Systems thinking and the biopsychosocial approach: A multilevel framework for patient‐centred care

Abstract

Patient‐centred care is an approach intended to include service‐users' needs and perspectives as crucial aspects of clinical treatment, superseding any attempt to paternalistic and unilateral attitude in the therapeutic relationship. It is a call to think about persons and not simply of their diseases and implies the adoption of a biopsychosocial perspective and shared decision making. Nonetheless, thinking about persons inevitably means taking the context into due consideration, as individuals are not isolated and any kind of illness experience cannot be thought as a simple matter of inner thoughts and feelings. This perspective article builds on the core tenets of systems thinking and the biopsychosocial approach, with the aim of developing a multilevel approach to patient‐centred care. Within this framework, a literature review has been conducted to gather relevant research findings concerning each level of analysis and the interrelations of such levels. Systems thinking is an ideal framework for capturing the multilayered aspects of illness, from the biological processes that lead to a given disease to the social context where people live. From this angle, we can argue that systems‐centred care is the framework we actually need to truly accomplish patient‐centred goals. This means seeing people as complex dynamical systems and always bearing in mind the ecology of their lives. This also means gearing research and clinical practice towards this direction because complex phenomena like health require adequate methods of inquiry and treatment plans. A multilevel approach is the main road to effective and enduring outcomes. On the contrary, fragmentation of knowledge and excessive specialization without integration can pave the way to short‐term solutions and weak or vanishing improvements in the long run, with obvious costs for persons, families and the community.

Systems thinking epistemological underpinnings of practice among rehabilitation professionals: Case study of the major text of a French physiotherapy founder

“…This interdisciplinary field studies "the relations between psychic processes and pathological physical manifestations, be they functional or organic" [our translation] (del Volgo, 2003, p. 127). It also echoes the bio-psycho-social model later proposed by Engel (Engel, 1980) or more recently by Hallo (Hallo et al, 2021) and by Tramonti (Tramonti et al, 2021) as explained previously.…”

COVID‐19, systems thinking and the ecology of disease: A focus on the family

“…Under the pressure of a rapidly and widely expanding menace, the current situation confirms that all the biopsychosocial dimensions of disease are closely interconnected as parts of the same complex reality 5 . The basic tenets of systems thinking thus can serve as guiding principles for an accurate analysis of such complex reality and the ecology of individual lives 6 . For human beings, this includes family relations, social networks, societies, and the cultural milieu, not forgetting the nonhuman environment.…”

“…5 The basic tenets of systems thinking thus can serve as guiding principles for an accurate analysis of such complex reality and the ecology of individual lives. 6 For human beings, this includes family relations, social networks, societies, and the cultural milieu, not forgetting the nonhuman environment.…”

Making Family-Centered Care for Adults in the ICU a Reality

“…Systems thinking offers a helpful framework for conceptualizing the multilayered aspects of ICU patients' medical situation, from the biological processes that account for their health status, to the psychological processes that influence their coping and adaption, to the family/social, and cultural contexts in which they are embedded ( 27 , 28 ). It lays the foundation for viewing families as essential to patients' health and well-being, allies in care, and key members of the care continuum and caregiving team.…”