scholarly journals The Challenges of Putting Systems Thinking into Practice Comment on "What Can Policy-Makers Get Out of Systems Thinking? Policy Partners’ Experiences of a Systems-Focused Research Collaboration in Preventive Health"

Author(s):  
John Boswell ◽  
Janis Baird ◽  
Ravita Taheem

In theory, ‘systems thinking’ offers a remarkably attractive solution to the persistent challenges of preventive public health. Haynes and colleagues’ recent analysis of the Prevention Centre in Australia offers reason for optimism that it might be possible to translate this promise into action on the ground. In this commentary, we critically assess the claims from this promising case study and their broader applicability to the cause of preventive health. We argue that, in many other contexts, persistent obstacles remain, such as a lack of buy-in from senior policy actors, and a lack of tangible or concrete action following through on an abstract commitment to systems thinking.

2019 ◽  
Vol 9 (2) ◽  
pp. 65-76
Author(s):  
Abby Haynes ◽  
Kate Garvey ◽  
Seanna Davidson ◽  
Andrew Milat

Background: There is increasing interest in using systems thinking to tackle ‘wicked’ policy problems in preventive health, but this can be challenging for policy-makers because the literature is amorphous and often highly theoretical. Little is known about how best to support health policy-makers to gain skills in understanding and applying systems thinking for policy action. Methods: In-depth interviews were conducted with 18 policy-makers who are participating in an Australian research collaboration that uses a systems approach. Our aim was to explore factors that support policy-makers to use systems approaches, and to identify any impacts of systems thinking on policy thinking or action, including the pathways through which these impacts occurred. Results: All 18 policy-makers agreed that systems thinking has merit but some questioned its practical policy utility. A small minority were confused about what systems thinking is or which approaches were being used in the collaboration. The majority were engaged with systems thinking and this group identified concrete impacts on their work. They reported using systems-focused research, ideas, tools and resources in policy work that were contributing to the development of practical methodologies for policy design, scaling up, implementation and evaluation; and to new prevention narratives. Importantly, systems thinking was helping some policy-makers to reconceptualise health problems and contexts, goals, potential policy solutions and methods. In short, they were changing how they think about preventive health. Conclusion: These results show that researchers and policy-makers can put systems thinking into action as part of a research collaboration, and that this can result in discernible impacts on policy processes. In this case, action-oriented collaboration and capacity development over a 5-year period facilitated mutual learning and practical application. This indicates that policy-makers can get substantial applied value from systems thinking when they are involved in extended co-production processes that target policy impact and are supported by responsive capacity strategies.


Author(s):  
Matt Egan ◽  
Elizabeth McGill

Advocates suggest that a paradigm shift in preventive health towards systems thinking is desirable and may be underway. In a recent study of policy-makers’ opinions, Haynes and colleagues found a mixed response to an Australian initiative that sought to apply systems theories and associated methods to preventive health. Some were enthusiastic about systems, but others were concerned or unconvinced about its usefulness. This commentary responds to such concerns. We argue that a systems perspective can help provide policy-makers with timely evidence to inform decisions about intervention planning and delivery. We also suggest that research applying a systems perspective could provide policy-makers with evidence to support planning and incremental decision-making; make recommendations to support intervention adaptability; consider potential barriers due to incoherent systems, and consider the political consequences of interventions.


Author(s):  
Sobia Khan

Systems thinking provides the health system with important theories, models and approaches to understanding and assessing complexity. However, the utility and application of systems thinking for solution-generation and decision-making is uncertain at best, particularly amongst health policy-makers. This commentary aims to elaborate on key themes discussed by Haynes and colleagues in their study exploring policy-makers’ perceptions of an Australian researcher-policy-maker partnership focused on applications of systems thinking. Findings suggest that policy-makers perceive systems thinking as too theoretical and not actionable, and that the value of systems thinking can be gleaned from greater involvement of policy-makers in research (ie, through co-production). This commentary focuses on the idea that systems thinking is a mental model that, contrary to researchers’ beliefs, may be closely aligned with policy-makers’ existing worldviews, which can enhance adoption of this mental model. However, wider application of systems thinking beyond research requires addressing multiple barriers faced by policy-makers related to their capability, opportunity and motivation to action their systems thinking mental models. To make systems thinking applicable to the policy sphere, multiple approaches are required that focus on capacity building, and a shift in shared mental models (or the ideas and institutions that govern policy-making).


Author(s):  
Bev J. Holmes

In "What Can Policy-Makers Get Out of Systems Thinking? Policy Partners’ Experiences of a Systems-Focused Research Collaboration in Preventive Health," Haynes et al glean two important insights from the policy-makers they interview. First: active promotion of systems thinking may work against its champions. Haynes and colleagues’ findings support a backgrounding of systems thinking; more important for policy-makers than understanding the finer details of systems thinking is working in situations of mutual learning and shared expertise. Second: coproduction may be getting short shrift in prevention research. Most participant comments were not about systems thinking, but about the benefits of working across sectors. Operationalizing the ‘co’ in co-production is not easy, but it may be where the pay-off will be for prevention researchers, who must understand the critical success factors of co-production and its potential pitfalls, to capitalize on its significant opportunities.


Author(s):  
Ana Teixeira de Melo

In this paper we argue, for an increased congruence between the conceptual frameworks and the research methodology in studies focused on the theory or practice of systems and complexity-informed thinking (SCT). In doing so, we believe we can build more complex forms of knowledge with clearer and more impactful implications for practice. There is scope for both methodological innovations and the adaptation of traditional research methods to enact properties congruent with the systemic complexity of our targeted realities. We organise our reflection around the paper of Haynes et al. We provide examples of how a research methodology more deeply embedded in systems and complexity-thinking may add depth and meaning to the research results and their interpretation. We explore the creative adaptation of the interview techniques to integrate systemic forms of questioning (eg, circular and reflexive questioning) to map the patterns of interaction contributing to the outcomes of interventions.


Author(s):  
Monica E. Nyström ◽  
Sara Tolf ◽  
Helena Strehlenert

It is widely acknowledged that systems thinking (ST) should be implemented in the area of public health, but how this should be done is less clear. In this commentary we focus on sense-making and double-loop learning processes when using ST and soft systems methodology in research collaborations with policy-makers. In their study of policymakers’ experiences of ST, Haynes et al emphasize the importance of knowledge processes and mutual learning between researchers and policy-makers, processes which can change how policy-makers think and thus have impact on real-world policy concerns. We provide some additional examples from Sweden on how ST has been applied to create learning and shared mental models among stakeholders and researchers in national and regional healthcare development initiatives. We conclude that investigating and describing such processes on micro-level can aid the knowledge on how to implement ST in public health.


Author(s):  
Nicky Murray

The term 'Workforce Development’ is used with increasing frequency by policy makers, academics and labour market practitioners. On the surface, it is a relatively unproblematic term, yet closer investigation suggests that it is often used as a 'catch-all ' phrase, which may have quite different meanings and implications, depending upon the user and the context. In this exploratory paper, I first trace the genesis of the term, noting its theoretical underpinnings in systems thinking. I then discuss some of the drivers behind the evolution of the concept of Workforce Development and examine why it appears to have supplanted notions of workforce or manpower 'planning’. Using the health and disability sector as a case study, I highlight some of the differences in how the term is used, and discuss the implications. Finally I ask if the use of a new term, reflecting a presumably significant shift in ways of thinking about the 'workforce’, translates into actions that do, in fact, 'develop’ that workforce.


Author(s):  
Tara Lamont

Systems thinking provides new ways of seeing the world, focusing attention on the relationship between elements in complex systems and the spaces inbetween. Haynes study shows that many policy-makers valued systems thinking as a new way to approach old problems. But they also wanted greater focus on useful policy solutions. This raises interesting questions about the tensions between complexity and simple, action-oriented solutions and how evidence is used in decision-making. Backstage understanding of the complexity of policy problems is matched with the frontstage need to focus on what works. This reflects trends in recent public policy for evidence centres providing decision-makers with toolkits and dashboards of ‘proven’ interventions. There are good examples of evaluations using systems thinking allowing for complexity while addressing policymaker needs to be accountable for public investment and decisions. Strategic communication skills are needed to provide compelling stories which embrace systems thinking without losing clarity and impact.


Author(s):  
Diane T. Finegood

The published literature on the application of systems thinking to influence policies and programs has grown in recent years. The original article by Haynes et al and the subsequent commentaries have focused on the upstream connection between capacity building for systems thinking and systems informed decision-making. This commentary explores the downstream connection between systems-informed decision-making and broader impacts on the health system, the health of the population and other economic and social benefits. Storytelling, systems-based syntheses and systems intervention principles are explored as approaches to strengthen the evidence base. For systems thinking to gain broader acceptance and application to complex health-related challenges, we need more of an evidence base demonstrating impact.


2010 ◽  
Vol 52 (1) ◽  
pp. 26-45 ◽  
Author(s):  
EMMA G. THOMAS ◽  
HANNAH E. BARRINGTON ◽  
KAMALINI M. LOKUGE ◽  
GEOFFRY N. MERCER

AbstractHigh tuberculosis (TB) prevalence in Papua New Guinea (PNG) is a serious public health concern. The epidemic in this region is exacerbated by the presence of drug-resistant TB strains as well as HIV infection. This presents a public health threat not only locally but also to Australia due to the high potential for cross-border transmission between PNG’s Western Province and the Australian Torres Strait Islands. We present two mathematical models of TB in the Western Province: a simple model of the underlying TB dynamics, and a detailed model which accounts for the additional effects of HIV and drug resistance. The detailed model is used to make quantitative predictions about the impact of expanding the TB case detection rate under the Directly Observed Treatment, Short-course treatment regimen. This paper provides a framework for future investigation into the economic costs and public health benefits of potential TB interventions in this region, with the eventual aim of providing recommendations to guide policy makers in both PNG and Australia.


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