Writing Assignment #4
-TWO PAGES.Apply a Systems Thinking tool from the slide presentation,"Systems Tools for Complex Health Systems: A Guide to Creating Causal Loop Diagrams"to one of the high leverage problems of obesity, chronic disease or poverty listed in the video, "CDC on System Thinking in Public Health."
Example: Change versus consequences, Impact Pathway Analysis, System Archetypes, Rich Pictures, Inter-relationship diagraphs, systems maps (causal loop diagrams), Systems dynamic modeling, agent based modeling, network analysis, Scenario Development
***Students are expected to use evidence in their writing and to cite reference in APA 7th edition style, and adequate referencing.
PowerPoint Presentation SYSTEMS TOOLS FOR COMPLEX HEALTH SYSTEMS: A GUIDE TO CREATING CAUSAL LOOP DIAGRAMS 1. An introduction to Systems Thinking 2. Developing a Rich Picture 3. Creating Interrelationship Digraphs 4. Surfacing Causal Loop Diagrams 5. Applying Systems Thinking Tools Five sessions Session One 2 SESSION ONE INTRODUCTION TO SYSTEMS THINKING 1. An introduction to Systems Thinking 2. Developing a Rich Picture 3. Creating Interrelationship Digraphs 4. Surfacing Causal Loop Diagrams 5. Applying Systems Thinking Tools Five sessions Session One 4 • The complexity of health systems • Thinking about “systems” • What is systems thinking? • How can systems thinking help us address health system challenges? • Introducing systems thinking tools Session outline Session One 5 • The complexity of health systems • Thinking about “systems” • What is systems thinking? • How can systems thinking help us address health system challenges? • Introducing systems thinking tools Session One 6 Session outline • What is our current reality? • How has this changed over time? Working in health systems... Session One 7 Current reality for health systems “practitioners” Prior context • Discipline-based expertise (e.g., epidemiology) • Disease-focused initiatives • Disease-focused teams and units • Donors/agencies working in parallel • Donor-driven programs Current context • Focus on Health system strengthening • Inter- and multi-disciplinary teamwork • Collaborative partnerships and joint planning • Complex flows of funding, information and communication channels • Increased use of technology • Country-owned sustainable national health strategies Session One 8 Events and Symptoms Patterns Systems and Structure Crises Tasks Trends Reward Systems Unwritten Rules Political dynamics Hargreaves M, 2010 What is happening now? How do patterns play out over time and space? What are the drivers and deep structures? How are they related? Session One 9 How do we understand our reality? Events and Symptoms Patterns Systems and Structure Crises Tasks Trends Reward Systems Unwritten Rules Political dynamics Session One 10 Hargreaves M, 2010 Fire-fighting Anticipating Designing How do we respond to our reality? • The complexity of health systems • Thinking about “systems” • What is systems thinking? • How can systems thinking help us address health system challenges? • Introducing systems thinking tools Session outline Session One 11 Elements of a system Components/ Variables Inter- connections Function Session One 12 • System: an assembly of components connected together in an organized way – Components are affected by being in the system and are changed if they leave it • Assembly of components does something –Assembly has been identified by someone as being of interest What is a system? Session One 13 The central concept “system” embodies the idea of a set of elements connected together which form a whole, this showing properties which are properties of the whole, rather than properties of its component parts. (Checkland, 1981) What is a system? “ ” Session One 14 • A system is more than the sum of its parts. • How a system behaves and performs is determined by its components, the relationships amongst these components and resultant structure of the system. • System behavior reveals itself as a series of events over time. Thinking about systems Session One 15 Distinguish between systems based on: • degree of certainty about the link between cause and effect amongst variables in the system and • degree of agreement as to the best course of action in a situation in order to produce a consistent outcome Thinking about systems Session One 16 http://www.replacementcarkeys.net/ Thinking about systems Mills A, 2010 High High Low Low Degree of certainty D eg re e of a gr ee m en t Complex systems Random systems Simple systems Session One 17 • Simple (puzzle) • Complicated (problem) • Complex (mess) General types of systems Session One 18 Following a recipe • The recipe is essential • Recipes are tested to assure replicability of later efforts • No particular expertise required; knowing how to cook increases success • Recipe notes the quantity and nature of “parts” needed • Recipes produce standard products • Certainty of same results every time Simple (puzzle) systems Freedman, 2008. Session One 19 Sending a rocket to the moon • Formulae are critical and necessary • Sending one rocket increases assurance that next will be ok • High level of expertise in many specialized fields + coordination • Separate into parts and then coordinate • Rockets similar in critical ways • High degree of certainty of outcome Complicated (problem) systems Freedman, 2008. Session One 20 Raising a Child • Formulae have only a limited application • Raising one child gives no assurance of success with the next • Expertise can help but is not sufficient - relationships are key • Can’t separate parts from the whole • Every child is unique • Uncertainty of outcome remains Complex (mess) systems Freedman, 2008. Session One 21 • Collaborating with partners? • Implementing a supply chain system? • Strengthening adherence to anti- retrovirals? Simple, complicated or complex? Session One 22 A complex adaptive system is a collection of individual actors with freedom to act in ways that are often not predictable, and whose actions are interconnected, so that one agent's actions changes the context for other agents (Plesk 2001) What is a Complex Adaptive System? “ ” Session One 23 Observance of health systems – including findings from failed interventions – tells us that a health system is a complex adaptive system BUT Methods for addressing health system problems are designed as though the health system is merely complicated Health systems are complex systems Session One 24 • The complexity of health systems • Thinking about “systems” • What is systems thinking? • How can systems thinking help us address health system challenges? • Introducing systems thinking tools Session outline Session One 25 Systems thinking is a discipline for seeing wholes, recognizing patterns and interrelationships, and learning how to structure those interrelationships in more effective, efficient ways. (Senge & Lannon-Kim 1991) What is systems thinking? “ ” Session One 26 It is a way of thinking in approaching problems and in designing solutions that appreciates the very nature of complex [adaptive] systems as: – dynamic, constantly changing, – governed by history and by feedback, – where the role and influence of stakeholders and context is critical, and – where new policies and actions (of different stakeholders) often generate counterintuitive and unpredictable effects, sometimes long after policies have been implemented – policy resistance. What is systems thinking? “ ” (Adam 2012) Session One 27 It is a way of thinking in approaching problems and in designing solutions that … …allows the identification of solutions that simultaneously address different problem areas and leverage improvement throughout the system. What is systems thinking? Allen W, 2013 Session One 28 Events and Symptoms Patterns Systems and Structure Crises Tasks Trends Reward Systems Unwritten Rules Political dynamics Systems Thinking moves from this…. Hargreaves M, 2010 What is happening now? How do patterns play out over time and space? What are the drivers and deep structures? How are they related? Session One 29 Events and Symptoms Patterns Systems and Structure Crises Tasks Trends … to making sense of the dynamics Hargreaves M, 2010 What is happening now? How do patterns play out over time and space? What are the drivers and deep structures? How are they related? Session One 30 • The complexity of health systems • Thinking about “systems” • What is systems thinking? • How can systems thinking help us address health system challenges? • Introducing systems thinking tools Session outline Session One 31 Applying systems thinking to health system helps to: • anticipate synergies • mitigate negative emergent behaviours, policy resistance and unintended consequences when • designing changes in the health system • evaluating these interventions Health systems are complex systems Session One 32 Practitioners need to: • SEE differently • THINK differently • ACT differently How can “Systems Thinking” help to understand health systems? Session One 33 SEE differently Session One 34 From • Understanding individual health systems building blocks To • Understanding the relationships amongst building blocks Expanding our vision of health systems World Health Organization. 2007 Session One 35 From: • Patients Towards people: • who are consumers, taxpayers, citizens and co- producers of health and • who interact with each other and their environment in complex, adaptive ways Expanding our vision of health systems Session One 36 From • a sole focus on health outcomes Towards • emergent properties that serve to strengthen the health system including: • Equity • Trust • Responsiveness • Social and fair financing protection • Efficiency Expanding our vision of health systems Session One 37 From • technical interventions Towards • understanding implementation within an enabling environment Expanding our vision of health systems Session One 38 THINK differently Session One 39 We cannot solve our