Thinking about complexity in health: A systematic review of the key systems thinking and complexity ideas in health

Rusoja, Evan; Haynie, Deson; Sievers, Jessica; Mustafee, Navonil; Nelson, Frederick David; Reynolds, Martin; Sarriot, Eric; Swanson, R. Chad; Williams, Bob

doi:10.1111/jep.12856

Cited by 87 publications

(99 citation statements)

References 25 publications

(49 reference statements)

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“…18 Systems thinking in public health is a broad conceptual lens informed by a multi-disciplinary body of established theories, tools and methods. 17,[19][20][21] It posits that the world is comprised of systems-including health systems-which have interdependent parts that act synergistically and which constantly adapt in non-linear ways that can be resistant to 'logical' interventions. Systems thinking focuses on casual patterns rather than independent forces, and on root causes rather than symptoms.…”

Section: Introductionmentioning

confidence: 99%

What Can Policy-Makers Get Out of Systems Thinking? Policy Partners’ Experiences of a Systems-Focused Research Collaboration in Preventive Health

Haynes

Garvey

Davidson

et al. 2019

Int J Health Policy Manag

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Background: There is increasing interest in using systems thinking to tackle ‘wicked’ policy problems in preventive health, but this can be challenging for policy-makers because the literature is amorphous and often highly theoretical. Little is known about how best to support health policy-makers to gain skills in understanding and applying systems thinking for policy action. Methods: In-depth interviews were conducted with 18 policy-makers who are participating in an Australian research collaboration that uses a systems approach. Our aim was to explore factors that support policy-makers to use systems approaches, and to identify any impacts of systems thinking on policy thinking or action, including the pathways through which these impacts occurred. Results: All 18 policy-makers agreed that systems thinking has merit but some questioned its practical policy utility. A small minority were confused about what systems thinking is or which approaches were being used in the collaboration. The majority were engaged with systems thinking and this group identified concrete impacts on their work. They reported using systems-focused research, ideas, tools and resources in policy work that were contributing to the development of practical methodologies for policy design, scaling up, implementation and evaluation; and to new prevention narratives. Importantly, systems thinking was helping some policy-makers to reconceptualise health problems and contexts, goals, potential policy solutions and methods. In short, they were changing how they think about preventive health. Conclusion: These results show that researchers and policy-makers can put systems thinking into action as part of a research collaboration, and that this can result in discernible impacts on policy processes. In this case, action-oriented collaboration and capacity development over a 5-year period facilitated mutual learning and practical application. This indicates that policy-makers can get substantial applied value from systems thinking when they are involved in extended co-production processes that target policy impact and are supported by responsive capacity strategies.

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Section: Introductionmentioning

confidence: 99%

What Can Policy-Makers Get Out of Systems Thinking? Policy Partners’ Experiences of a Systems-Focused Research Collaboration in Preventive Health

Haynes

Garvey

Davidson

et al. 2019

Int J Health Policy Manag

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“…15 The current research emphasis is largely methods based, such as causal loop diagrams and social network analysis. 1,2,31 In contrast, this paper considers one skill (of a suite, e.g. exploring multiple perspectives, maintaining boundaries, identifying feedback loops) that is relevant to health promotion practitioners who are trying to solve complex public health problems.…”

Section: Discussionmentioning

confidence: 99%

Applying influence for systems change in a large-scale community-based prevention intervention

Bensberg¹

2021

Public Health Res Pract

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Within a systems approach to preventive health, practitioners who see themselves as part of the system that surrounds them can use their influence as a means of establishing health-promoting change • Many health promotion practitioners need to build their capacity so they can employ 'self-in-the-system' tactics. This could help to shift their practical know-how from programmatic approaches based on individual projects towards more systemic ones

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“…A systems thinking approach enables understanding of inter-relationships, interactions, and various perspectives of a system, including reflecting on the system's boundaries. Systems reflect dynamic, often unpredictable interactions amongst diverse, constantly adapting parts that continually change in relation to each other and the collective environment [43]. These relationships can be represented via causal loop diagrams, which use reinforcing loops (representing feedback loops that accelerate change) and balancing loops (representing feedback PLOS ONE loops that resist change) to generate systems maps.…”

Section: Systems Thinking Diagramsmentioning

confidence: 99%

Moving towards culturally competent health systems for migrants? Applying systems thinking in a qualitative study in Malaysia and Thailand

et al. 2020

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Background Cultural competency describes interventions that aim to improve accessibility and effectiveness of health services for people from ethnic minority backgrounds. Interventions include interpreter services, migrant peer educators and health worker training to provide culturally competent care. Very few studies have focussed on cultural competency for migrant service use in Low-and Middle-Income Countries (LMIC). Migrants and refugees in Thailand and Malaysia report difficulties in accessing health systems and discrimination by service providers. In this paper we describe stakeholder perceptions of migrants' and health workers' language and cultural competency, and how this affects migrant workers' health, especially in Malaysia where an interpreter system has not yet been formalised. Method We conducted in-depth interviews with stakeholders in Malaysia (N = 44) and Thailand (N = 50), alongside policy document review in both countries. Data were analysed thematically. Results informed development of Systems Thinking diagrams hypothesizing potential intervention points to improve cultural competency, namely via addressing language barriers. Results Language ability was a core tenet of cultural competency as described by participants in both countries. Malay was perceived to be an easy language that migrants could learn quickly, with perceived proficiency differing by source country and length of stay in Malaysia. Language barriers were a source of frustration for both migrants and health workers, which compounded communication of complex conditions including mental health as well as obtaining informed consent from migrant patients. Health workers in Malaysia used

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Thinking about complexity in health: A systematic review of the key systems thinking and complexity ideas in health

Cited by 87 publications

References 25 publications

What Can Policy-Makers Get Out of Systems Thinking? Policy Partners’ Experiences of a Systems-Focused Research Collaboration in Preventive Health

What Can Policy-Makers Get Out of Systems Thinking? Policy Partners’ Experiences of a Systems-Focused Research Collaboration in Preventive Health

Applying influence for systems change in a large-scale community-based prevention intervention

Moving towards culturally competent health systems for migrants? Applying systems thinking in a qualitative study in Malaysia and Thailand

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