Teaching and Learning Complex Systems Thinking in Health: Getting Past the Obstacles
Today’s health challenges are increasingly complex. There doesn’t seem to be only one solution. The challenges overlap, change frequently, and cross geographic, professional, and other boundaries. In this blog post, we introduce a promising approach to today’s health challenges: complex systems thinking (CST). We focus on some key and frequent obstacles that we have found in teaching and learning CST.
Getting past the jargon and confusing terminology
There are several barriers faced when learning CST. One of these is the initial confusion that may come from all of the various terms and jargon: systems thinking, complex adaptive system, systems dynamics, complexity science, systems sciences, general systems theory, etc.
The above visual is a dizzying attempt to map many of these terms. All of these threads of thought come from various disciplines such as business, physics, and engineering. In fact, complexity science is not a single theory. Rather, it encompasses frameworks from many different theories including holism, general systems theory, and many others.
It is easy to become overwhelmed with this new terminology and assume that thinking systematically requires a deep understanding of all of these new concepts and language. Not so.
We find it helpful to consider and focus on just those theories, methods and tools that are most applicable to the particular situation. Some examples include causal loop diagrams, systems archetypes, scenario planning, and social network analysis. See here for a table by David Peters of frequently used systems thinking theories, methods and tools.
We’ve found however, that the power and potential of CST extend well beyond tools and methods. We think that viewing health challenges with a CST lens results in a dramatic change in the way that we frame and approach those challenges and possible solutions.
A shift in mindset
Put simply, CST is all about optimizing interactions over time to accomplish what we as a society really want: maximal population health; individual and community wellness; equity; local capacity; efficiency; satisfaction; emergency care; etc.
Bob Williams describes the essence of systems thinking as the consideration of interrelationships, perspectives, and boundaries. It is a lens, mindset, paradigm, and worldview that contrasts with (and complements) the leading paradigm in science, reductionism. While reductionism focuses on targeting one symptom, disease, programme, or policy at a time, CST assumes that the whole is greater than the sum of its parts and to improve health we must focus on the relationships and interactions between the parts.
The following table contrasts concepts of CST with those of reductionism (modified from Tagreed Adam and Don de Savigny’s book on systems thinking for health systems strengthening):
A reductionist approach is no longer sufficient to address many real-world problems. It is not enough to divide and conquer and expect parts of a system to equal the whole. Problems are interconnected and interdependent and solving them requires taking this into account. The outcomes of unpredictable interactions over time are crucial considerations.
Why do we need CST in our health education?
While current health education focuses on preparing students to excel our present, broken health system, CST challenges the status quo in a meaningful way and stimulates individuals to envision a better system. Current education has a reductionist approach, based on breaking down problems and finding one-dimensional solutions. CST requires collaboration that crosses disciplines, professions, and sectors. This multidimensional approach shifts our mindset from addressing problems individually to systematically and is an essential skill set to creating real-world solutions for real-world problems.
Strengthening a health system is too often approached with the assumption that the final output will simply equal the sum of the individual inputs. However, results are often greater or different than the sum of their parts. This approach too often results in unintended consequences, because humans aren’t parts; we have assumptions and biases and feelings and hidden agendas. We are continuously interacting with, and influenced by, others. As argued by Jim Woodhill, we require “soft” capacities of “communication, trust building, diplomacy, networking, making sense of messy social situations, political advocacy and leadership” to strengthen systems.
The effects of actions in complex social systems like health are nonlinear and often unpredictable; the magnitude of the outcome does not correspond to the magnitude of the input. The outcomes of unpredictable interactions over time are crucial considerations.
In order to address the complex problems faced in healthcare and public health today, there is a need for adaptable leaders who view the world with a CST lens. That need extends to many aspects of health policy and practice, including capacity development, leadership, and learning. These leaders can be made in part by incorporating more CST in education.
We have recently formed a small network that is interested in catalysing or contributing to a global transformation in health education to incorporate more CST. We hope that you’ll join us! Learn more at revolutionizehealth.org and read our white paper on Health Education and Complex Systems Thinking.
R. Chad Swanson, DO, MPH; Kate Strickling Lyman; and Jessica Wilkinson
This blog post uses material from "Complex Systems Thinking in Health: A Brief Introduction", written by Dr. Chad Swanson with funding from DDCF's African Health Initiative.