By James Johnson, Author of Health Systems Thinking: A Primer (with co-authors Douglas E. Anderson and Caren C. Rossow), Comparative Health Systems (with co-author Carleen Stoskopf and Leiyu Shi), and Health Organizations (with co-author Caren C. Rossow).
In this time of a dynamic, uncertain, complex, and ambiguous health challenges at all levels worldwide, systems thinking, as it pertains to health, is critically needed. As described in our book, Health Systems Thinking: A Primer, systems thinking has gained wide acceptance in management, medical, and social sciences, including the domains of healthcare and public health. Increasingly, we also see its embrace in clinical practice, public policy, and health professions education. It has been advocated by the World Health Organization, implemented at the Centers for Disease Control and Prevention, promoted by the American Medical Association, and utilized widely at the National Institutes of Health. Currently, the accrediting commissions within public health, health administration, and nursing are including systems thinking as part of the core competencies in their respective fields. Likewise, in medicine, we are seeing health systems science being added to medical school curricula.
What Systems Thinking Does
Systems thinking challenges health leaders and clinicians to assess the interactions and interdependencies among elements in a system and seek out opportunities to generate sustainable solutions based on deeper understanding of a given system. This typically follows systematic analysis of root causes of problems and inefficiencies. Furthermore, systems thinking focuses on nonlinear assumptions about human behavior and feedback loops to determine a system’s behavior over time, thus finding leverage points to create more reliable and innovative health systems that adapt to achieve desired goals. The theories, concepts, and methods of systems thinking are suited to a myriad of health settings and professions, organizational cultures, and policy challenges.
A Worldly Perspective
In an April 16, 2018 Time Magazine interview with Bill Gates, founder of Microsoft and Co-President of the Bill and Melinda Gates Foundation, Mr. Gates made the following statement about systems, “Modernity is a miracle of systems. Jonas Salk was an amazing scientist, but he isn’t the only reason we’re on the doorstep of eradicating polio—it’s also thanks to the coordinated vaccination effort of health workers, NGOs, and governments. We miss the progress that’s happening right in front of us when we look for heroes instead of systems. If you want to improve some- thing, look for ways to build better systems.”
Overview of the Primer
The Primer describes the foundations of systems thinking, while presenting tools, applications, and cases to enhance the readers’ understanding and practical value of such an approach and methodology. The Primer provides a foundations chapter to introduce the reader to systems theory, systems science, and systems thinking. This is followed by a chapter focused on systems thinking for health administration, a chapter on systems thinking for clinicians, and a subsequent chapter on systems thinking for public and global health. Each of these chapters includes essential concepts along with interviews of systems thinkers and illustrations of various systems thinking tools and processes. Finally, there is a fifth chapter that is comprised of systems thinking cases selected to profile a sample of systems thinking applications in a variety of settings addressing diverse challenges and problems.
Unfortunately, academic programs do not have sufficient learning materials on this topic to give students the requisite knowledge expected of the next generation of health professionals. This Primer addresses the void by empowering its readers with greater understanding of this important and timely topic, while increasing appreciation for the tremendous potential and urgent necessity of systems thinking.
About the Author
Dr. James A. Johnson is a medical social scientist who specializes in international health and organization development in public health. He is the former chair of the Department of Health Administration and Policy at the Medical University of South Carolina and currently professor of health administration and health sciences in the Herbert H. and Grace A. Dow College of Health Professions at Central Michigan University. Additionally, he is visiting professor in the Department of Preventive Medicine and Public Health at St. George’s University in Grenada, West Indies and adjunct professor of health policy at Auburn University. Dr. Johnson has also been an active researcher and health science writer, with more than 100 journal articles and 15 books published.