Systems Thinking

The importance of healthcare is undeniable in today’s society. It certainly plays a crucial role and it takes precedence on many governmental concerns. This is particularly evident in the amount allocated to the healthcare sector not just in the United States. Despite this, there is still a growing number of poor outcomes and increasing dissatisfaction with the quality of services. These failings within healthcare systems are largely brought about by the inadequate methods and diagnostic tools that help analyze, design and implement policies and procedures. Health care systems are often complex and are composed of many elements and factors. Oftentimes, decisions or actions may resolve one aspect of the issue and does not provide solutions that address the totality of the issue or problem at hand.

Due to the complex nature of healthcare, a Systems Thinking approach is necessary to understand an isolated action or event as part of a system. The essence of systems thinking is distinguishing and understanding inter-relationships instead of focusing on the cause-and-effect (Senge, 1990). However, health care providers do not often utilize a systems thinking approach, nor does it come naturally to them. As healthcare professionals, personal responsibility is taught foremost along with mastery of knowledge and gaining the skills to deliver care to the general population. Some challenges posed by a systems thinking approach may include:

  1. Any output achieved results from the design of the system. Therefore, unplanned or unintended system design can still affect the output.
  2. Each system is composed of a variety of interconnected elements such as people, processes, equipment and data. Each element can affect not just the whole system, but also each of the other elements within the system.
  3. The aim of a systems approach is to maximize output of the system and not the output of its elements. Thus, system elements must be optimized in order to get the best output from the system.
  4. The output generated by the system is composed of multiple facets and components. In health care, these components can be translated to areas such as patient safety, efficiency, and equity. Stakeholders of the system often do not agree on priorities and optimization of each element is based on the value applied by stakeholders.
  5. Systems are oftentimes part of a larger system. In healthcare, people, equipment and data can make up a single system within the hospital setting. This system (the hospital) can be part of a larger system, which can be equated to the healthcare system of the United States.
  6. Systems often produce unintentional consequences or outcomes that have unpredictable beneficial or harmful effects.

The above examples highlight the challenges posed by a systems thinking approach and further proves that systems thinking is not an easy matter. It is essential, therefore, to gain more knowledge about applying systems thinking in the field of healthcare. There is a need to identify both Microsystems and macrosystems within the field of health care and assessing these systems’ interaction, their strengths and weaknesses, performance criteria and measurement, identifying their functions and ways to optimize performance. It is also crucial to understand that systems are complex in that it is merely a mental representation of the real world. Despite trying to complete the model as precisely as possible, it can never be completely and entirely accurate and will never be able to provide all the answers. This is primarily the reason why findings can be contradictory at times and methods of analysis can lead to different conclusions.

The field of healthcare is constantly besieged with calls for quality improvement and better outcomes. There have been numerous cases of medical errors, negligence and incidents that have resulted in further harm for patients and clients. According to the Institute of Medicine (1999), a large proportion of medical errors result from flawed systems and processes and not from human error. The provision of healthcare is not just carried out by a single entity, but rather, it is a concentrated effort from the healthcare team, usually consisting of people in various fields such as doctors, nurses, social worker, dietician, etc. In addition, the provision of safe, effective and quality care is dependent not just on the knowledge and skill of a single person but also on the work environment, group dynamics within the work environment and inherent behavior of the worker. These attributes have made healthcare is a highly complex entity, wherein even the smallest changes within the field can contribute to errors. A systems approach is one such method in order to analyze events and identify factors behind these errors or mishaps. The systems thinking approach focuses on the entirety of the system and takes into account all perspectives, ranging from human factors, technical factors and processes. Systems thinking examine the interaction of these factors and analyze it as a whole. There is a shift from a blaming culture to a culture of understanding, focusing on the underlying causes and attempting to understand the processes that have led to the event. Information gleaned from this process can then be utilized to design safety measures or identify gaps in practice that need to be addressed.


Institute of Medicine (1999). To err is human: building a safer health system. Washington, DC: National Academy Press.

Senge, P. (1990). The Fifth Discipline: the art and practice of the learning organisation. London, Century Business

Sterman, J.D (2000). Business dynamics. Systems Thinking and modeling for a complex world. Mc-Graw Hill/Irwine, International edition.

University of Washington Center for Health Sciences (2005). Best practices in patient safety education module handbook. Seattle, Center for Health Sciences.