Time to Shift from Systems Thinking-Talking to Systems Thinking-Action; Comment on “Constraints to Applying Systems Thinking Concepts in Health Systems: A Regional Perspective from Surveying Stakeholders in Eastern Mediterranean Countries”

Document Type : Commentary


1 Michael Smith Foundation for Health Research, Vancouver, British Columbia, Canada

2 School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada

3 Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada

4 InSource Research Group, Vancouver, British Columbia, Canada


A recent International Journal of Health Policy and Management (IJHPM) article by Fadi El-Jardali and colleagues makes an important contribution to the literature on health system strengthening by reporting on a survey of healthcare stakeholders in Low- and Middle-Income Countries (LMICs) about Systems Thinking (ST). The study’s main contributions are its confirmation that healthcare stakeholders understand the importance of ST but do not know how to act on that understanding, and the call for collective action by the global community of systems thinkers committed to healthcare improvement. We offer three basic considerations for next steps by this community, derived from our recent work in ST and the related field of Knowledge Translation (KT): resist the temptation to adopt a reductionist approach; recognize not everyone needs to understand ST; and do not wait for everything to be in place before getting started.


Main Subjects

  1. El-Jardali F, Adam T, Ataya N, Jamal D, Jaafar M. Constraints to applying systems thinking concepts in health systems: A regional perspective from surveying stakeholders in Eastern Mediterranean Countries. Int J Health Policy Manag 2014; 3:  399-407.  doi: 10.15171/ijhpm.2014.124
  2. Holmes BJ, Best A, Finegood D, Riley B. Systems Theory and Approaches to Dissemination and Implementation. In: Brownson RC, Colditz GA, Proctor EK, eds. Dissemination and Implementation Research in Health: Translating Science to Practice. New York: Oxford University Press; 2012. P. 175-91. 
  3. Wagner A. Causality in complex systems. Biol Philos 1999; 14: 83-101. doi: 10.1023/a:1006580900476
  4. Holmes BJ, Scarrow G, Schellenberg M. Translating evidence into practice: the role of health research funders. Implement Sci 2012; 7: 39. doi: 10.1186/1748-5908-7-39
  5. Best A, Holmes, BJ. Systems thinking, knowledge and action: Towards better models and methods. Evid Policy 2010; 6: 135-59. doi: 10.1332/174426410x502284
  6. Holmes BJ, Schellenberg M, Schell K, Scarrow G. How funding agencies can support research use in healthcare: an online province-wide survey to determine knowledge translation training needs. Implement Sci 2014; 9: 71. doi: 10.1186/1748-5908-9-71
  7. BC’s Clinical Care Management Initiative: A Case Study for Health System Transformation. June 2014.  Available from: http://bcpsqc.ca/documents/2014/09/A-Case-Study-of-BCs-Clinical-Care-Management-Initiative.pdf
  8. InSource [home page on the internet]. The Challenge of Complexity. Available from: http://www.in-source.ca/