using traditional reductionist thinking

Tools for systems thinking.
Pixabay: This Photo by Unknown Author is licensed under CC BY-SA
Complex problems need a different
way of thinking
• In using traditional
reductionist thinking, the
focus is on the problem
rather than the whole
system where the
problem exists.
• Thinking in terms of the
problem within the
context of the system
provides opportunity for
better understanding.
• Systems thinking
tends to focus on the
broader ecosystem
rather than the problem
This Photo by Unknown Author is licensed under CC BY-SA
Senge (1991) described systems thinking
“a discipline for seeing wholes and a
framework for seeing interrelationships
rather than things, for seeing patterns of
change rather than static snapshots.”
What is systems thinking?
Senge, P. M. (1991) The Fifth Discipline. The art and practice of the learning
organization, London: Random House (p. 683).
Jamkhed: Systems Thinking
Example (4:00 mins)
• Many tools are used to support systems
thinking – mainly to measure and visualise
• Some of these tools act as mental short
cuts to support the process of thinking
about health issues as problems with
• The following are just a few of the
available tools that might be used in
systems thinking.
Systems thinking tools:
Mind Mapping
• A Mind Map:
– is a visual
thinking tool.
– can be used for
brainstorming and
exploring ideas.
– is a graphical
of information.
– improves our
capacity to see
the bigger picture.
This Photo by Unknown Author is licensed under CC BY-SA
Useful resources
• The Power of a mind to map: Tony Buzan
• Mind mapping basics:
• How to make a mind map – the basics:
SWOT analysis
• A SWOT analysis:
– is a tool used to work out
the internal and external
factors affecting a problem.
– Assists in the identification
of how to:
• build on strengths (S)
• minimise weakness (W)
• seize opportunities (O)
• counteract threats (T).
This Photo by Unknown Author is licensed under CC BY
Useful resources
• SWOT Analysis – What is SWOT?:
• How to do a SWOT analysis in healthcare:
• SWOT Example:
PEST / PESTLE analysis
• A PEST analysis is:
– A framework used to
analyse external trends
that affect a health care
• Political factors
• Economic factors
• Sociocultural factors
• Technological factors
– A variation that adds
additional factors to form
PESTEL also includes:
• Environmental factors
• Legal factors
This Photo by Unknown Author is licensed under CC BY
Useful resources
• PESTLE Analysis Explained:
• PESTLE basics:
• PESTLE Example:
Systems thinking diagrams
• Diagrams are:
– Powerful tools that help to understand how
complex systems work.
– Helpful in showing how a change in one factor
may impact elsewhere.
– Useful in mapping out the structure of a
– Used to show the factors and relationships
that are important, and to explore the linkages
between factors.
• Systems thinking considers that:
– Everything is interconnected.
– Everything is reliant upon something else for
– The world is a dynamic, chaotic,
interconnected array of relationships and
feedback loops.
• A systems thinker uses this mindset to
untangle and work within the complexity of
life on Earth.
• At the heart of the use of system diagrams is
the idea of linking factors to show a
relationship between them.
• For example a health system may link the
factors of patient medication education with
medication compliance.
• Therefore, there is a link between the quality
of its information exchange, with patience
using medication as per instructions.
• This link is shown diagrammatically as an
arrow linking the two factors.
A simple causal relationship
The diagram indicates that as medication education
improves, so will the medication compliance of the
patient. The arrow shows the direction of the
relationship: raising patient knowledge causes a rise
in medication compliance.
causality refers to the relationship between two
A simple same way polarity
relationship between two factors
The + shows that the factors move in the same way – as medication education
improves, so will the medication compliance of the patient. The arrow shows the
direction of the relationship: raising patient knowledge does not necessarily raise
the medication compliance, some other factors may be afoot (e.g. adolescents
not wanting to appear to be ‘different’, inability to afford medications and such
These relationships can also work the other way.
An opposite polarity relationship
between two factors

The – shows that the relationship works in the opposite way: in this case as you
medication education, patient’s perceptions of medication value reduce.
A causal feedback loop
• The central element of a causal loop diagram
is the feedback loop.
• Feedback is an important concept in the use
of system diagrams.
• Feedback loops capture the interdependency
between elements in a system.
• In very many cases changing one factor will
impact on another factor, which will then
affect the first.
A causal feedback loop
+ –
– +
Reinforcing Loop
Balancing Loop
Reinforcing loops
• Feedback increases the
impact of a change.
• The example shows an
increase in knowledge about
medication increases
medication compliance, which
in turn decreases the need
for more education.
• Note the small circular arrow
in the middle of the loop. This
shows which way round the
loop is running. In complex
diagrams with many loops,
this arrow will be labelled and
will identify loops.
+ –
Balancing loops
• Are characterised by a
dampening effect.
• The feedback reduces the
impact of a change.
• The example shows an
increase in knowledge about
medication may compromise
medication compliance due to
a greater understanding of
the effects the medication
may have, which in turn
triggers the requirement for
more education.
– +
External factors
• The system diagrams we
have looked at so far
completely ignore the
impact of external
• Using the example of the
previous balancing
loops, adding additional
research data to the mix
provides additional
education activity.
– +
Stock / Flow Diagram
• A stock / flow diagram
– can help identify methods for improving
performance in the system
– can be used to create systems maps that show the
connections between different elements of a
This Photo by Unknown Author is licensed under CC BY-SA-NC
Stock / Flow Diagram
• Stocks = accumulations.
– for example: water in a bathtub, money in a bank
account, people aged 65+ years.
– can be counted or measured at any point in time
e.g. how many flu vaccines are available across
the health system today?
• Flows = actions or activities that fill or drain
accumulations over time.
– For example: a flow into the bathtub increases
the stock of water or an outflow via the drain
subtracts water from the bathtub, a deposit into a
bank account increases the balance, as a
withdrawal decreases the balance.
Useful resources
• Introduction to causal loops:
• Step by step:
• Systems thinking tools:
Behaviour over time (BOT)
• The BOT graph is a systems thinking tool that
illustrates patterns and trends.
• The graphs:
– show how something changes over time, rather than
on isolated events.
– are a valuable tool for understanding complexity.
– tell the story of the variable or element being graphed.
– make thinking visible.
– communicate differently than words alone thus they
allow users to explain their thinking
– lead to rich discussions and promote deeper thinking
about how and why something is changing.
Behaviour over time example
2000 2010 2020
2000 2010 2020
Useful resources
• Introduction to behaviour over time graphs:
• Step by step:
• Using BOT to spur systems thinking:

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