THE FUNDAMENTALS OF SYSTEMS THINKING IN HEALTHCARE 2nd Edition
INTRODUCTION
The foundational literature of systems science comprises a deep and demanding pool of readings, amply augmented by a bracing outpour of academic papers. A secondary literature then streams through trade journals and popular publications, providing valuable applied examples. A veritable tertiary flood of managerial conversations is centered on systems. Even when such discussions are short on substance, one senses that systems and systems thinking probably refer to something worth attending to. As Peter Senge framed it in The Fifth Discipline, “...systems thinking is the cornerstone of how learning organizations think about their world.” It is that, and far more than that. My task is to state the fundamentals plainly, while pointing the way toward deeper waters.
This text has principally been written to accompany college-level courses in systems thinking for those training for health services delivery or management careers. For readers already employed in these fields, and for motivated students not enrolled in a formal course, there is also much of value herein (though certainly more is asked of such readers). With an eye to the simplicity on the other side of complexity, the material has been condensed to its core elements. To properly unpack this series of synopses, all readers would be well advised to acquaint themselves with the referenced texts and the additional works cited in the bibliography. Detailed accounts of many specific topics can be located on Wikipedia and other Internet sites. This terse guide is intended to direct and spur more extensive study.
Section 1 of the text provides the background necessary to appreciate the nature of systems science, how it contrasts with “normal science”, and its relevance to healthcare. Section 2 presents a framework for depicting human activity systems. That depiction is commonly called systems analysis. Section 3 supplements systems depiction with the multiple lines perspective developed by philosopher Ken Wilber. His trenchant contributions stem from the recognition that all phenomena have interior and exterior aspects, and may be additionally considered in individual and collective contexts. Section 4 applies systems thinking approaches to the confrontation of problematic situations. Therein we come to acknowledge at the outset that the problem is the problem. Section 5 contains practical guidance for navigating the contexts of mainstream healthcare systems. Some of this material is oriented to prospective healthcare system employees. Yet a brief review of basics is oft refreshing for more seasoned system negotiants as well.
Do not neglect the exercises throughout the text. Using systems thinking is a necessary step toward mastery. Illustrative examples have been drawn from healthcare as well as from other domains of human activity.
There are many intertwining traditions, methods, and jargons within systems science. I have made visible those sources I have found of greatest value. Making those selections does not imply that other systems approaches are inferior or lacking in utility. I have tried to limit the use of jargon, but some use is unavoidable and justifiable. Keep in mind that fundamental is not necessarily equivalent to easy. Systems thinking touches on profoundly basic matters that demarcate entire worldviews.
I am keenly aware of my indebtedness to leading contributors to systems theory, and to those who have added so much to my ability to comprehend it. A salute is due to Russell Ackoff, W. Ross Ashby, Ludwig von Bertalanffy, C. West Churchman, Jay W. Forrester, Jamshid Gharajedaghi, Michael Polanyi, Nicholas Rescher, Peter Senge, Werner Ulrich, Heinz Von Foerster, John Warfield, Warren Weaver, Karl Weick, and Ken Wilber, among many others. Perchance you will become more closely acquainted with their light as well!
A special note of acknowledgment is due to the small but dedicated band of professors with whom I taught an interdisciplinary course on systems thinking at Oregon State University: Dave Bella, Len Friedman, Jonathan King, Jack Peters, and Ray William. Such errors as may be in the text are mine alone. This work would not have come to fruition without the invitation from Dr. Mark Seem, President of Tri-State College of Acupuncture in New York, to teach the material anew at an advanced level. Questions and suggestions from students have led to improvements found in this edition.
Welcome to the unfolding dance of parts and wholes that is systems thinking!
David C. Kailin Corvallis, OR http://www.convergentmedical.com
Reference: P. Senge, 1990. The Fifth Discipline. NY: Currency Doubleday. p69.
copyright 2010, 2011 D. Kailin All Rights Reserved.