What Can Policy-Makers Get Out of Systems Thinking? Policy Partners’ Experiences of a Systems-Focused Research Collaboration in Preventive Health

Document Type : Original Article

Authors

1 The Australian Prevention Partnership Centre, Sydney, NSW, Australia

2 Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia

3 Australia Public Health Services, Department of Health Tasmania, Hobart, TAS, Australia

4 The Systems School, Melbourne, VIC, Australia

5 Centre for Epidemiology and Evidence, NSW Ministry of Health, Sydney, NSW, Australia

Abstract

Background
There is increasing interest in using systems thinking to tackle ‘wicked’ policy problems in preventive health, but this can be challenging for policy-makers because the literature is amorphous and often highly theoretical. Little is known about how best to support health policy-makers to gain skills in understanding and applying systems thinking for policy action.
 
Methods
In-depth interviews were conducted with 18 policy-makers who are participating in an Australian research collaboration that uses a systems approach. Our aim was to explore factors that support policy-makers to use systems approaches, and to identify any impacts of systems thinking on policy thinking or action, including the pathways through which these impacts occurred.
 
Results
All 18 policy-makers agreed that systems thinking has merit but some questioned its practical policy utility. A small minority were confused about what systems thinking is or which approaches were being used in the collaboration. The majority were engaged with systems thinking and this group identified concrete impacts on their work. They reported using systems-focused research, ideas, tools and resources in policy work that were contributing to the development of practical methodologies for policy design, scaling up, implementation and evaluation; and to new prevention narratives. Importantly, systems thinking was helping some policy-makers to reconceptualise health problems and contexts, goals, potential policy solutions and methods. In short, they were changing how they think about preventive health.
 
Conclusion
These results show that researchers and policy-makers can put systems thinking into action as part of a research collaboration, and that this can result in discernible impacts on policy processes. In this case, action-oriented collaboration and capacity development over a 5-year period facilitated mutual learning and practical application. This indicates that policy-makers can get substantial applied value from systems thinking when they are involved in extended co-production processes that target policy impact and are supported by responsive capacity strategies.

Highlights

Commentaries Published on this Paper

  • Without Systems and Complexity Thinking There Is no Progress - or Why Bureaucracy Needs to Become Curious; Comment on “What Can Policy-Makers Get out of Systems Thinking? Policy Partners’ Experiences of a Systems-Focused Research Collaboration in Preventive Health”

         Abstract | PDF

 

  • Overcoming Barriers to Applying Systems Thinking Mental Models in Policy-Making; Comment on “What Can Policy-Makers Get Out of Systems Thinking? Policy Partners’ Experiences of a Systems-Focused Research Collaboration in Preventive Health”

          Abstract | PDF

 

  •  Can Systems Thinking Become “The Way We Do Things?”; Comment on “What Can Policy-Makers Get Out of Systems Thinking? Policy Partners’ Experiences of a Systems-Focused Research Collaboration in Preventive Health”

          Abstract | PDF

 

  • But Does It Work? Evidence, Policy-Making and Systems Thinking; Comment on “What Can Policy-Makers Get Out of Systems Thinking? Policy Partners’ Experiences of a Systems-Focused Research Collaboration in Preventive Health”

          Abstract | PDF

 

  • The Challenges of Putting Systems Thinking into Practice; Comment on “What Can Policy-Makers Get Out of Systems Thinking? Policy Partners’ Experiences of a Systems-Focused Research Collaboration in Preventive Health”

          Abstract | PDF

 

  • Sense-Making, Mutual Learning and Cognitive Shifts When Applying Systems Thinking in Public Health – Examples From Sweden; Comment on “What Can Policy-Makers Get Out of Systems Thinking? Policy Partners’ Experiences of a Systems-Focused Research Collaboration in Preventive Health”

          Abstract | PDF

 

  • Applying a Systems Perspective to Preventive Health: How Can It Be Useful?; Comment on “What Can Policy-Makers Get Out of Systems Thinking? Policy Partners’ Experiences of a Systems-Focused Research Collaboration in Preventive Health”

          Abstract | PDF

 

  • Can We Build an Evidence Base on the Impact of Systems Thinking for Wicked Problems?; Comment on “What Can Policy-Makers Get Out of Systems Thinking? Policy Partners’ Experiences of a Systems-Focused Research Collaboration in Preventive Health”

        Abstract | PDF

 

  • Reflections on Methodological Congruence in Systems and Complexity-Informed Research; Comment on “What Can Policy-Makers Get Out of Systems Thinking? Policy Partners’ Experiences of a Systems-Focused Research Collaboration in Preventive Health”

        Abstract | PDF

Keywords

Main Subjects


  1. Deloitte. Global health care outlook: shaping the future. Deloitte life sciences and health care; 2019.
  2. Head BW, Alford J. Wicked problems: the implications for public management. Brisbane: Paper presented at: Presentation to Panel on Public Management in Practice, International Research Society for Public Management 12th Annual Conference; 2008.
  3. Lindblom CE. The science of "muddling through." Public Adm Rev. 1959;19(2):79-88.
  4. Jones H. Taking responsibility for complexity: how implementation can achieve results in the face of complex problems (Working Paper 330). London: Overseas Development Institute; 2011.
  5. Begun JW, Zimmerman B, Dooley K. Health care organizations as complex adaptive systems. In: Mick SM, Wyttenbach M, eds. Advances in Health Care Organization Theory. Vol 253. San Francisco: Jossey-Bass; 2003:253-288.
  6. Sweeney K, Griffiths F. Complexity and Healthcare: An Introduction. Oxford: Radcliffe Medical Press; 2002.
  7. Sterman JD. Learning from evidence in a complex world. Am J Public Health. 2006;96(3):505-514. doi:10.2105/ajph.2005.066043 
  8. Lanham HJ, Leykum LK, Taylor BS, McCannon CJ, Lindberg C, Lester RT. How complexity science can inform scale-up and spread in health care: understanding the role of self-organization in variation across local contexts. Soc Sci Med. 2013;93:194-202. doi:10.1016/j.socscimed.2012.05.040
  9. Garside R, Pearson M, Hunt H, Moxham T, Anderson R. Preventing obesity using a ‘whole system’ approach at local and community level: PDG1. NICE Centre for Public Health Excellence. Peninsula Technology Assessment Group (PenTAG), Peninsula Medical School, Universities of Exeter and Plymouth NICE Centre for Public Health Excellence; 2010.
  10. Plsek PE, Greenhalgh T. Complexity science: The challenge of complexity in health care. BMJ. 2001;323(7313):625-628. doi:10.1136/bmj.323.7313.625
  11. World Health Organization (WHO). Systems thinking for health systems strengthening: Alliance for Health Policy and Systems Research. WHO; 2009.
  12. Best A, Holmes B. Systems thinking, knowledge and action: towards better models and methods. Evid Policy. 2010;6(2):145-159. doi:10.1332/174426410x502284
  13. Cherney A, Head B. Supporting the knowledge-to-action process: a systems-thinking approach. Evid Policy. 2011;7(4):471-488. doi:10.1332/174426411x603461
  14. OECD. Applications of Complexity: Science for Public Policy: New Tools for Finding Unanticipated Consequences and Unrealised Opportunities. Erice, Sicily: Ettore Majorana International Centre for Scientific Culture; 2009.
  15. Sanderson I. Complexity, 'practical rationality' and evidence-based policy making. Policy Polit. 2006;34(1):115-132. doi:10.1332/030557306775212188
  16. Johnson JA, Anderson DE, Rossow CC. Health Systems Thinking: A Primer. Burlington, MA: Jones & Bartlett Learning; 2019.
  17. Peters DH. The application of systems thinking in health: why use systems thinking? Health Res Policy Syst. 2014;12:51. doi:10.1186/1478-4505-12-51
  18. Kickbusch I, Gleicher D. Governance for health in the 21st century. World Health Organization; 2012:75.
  19. Meadows D. Thinking in Systems: A Primer. London: Earthscan; 2009.
  20. Rusoja E, Haynie D, Sievers J, et al. Thinking about complexity in health: A systematic review of the key systems thinking and complexity ideas in health. J Eval Clin Pract. 2018;24(3):600-606. doi:10.1111/jep.12856
  21. Reynolds M, Holwell S. Introducing Systems Approaches. In: Reynolds M, Holwell S, eds. Systems Approaches to Managing Change: A Practical Guide. Milton Keynes: Springer; 2010:1-23.
  22. Senge PM. The Fifth Discipline: The Art & Practice of The Learning Organization. Broadway Business; 2006.
  23. Shankardass K, O'Campo P, Muntaner C, Bayoumi AM, Kokkinen L. Ideas for extending the approach to evaluating health in all policies in South Australia: Comment on "Developing a framework for a program theory-based approach to evaluating policy processes and outcomes: Health in All Policies in South Australia." Int J Health Policy Manag. 2018;7(8):755-757. doi:10.15171/ijhpm.2018.25
  24. Parsons B. Using complexity science concepts when designing system interventions and evaluations. InSites website. http://insites.org/resource/using-complexity-science-concepts-when-designing-system-interventions-and-evaluations/. Published 2010.
  25. Eppel E, Matheson A, Walton M. Applying complexity theory to New Zealand public policy: principles for practice. Policy Quarterly. 2011;7(1):48-55. doi:10.26686/pq.v7i1.4369
  26. Johnson JA, Rossow CC. Health Organizations: Theory, Behavior, and Development. 2nd ed. Burlington, MA: Jones & Bartlett Learning; 2019.
  27. Kania J, Kramer M, Senge P. The Water of Systems Change. FSG; 2018.
  28. Holmes B, Finegood D, Riley B, Best A. Systems thinking in dissemination and implementation research. In: Brownson R, Colditz G, Proctor E, eds. Dissemination and Implementation Research in Health: Translating Science to Practice. Oxford: Oxford University Press; 2012.
  29. Cairney P. Complexity Theory in Political Science and Public Policy. Political Stud Rev. 2012;10(3):346-358. doi:10.1111/j.1478-9302.2012.00270.x
  30. Galea S, Riddle M, Kaplan GA. Causal thinking and complex system approaches in epidemiology. Int J Epidemiol. 2010;39(1):97-106. doi:10.1093/ije/dyp296
  31. Hawe P, Shiell A, Riley T. Theorising interventions as events in systems. Am J Community Psychol. 2009;43(3-4):267-276. doi:10.1007/s10464-009-9229-9
  32. Gates EF. Making sense of the emerging conversation in evaluation about systems thinking and complexity science. Eval Program Plann. 2016;59:62-73. doi:10.1016/j.evalprogplan.2016.08.004
  33. Abercrombie R, Boswell K, Thomasoo R. Thinking big: how to use theory of change for systems change. UK: Lankelly Chase Foundation; 2018.
  34. Swanson RC, Cattaneo A, Bradley E, et al. Rethinking health systems strengthening: key systems thinking tools and strategies for transformational change. Health Policy Plan. 2012;27 Suppl 4:iv54-61. doi:10.1093/heapol/czs090
  35. Carey G, Malbon E, Carey N, Joyce A, Crammond B, Carey A. Systems science and systems thinking for public health: a systematic review of the field. BMJ Open. 2015;5(12):e009002. doi:10.1136/bmjopen-2015-009002
  36. Kessler R, Glasgow RE. A proposal to speed translation of healthcare research into practice: dramatic change is needed. Am J Prev Med. 2011;40(6):637-644. doi:10.1016/j.amepre.2011.02.023
  37. Holmes BJ, Noel K. 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." Int J Health Policy Manag. 2015;4(4):245-247. doi:10.15171/ijhpm.2015.38
  38. Agyepong IA. "Wood already touched by fire is not hard to set alight": Comment on "Constraints to applying systems thinking concepts in health systems: A regional perspective from surveying stakeholders in Eastern Mediterranean countries." Int J Health Policy Manag. 2015;4(3):191-193. doi:10.15171/ijhpm.2015.34
  39. Armson R. Growing Wings on the Way: Systems Thinking for Messy Situations. Triarchy Press Limited; 2011.
  40. Hovmand PS. Community Based System Dynamics. New York: Springer; 2014.
  41. Williams B, Hummelbrunner R. Systems concepts in action: a practitioner's toolkit. Stanford University Press; 2010.
  42. Kim DH. Systems thinking tools: a user's reference guide. Pegasus Communications; 2000.
  43. Burnes B. Complexity theories and organizational change. ‎Int J Manag Rev. 2005;7(2):73-90. doi:10.1111/j.1468-2370.2005.00107.x
  44. Lissack MR. Complexity: the science, its vocabulary, and its relation to organizations. Emergence. 1999;1(1):110-126. doi:10.1207/s15327000em0101_7
  45. Tenbensel T. Complexity and health policy. In: Geyer R, Cairney P, eds. Handbook on Complexity and Public Policy. Cheltenham: Edward Elgar Pub; 2015:369-383.
  46. Sautkina E, Goodwin D, Jones A, et al. Lost in translation? Theory, policy and practice in systems-based environmental approaches to obesity prevention in the Healthy Towns programme in England. Health Place. 2014;29:60-66. doi:10.1016/j.healthplace.2014.05.006
  47. Leischow SJ, Best A, Trochim WM, et al. Systems thinking to improve the public's health. Am J Prev Med. 2008;35(2 Suppl):S196-203. doi:10.1016/j.amepre.2008.05.014
  48. Holmes BJ, Best A, Davies H, et al. Mobilising knowledge in complex health systems: a call to action. Evid Policy. 2017;13(3):539-560. doi:10.1332/174426416X14712553750311
  49. Martin GP, Ward V, Hendy J, et al. The challenges of evaluating large-scale, multi-partner programmes: the case of NIHR CLAHRCs. Evid Policy. 2011;7(4):489-509. doi:10.1332/174426411X603470
  50. Allender S, Nichols M, Foulkes C, et al. The development of a network for community-based obesity prevention: the CO-OPS Collaboration. BMC Public Health. 2011;11:132. doi:10.1186/1471-2458-11-132
  51. Cooke J. A framework to evaluate research capacity building in health care. BMC Fam Pract. 2005;6:44. doi:10.1186/1471-2296-6-44
  52. Gagliardi AR, Webster F, Brouwers MC, Baxter NN, Finelli A, Gallinger S. How does context influence collaborative decision-making for health services planning, delivery and evaluation? BMC Health Serv Res. 2014;14:545. doi:10.1186/s12913-014-0545-x
  53. Hinchcliff R, Greenfield D, Braithwaite J. Is it worth engaging in multi-stakeholder health services research collaborations? Reflections on key benefits, challenges and enabling mechanisms. Int J Qual Health Care. 2014;26(2):124-128. doi:10.1093/intqhc/mzu009
  54. Phipps DJ, Shapson S. Knowledge mobilisation builds local research collaborations for social innovation. Evid Policy. 2009;5(3):211-227. doi:10.1332/174426409X463767
  55. Gagliardi AR, Berta W, Kothari A, Boyko J, Urquhart R. Integrated knowledge translation (IKT) in health care: a scoping review. Implement Sci. 2016;11:38. doi:10.1186/s13012-016-0399-1
  56. Cherney A. Academic–industry collaborations and knowledge co-production in the social sciences. J Sociol. 2015;51(4):1003-1016. doi:10.1177/1440783313492237
  57. Swinburn BA, Kraak VI, Allender S, et al. the global syndemic of obesity, undernutrition, and climate change: The Lancet Commission report. Lancet. 2019;393(10173):791-846. doi:10.1016/s0140-6736(18)32822-8
  58. Willis CD, Best A, Riley B, Herbert CP, Millar J, Howland D. Systems thinking for transformational change in health. Evid Policy. 2014;10(1):113-126. doi:10.1332/174426413X662815
  59. Observatory of Public Sector Innovation (OECD). Systems approaches to public sector challenges: working with change. OECD; 2017.
  60. NHMRC. National Health and Medical Research Council Partnership Centres for Better Health - frequently asked questions. Canberra: Australian Government; 2016.
  61. World Health Organization (WHO). Global action plan for the prevention and control of noncommunicable diseases 2013-2020. Geneva: WHO; 2013.
  62. World Health Organization (WHO). Global status report on noncommunicable diseases 2014. Geneva: WHO; 2014.
  63. Wilson A, Wutzke S, Overs M. The Australian Prevention Partnership Centre: systems thinking to prevent lifestyle-related chronic illness. Public Health Res. 2014;25(1).
  64. Wutzke S, Rowbotham S, Haynes A, et al. Knowledge mobilisation for chronic disease prevention: the case of the Australian Prevention Partnership Centre. Health Res Policy Syst. 2018;16(1):109. doi:10.1186/s12961-018-0379-9
  65. Slaytor E, Wilson A, Rowbotham S, Signy H, Burgess A, Wutzke S. Partnering to prevent chronic disease: reflections and achievements from The Australian Prevention Partnership Centre. Public Health Res. 2018;28(3):2831821. doi:10.17061/phrp2831821
  66. Haynes A, Rowbotham S, Davidson S, Lee K, Slaytor E, Wilson A, et al. Knowledge mobilisation in practice: an evaluation of the Australian Prevention Partnership Centre [Under review].
  67. Wutzke S, Redman S, Bauman A, Hawe P, Shiell A, Thackway S, et al. A new model of collaborative research: experiences from one of Australia’s NHMRC Partnership Centres for better health. Public Health Res. 2017;27(1):e2711706.
  68. Legard R, Keegan J, Ward K. In-depth interviews. In: Ritchie J, Lewis J, eds. Qualitative Research Practice: A Guide for Social Science Students and Researchers. London: Sage; 2003:138-169.
  69. Thorne S. Interpretive Description. Vol 2. Walnut Creek, CA: Left Coast Press; 2008.
  70. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77-101. doi:10.1191/1478088706qp063oa
  71. Maxwell JA. Designing a qualitative study. In: Bickman L, Rog DJ, eds. The Sage Handbook of Applied Social Research Methods. 2nd ed. Sage; 2009:214-253.
  72. QSR International Pty Ltd. NVivo qualitative data analysis software. Version 10. Published 2012.
  73. Birks M, Chapman Y, Francis K. Memoing in qualitative research: probing data and processes. J Res Nurs. 2008;13(1):68-75. doi:10.1177/1744987107081254
  74. Bryson JM, Crosby BC, Stone MM. Designing and Implementing Cross-Sector Collaborations: Needed and Challenging. Public Adm Rev. 2015;75(5):647-663. doi:10.1111/puar.12432
  75. Heaton J, Day J, Britten N. Collaborative research and the co-production of knowledge for practice: an illustrative case study. Implement Sci. 2016;11:20. doi:10.1186/s13012-016-0383-9
  76. Nutley SM, Davies H. Knowledge mobilisation: creating, sharing and using knowledge. In: Orr K, Nutley S, Russell S, Bain R, Hacking B, Moran C, eds. Knowledge and Practice in Business and Organisations. London: Routledge; 2016.
  77. Rycroft-Malone J, Burton CR, Bucknall T, Graham ID, Hutchinson AM, Stacey D. Collaboration and Co-Production of Knowledge in Healthcare: Opportunities and Challenges. Int J Health Policy Manag. 2016;5(4):221-223. doi:10.15171/ijhpm.2016.08
  78. Ward V. Why, whose, what and how? a framework for knowledge mobilisers. Evid Policy. 2017;13(3):477-497. doi:10.1332/174426416X14634763278725
  79. Weyrauch V, Echt L, Suliman S. Knowledge into policy: going beyond "Context Matters." International Network for the Availability of Scientific Publications; 2016.
  80. Maxwell JA. A Realist Approach for Qualitative Research. Thousand Oaks, CA: Sage; 2012.
  81. Patton MQ. Enhancing the quality and credibility of qualitative analysis. Health Serv Res. 1999;34(5 Pt 2):1189-1208.
  82. Furtado BA, Sakowski PAM, Tóvolli MH. A complexity approach for public policies: discussion paper. Brasilia: Institute for Applied Economic Research; 2015.
  83. Freebairn L, Atkinson JA, Kelly PM, McDonnell G, Rychetnik L. Decision makers' experience of participatory dynamic simulation modelling: methods for public health policy. BMC Med Inform Decis Mak. 2018;18(1):131. doi:10.1186/s12911-018-0707-6
  84. Page A, Atkinson JA, Campos W, et al. A decision support tool to inform local suicide prevention activity in Greater Western Sydney (Australia). Aust N Z J Psychiatry. 2018;52(10):983-993. doi:10.1177/0004867418767315
  85. Roberts N, Li V, Atkinson JA, et al. Can the target set for reducing childhood overweight and obesity be met? A system dynamics modelling study in New South Wales, Australia. Syst Res Behav Sci. 2019;36(1):36-52. doi:10.1002/sres.2555
  86. Grisold T, Peschl MF. Why a systems thinking perspective on cognition matters for innovation and knowledge creation. a framework towards leaving behind our projections from the past for creating new futures. Syst Res Behav Sci. 2017;34(3):335-353. doi:10.1002/sres.2456
  87. Rutledge M. Sensemaking as a tool in working with complexity. OD Practitioner. 2009;41(2):19-24.
  88. Best A, Greenhalgh T, Lewis S, Saul JE, Carroll S, Bitz J. Large-system transformation in health care: a realist review. Milbank Q. 2012;90(3):421-456. doi:10.1111/j.1468-0009.2012.00670.x
  89. Hall PA. Policy paradigms, social learning, and the state: the case of economic policymaking in Britain. Comp Polit. 1993;25(3):275-296. doi:10.2307/422246
  90. Greenhalgh T, Wieringa S. Is it time to drop the 'knowledge translation' metaphor? A critical literature review. J R Soc Med. 2011;104(12):501-509. doi:10.1258/jrsm.2011.110285
  91. Zuber-Skerritt O. The concept of action learning. The Learning Organization. 2002;9(3):114-124. doi:10.1108/09696470210428831
  92. Zuber-Skerritt O. Action learning and action research: paradigm, praxis and programs. In: Sankara S, Dick B, Passfield R, eds. Effective change management through action research and action learning: concepts, perspectives, processes and applications. Lismore: Southern Cross University Press; 2001:1-20.
  93. Nowotny H, Scott P, Gibbons M. Re-thinking science: knowledge and the public in an age of uncertainty. Argentina: SciELO; 2001.
  94. Weiss CH, Bucuvalas MJ. Truth tests and utility tests: decision-makers' frames of reference for social science research. Am Sociol Rev. 1980;45(2):302-313. doi:10.2307/2095127
  95. Nyström ME, Karltun J, Keller C, Andersson Gäre B. Collaborative and partnership research for improvement of health and social services: researcher's experiences from 20 projects. Health Res Policy Syst. 2018;16(1):46. doi:10.1186/s12961-018-0322-0
  96. Kislov R, Wilson PM, Knowles S, Boaden R. Learning from the emergence of NIHR Collaborations for Leadership in Applied Health Research and Care (CLAHRCs): a systematic review of evaluations. Implement Sci. 2018;13(1):111. doi:10.1186/s13012-018-0805-y
  97. Pokhrel S. Return on investment (ROI) modelling in public health: strengths and limitations. Eur J Public Health. 2015;25(6):908-909. doi:10.1093/eurpub/ckv136
Volume 9, Issue 2
February 2020
Pages 65-76
  • Receive Date: 27 March 2019
  • Revise Date: 25 June 2019
  • Accept Date: 02 October 2019
  • First Publish Date: 01 February 2020