1. Module VI Understanding Systems Systems

2. Systems System Behavior Feedback Understanding Systems

3. Learning Objectives Systems – Clarify terms – Describe characteristics Complexity – Clarify terms – Describe characteristics

4. SYSTEMS

5. Definition System: a collection of parts that interact with each other to form an interdependent whole

6. Characteristics of Systems “Systems have specific purposes… A system’s parts must all be present for the system to carry out its purpose optimally A system’s parts must be arranged in a certain way for the system to carry out its purpose Systems maintain their stability through fluctuation and adjustments Systems have feedback ” Source: Anderson and Johnson. Systems Thinking: From Concepts to Causal Loops. Pp. 3-4.

7. Organizations as systems Organization a “social structure created by individuals to support the collaborative pursuit of specified goals” - Scott, 2011.

8. Clarify Terms District School Grade Class Nested Systems

9. Formal System http://www.cdc.gov/nphpsp/essentialservices.html

10. One System http://www.cdc.gov/nphpsp/essentialservices.html

11. Activity: Informal System? http://www.cdc.gov/nphpsp/essentialservices.html

12. Example: Informal System Women and Infants

13. Clarify Terms Systems Thinking: “…a discipline for seeing wholes…” - Peter Senge “…an interdisciplinary field that studies the interconnected factors that shape the behavior of complex systems that occur across many domains – including nature, business, science, public health, and society.” - Hassmiller Lich, Ginexi, Osgood, Mabry

15. COMPLEX SYSTEMS: DETAIL AND DYNAMIC COMPLEXITY

16. Detail Complexity Systems with a large number of parts Do not change over time Difficult to understand as a whole 16

17. Dynamic Complexity Dynamic complexity leads to counterintuitive behavior of complex systems because: – Things change over time – Lag time between cause and effect – Nonlinear relationships – Feedback loops 17

18. Dynamic Complexity “…cause and effect are subtle, and where the effects over time of interventions are not obvious”

19. Dynamic Complexity Dynamic complexity leads to counterintuitive behavior of complex systems because: – Things change over time – Lag time between cause and effect – Nonlinear relationships – Feedback loops 19

20. Dynamic Complexity Dynamic complexity leads to counterintuitive behavior of complex systems because: – Things change over time – Lag time between cause and effect – Nonlinear relationships – Feedback loops 20

21. WHO Surgical Checklist

22. Characteristics http://www.cdc.gov/nphpsp/essentialservices.html

23. Dynamic Complexity Dynamic complexity leads to counterintuitive behavior of complex systems because: – Things change over time – Lag time between cause and effect – Nonlinear relationships – Feedback loops 23

24. Dynamic Complexity Nonlinear relationships: “the same action has dramatically different effects in the short run and the long run... an action has one set of consequences locally and a very different set of consequences in another part of the system... and obvious interventions produce nonobvious consequences” - Diane Kelly

25. Tendency: Linear Thinking

26. Nonlinear Thinking

27. Dynamic Complexity Dynamic complexity leads to counterintuitive behavior of complex systems because: – Things change over time – Lag time between cause and effect – Nonlinear relationships – Feedback loops 27

28. Tradeoffs Problem Time Better Worse Short term Long term A. High leverage intervention B. Low leverage intervention

29. Tradeoffs Problem Time Better Worse Short term Long term High leverage intervention Low leverage intervention Program A Program B

30. Tradeoffs Problem Time Better Worse Short term Long term Program A Program B

31. More on “hard systems problems” Wicked problems Problem in which stakeholders do not agree on what the problem is, or even if there is a problem – threatening collective impact. - Vennix, 1999.

32. More on “hard systems problems” Messy problems “actually consist of multiple smaller problems that cannot be solved independently, and which often involve ‘socio-political’ or ‘moral- spiritual’ issues” - Gray and Gill, 2009.

33. Systems Now, step back from the details and think of a system as the important forces shaping a problem you want to address. Many different kinds of “systems” in which we might intervene to address a problem: – The state health department (or communication within it…) – Early childhood systems – All subsystems touching CSHCN – Forces shaping how states react to federal Health Care Reform, or – Life-course determinants of women’s health (MCH x chronic x infectious disease)

34. Bringing science to study systems Systems Science “an interdisciplinary field that studies the interconnected factors that shape the behavior of complex systems that occur across many domains – including nature, business, science, public health, and society.” - Hassmiller, Ginexi, Osgood, Mabry, 2013.

35. Summary Systems – Clarify terms – Describe characteristics Complexity – Clarify terms – Describe characteristics