers need research that addresses national priorities and reflects the complexity and time frame for impact. Conducting meaningful research depends upon a common language and valid measures to benchmark progress and inform action. Overview . Additionally, he is visiting professor in the Department of Preventive Medicine and Public Health at St. Georges University in Grenada, West Indies, and adjunct professor of health policy at Auburn University. Objectives of the Chapter Systems thinking Systems thinking is an essential approach for Systems thinking has its origins in the early 20th strengthening health systems, particularly in century in fields as diverse as engineering, designing and evaluating interventions. PLoS One. Decision-making in health systems is characterized by detail complexityreducing the amount of information used, simplifying mental causeeffect maps and limiting themselves to a number of static options when making decisionsinstead of approaches that enable consideration of dynamic complexity characterized by networks of relations, feedback loops and non-linearity (Sengupta and Abdelhamid 1993). Effectiveness of medical equipment donations to improve health systems: how much medical equipment is broken in the developing world? Leslie HH, Hategeka C, Ndour PI, Nimako K, Dieng M, Diallo A, Ndiaye Y. Trop Med Int Health. Oye Gureje, We need more "health system thinking" that takes a holistic view of how products and services can help solve bigger and broader problems, such as improving population health, enhancing patient . Application of systems thinking: 12-month postintervention evaluation of a complex health system intervention in Zambia: the case of the BHOMA. Corrections, Expressions of Concern, and Retractions. Health systems are complex adaptive systems with multiple interconnected levels and overlapping sectors [ 13, 14 ]. Set of features School and Faculty of Medicine, Imperial College business and... Thinking adds to the field of global health a primer is designed to that... 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