Systems thinking is a framework of approaching problems while looking at the bigger picture. Instead of trying to address a specific problem on a small scale, this method encourages to look at how different agents interact in a way that reproduces the issue (NIHR, 2019). These agents may involve people, services, organizations, and any other stakeholders involved in the processes surrounding specific issues and problems (NIHR, 2019). For example, when it comes to evaluating nurse medical errors from a systems perspective, it would go beyond specific mistakes made by particular nurses (Trockel et al., 2020). Greater issues may come into consideration. Some of these include the following: how understaffed is the hospital, what are the nursing schedules, their compensation, training, equipment, leadership, and a plethora of other pertinent factors.
If a problem is systemic and replicates itself frequently, then their roots lie beyond the scope of one specific nurse or even a department. It may be that nurses as a whole suffer from burnout and care fatigue that they were not trained to do specific tasks and are filling in because of employee shortages (Finn et al., 2018). It could be that the equipment is faulty, or any other combination of the factors mentioned. Understanding what factors in the bigger picture cause issues is critical for aiming interventions accordingly and addressing the root causes rather than the symptoms of a systems failure (NIHR, 2019). Such an understanding is necessary for large-scale interventions, policy-making efforts, and long-term change in medicine or any other related area of practice (NIHR, 2019). It was interesting and important to learn about systems thinking as the core logical construct to utilize when talking about healthcare on a large scale.
Systems thinking will play a major role in highlighting the processes and actors influencing the outcome of the proposed intervention. A local intervention, by design, cannot affect all of the major factors affecting the outcome for the population (NIHR, 2019). Its scope cannot reach all of the stakeholders and processes that affect the community on a greater scale. Some may be present and capable of being interacted with, either directly or indirectly, while others are not. As such, it has to be identified which actors and systems are influencing the results, and which effects are merely symptoms of a bigger problem, that cannot be affected beyond the ability to mitigate the aftermath.
This distinction is critical, as resources for any intervention are limited, and prioritization needs to take part. Trying to affect the symptoms without treating the core causes is, by definition, a stop-gap measure (NIHR School, 2018). It cannot be sustained for prolonged periods of time, and should that kind of support ever be removed, there would be an inevitable return to status quo (NIHR School, 2018). For example, the use of bariatric surgery to address obesity in an impoverished community would be an expensive stop-gap measure, as any reduction achieved through such means would be undone by the habits of unhealthy eating, overreliance on fast food, and low physical activity rates (Finn et al., 2018). Therefore, to address the community issues, bariatric surgery can be used only to help patients for whom obesity presents a danger right in this very moment. A systems approach would advocate for promoting healthier eating, active lifestyles, and access to products for cooking, versus having to rely on fast-food restaurants for daily nourishment (NIHR, 2019). In my research topic, I will apply systems thinking in a manner similar to that highlighted above.
References
Finn, K. M., Metlay, J. P., Chang, Y., Nagarur, A., Yang, S., Landrigan, C. P., & Iyasere, C. (2018). Effect of increased inpatient attending physician supervision on medical errors, patient safety, and resident education: a randomized clinical trial. JAMA Internal Medicine, 178(7), 952-959.
National Institute for Health Research (NIHR). (2019). Guidance on systems approaches to local public health evaluation. Web.
NIHR School for Public Health Research. (2018). What can a systems approach do for you? [Video]. Youtube. Web.
Trockel, M. T., Menon, N. K., Rowe, S. G., Stewart, M. T., Smith, R., Lu, M.,… &
Shanafelt, T. D. (2020). Assessment of physician sleep and wellness, burnout, and clinically significant medical errors. JAMA Network Open, 3(12), e2028111-e2028111.
