Health systems research and critical systems thinking: the case for partnership

Abstract

There has been a considerable growth in interest in Health Systems Research over the last 25 years. It is only recently, however, that health systems researchers have started to examine the key conceptual tool in their armoury the notion of 'system'and only then in a sporadic fashion. This paper argues that the failure to undertake this challenge has held back the field both theoretically and in terms of practice. Critical systems thinkers have, by contrast, spent the last 30 years conducting a second-order analysis of different systems and complexity approaches, the way they employ the concept of 'system', and the difference this makes to the theories espoused and the modes of intervention endorsed. They have also explored how different systems approaches can be used in combination to bring about improvement by addressing the multi-dimensional complexity thrown up by wicked problems. What critical systems thinkers have failed to do is get their hands dirty and demonstrate, through practical application, that their approach is useful in the health systems domain. Given the significance of health systems for public well-being, and their inherent complexity, this is something that needs rectifying. If Critical Systems Thinking can support Health Systems Research with appropriate theories and methodologies, and health systems researchers are willing to involve critical systems thinkers in tackling the major issues they face, then a fruitful partnership can be forged.

Systemic Problem Structuring in a Complex Hospital Environment using Viable System Diagnosis – Keeping the Blood Flowing

“…For the interested reader, we recommend consulting the following recent cases in the health topics, medicine procurement systems (Mouhib et al 2019) and health cluster development (Wong and Hiew 2019). An excellent broader overview to health systems research from a systemic point of view is given by Jackson and Sambo (2019). Much can be gleaned from a variety of other applications, such as viable organizations in disaster response (Preece et al 2013(Preece et al , 2015, the development of local communities (Espinosa and Walker 2013;Espinosa and Duque 2018;Velásquez-Rodríguez and Payán-Durán 2021), learning and educational development (Hart and Paucar-Caceres 2016;Rezk and Gamal 2020), governance of IT and software projects (Arghand et al 2021;Puche-Regaliza et al 2020), and in tourism (Sánchez-García et al 2020;Núñez-Ríos et al 2020).…”

Empowering health systems research to engage with technical, organizational, social and economic forces: Lessons from the 2014 Ebola epidemic

“…The last 25 years have seen a significant growth in interest in applying systems thinking and complexity theory in health research. A paper by Jackson and Sambo (2020) traces this development in HSR in terms of host institutions, reports and books, journal articles and conferences. The interest here, however, is in identifying the strengths and weaknesses of HSR in understanding and meeting the challenges posed by emergencies such as the 2014 Ebola epidemic.…”

Cyber blame and social theory

“…Cybernetics adds to the blame literature by providing a construct of causality in fluid, moving wholes. These ideas about cyber blame as self-steering, multi-focal, and capable of simultaneous, even co-dependent, attributions of right and wrong that come from a large, long time, and diverse body of works on cybernetics like (Jackson and Sambo 2020 ; Melo 2020 ; Wallis 2020 ; Wallis 2014 ; Guy 2018 ; Mavrofides et al 2011 ; Hanson 1995 ) and the groundbreaking work of Maruyana ( 1963 ), Bateson ( 1980 ) and Watzlawick et al ( 1967 ). It also harmonizes with revisions of mechanistic or binary views (Reiter 2020 ; Knio 2018 ; Hanson 2014 , 1995 ; Khoury 2013 ; Foley 2003 ; Egler 1970 ; Maruyana 1963 ) and arguments for more ecological, fuzzy, or leaky categories (Stalker 2019 ; Hinterleitner and Sager 2017 ; McDaniel 2003 ).…”