Systems Thinking 14

What Are the Initial Steps in Systems Analysis?

1.Identify the key influences or interventions on an outcome such as disease or the outcome of disease 2.Indicate the relative strength of the impact of each of the influences or interventions 3.Identify how these influences or interventions interact

What Additional Steps Are Needed to Complete A System Analysis?

4.Identify the dynamic changes that may occur in a system by identifying the feedback loops that occur in the system 5.Identify bottlenecks that limit the effectiveness of the system 6.Identify leverage points that provide opportunities to greatly improve outcomes

a system....

•A system changes if you take away or add pieces •Parts are connected to each other, work together, and the arrangement is crucial •Behavior of a system depends on its overall structure

What is a System?

•A system is an interacting group of items forming a unified whole

Systems analysis 101

•Systems analysis is increasingly being used to understand the influences that bring about disease and outcomes of disease

How Can We Use a Systems Analysis to Better Understand a Problem Such as Coronary Artery Disease?

•Table 14-1 illustrates how we can better understand a health problem through utilizing the six steps of systems analysis •See P. 273

How Can We Use Systems Diagrams to Display the Working of a System?

•The development of systems diagrams begins with identifying the key factors that will be included in the systems •For each factor, we need to: •Indicate the direction in which it operates (which way the arrow points) •Indicate whether the factor operates to reinforce or increase another factor/outcome (+) or operates to dampen or decrease another factor/outcome (-)

How Can Systems Analysis be Used to Understand the Health Research Process?

•Translational research •An attempt to bridge the gaps between basic research, clinical applications, and population health implications by seeing health research as a system •Identifies the pieces, looks at how they should connect, and attempts to put the pieces together as a coherent whole •"From bench to bedside"

Contributions of systems thinking to public health

•assisting in explanation, operation, and prediction (see p. 283) •Explanation asks... •what are the factors that influence the development and outcome of a disease or other problem as part of a system? •Operation asks... •How can an intervention be combined with other interventions to maximize the overall impact? •Prediction asks... •what changes in systems can be expected and how can they be channeled to improve future outcomes?

•Systems may be used to describe:

•complex biological relationships •organizations' relationships or processes •the working of factors/influences that bring about disease and the outcome of disease

Traditional thinking

•in public health, like most science based disciples, has used mostly reductionist thinking •Looks at one factor or variable at a time

What Makes Systems Thinking Different?

•looks at the impacts of multiple factors and how they work together as parts of a system •Often utilizes data derived from reductionist thinking but goes beyond to look at multiple factors that cause disease and disease outcomes

Negative feedback loop-

•one factor reinforces another factor which dampens yet another factor •Product of the signs is negative

Positive feedback loop-

•one factor reinforces another to magnify its impact •Product of the signs is positive