Health Systems Research and Critical Systems Thinking: The case for partnership | Michael C. Jackson, Luis G. Sambo | 2019/08

If we don’t first know “what is system is”, how do we approach an intervention? #MichaelCJackson OBE and Dr. #LuisGSambo appreciate the difference between “systems thinking” (plural) and “system dynamics” (singular), and suggest expanding theory with Critical #SystemThinking in Health Systems Research.

An ignorance of history is, if anything, even more pronounced among those authors in [Health Systems Research] influenced by complexity theory and the concept of ‘complex adaptive systems’. [….]

Most authors employing complexity theory in HSR seem to believe that it sprung forth fully formed from nothing or has somehow supplanted other bodies of work in systems thinking.

Such a poor appreciation of the history makes it almost inevitable that HSR will draw upon a restricted part of the systems and complexity tradition in developing its theories. In fact, it is the system dynamics and ‘complex adaptive systems’ strands that have come to dominate HSR at the expense of others. [….]

The problems start because of a lack of clarity in HSR about what type of ‘dynamic entity’, or ‘system’, a health system is. [….]

[Critical Systems Thinking] takes a radically different approach to HSR in the way it responds to the complexity encountered in the health systems domain. Primarily, HSR designates health systems as ‘complex adaptive systems’, and then looks to system dynamics to provide knowledge of their inner workings and supply insights into how they can best be managed. [….]

CST by contrast regards ‘messes’, like those found in public health, as ‘unknowable’. They give rise to what Rittel and Webber call ‘wicked problems’, which are intractable for decision-makers … [….]

CST, therefore, bypasses the issue of what kind of ‘system’ a health system is by stating that we will never know. Far from being a negative strategy, however, this opens up a whole new realm of possibilities, …

CST can assist … by referring to the three commitments of CST – ‘critical awareness’, ‘pluralism’, and ‘improvement’.

Source: Jackson, Michael C. & Sambo, Luis G. (2019). Health systems research and critical systems thinking: the case for partnership. 10.13140/RG.2.2.36160.48648.

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#critical-systems-thinking, #systems-thinking