Rethinking health systems strengthening: key systems thinking tools and strategies for transformational change

Abstract

While reaching consensus on future plans to address current global health challenges is far from easy, there is broad agreement that reductionist approaches that suggest a limited set of targeted interventions to improve health around the world are inadequate. We argue that a comprehensive systems perspective should guide health practice, education, research and policy. We propose key 'systems thinking' tools and strategies that have the potential for transformational change in health systems. Three overarching themes span these tools and strategies: collaboration across disciplines, sectors and organizations; ongoing, iterative learning; and transformational leadership. The proposed tools and strategies in this paper can be applied, in varying degrees, to every organization within health systems, from families and communities to national ministries of health. While our categorization is necessarily incomplete, this initial effort will provide a valuable contribution to the health systems strengthening debate, as the need for a more systemic, rigorous perspective in health has never been greater.

Key strategies to improve systems for managing patient complaints within health facilities – what can we learn from the existing literature?

“…Each component, being amongst the six building blocks of health systems [90], is crucial to well-functioning and responsive health systems [91–93]. The effects on these two components are often related – for example, improved use of complaints data in mental health hospitals in England was shown to lead to improvements in treatment programmes, staff shortages, and quality of meals [94].…”

Community Health Systems as Complex Adaptive Systems: Ontology and Praxis Lessons from an Urban Health Experience with Demonstrated Sustainability

“…(Ramalingam 2013) The fields of global health practice and research have so far not adapted the inventory of tool-such as the viable systems model of Stafford Beer, Checkland's soft systems methodology, among others-more familiar to organizational systemic practitioners, even though global health takes place within complex networks of organizations and communities. New efforts (Ramalingam et al 2008;Williams and Hummelbrunner 2010) (Paina and Peters 2011), (Swanson et al 2012) come with sometimes new language, which challenges the simple language of 'Grand Strategies'. (Hodgins 2014) Appendix 1 (Clarifying our Language: Systems or Complexity or Both?)…”

“…Confusion about systems thinking increases when authors and discussants fail to clarify this perspective (the nature of phenomenon, an intervention, or how to study both). Paina and Peters (2011) for example provides important ontological parameters in understanding health systems; (Peters et al 2012;Swanson et al 2012) uses ontological descriptions to develop interventions on health markets; Rihani stresses the nature of development processes in Southern Countries to recommend new ways of intervening for Northern partners. The work of Chambers has largely focused on development practice, based on implied understandings of the complexity of local systems.…”

Del lado de allá y del lado de acá: ¿qué pueden aprender mutuamente los países emergentes latinoamericanos y España para mejorar sus perfiles del médico de familia?

“…Sin embargo, el "Sur" no sólo recibe ideas, sino que las genera también 5,6 . En esta situación, faltan estudios comparativos del perfil profesional del MdF -organización del trabajo, actividades, competencias y responsabilidades, satisfacción profesional, relación médico-paciente, etc.-en países industrializadas y emergentes, siendo preciso favorecer la investigación y formación como procesos de doble vía, así como la evaluación adecuada de las fortalezas de los sistemas sanitarios de los países en desarrollo y las redes de colaboración entre países en desarrollo y desarrollados [7][8][9] .…”