Breaking the silos – how systems tools can bring us together

I recently had the opportunity to sit down with colleagues from Liquor & Gaming, Education, Premier and Cabinet, Mental Health, Drug and Alcohol, local government, primary health services and the community sector to discuss ways of addressing the serious problem of harmful alcohol consumption in Tasmania. Around the room, we each discussed how we were addressing this complex problem. Those of us working in the health sector explained how our focus was treatment, health promotion and improving health literacy. The Police were meeting their targets with random breath tests but also seeing the role alcohol played in violence call-outs. Our community sector partners and treatment services could paint the picture of alcohol harms at an individual and community level, local government could describe planning requirements, precinct development and community engagement, and Treasury was seeing the problem through the prism of regulation of liquor licences. What struck me was how much knowledge we held about the issue from our respective roles across Tasmania, and how important it is to stop and consider how our multiple policy approaches interact and influence each other. We had come together to work on a simulation model of alcohol harm in Tasmania, a systems tool developed by The Australian Prevention Partnership Centre in 2017 to inform our alcohol action framework. Now, we were further exploring insights, to guide action to achieve reductions in harmful alcohol use. The model has given us a visual representation and quantification of what happens when each of us pulls our individual policy levers. Sometimes, our policies have synergistic effects – they combine to produce an effect that is greater than the sum of the parts. But sometimes, the opposite occurs and our policies may achieve a smaller effect than we would expect from modelling each intervention individually. For example, we’ve found that in Tasmania, the most intensive intervention we can mount in the health sector, in-patient treatment programs, may make just a small long-term dent on alcohol-related harm compared to the relatively low-cost policies our colleagues in Treasury have at their disposal, restricting liquor licence densities. We’ve also found that increasing funding for the community-based Good Sports program, in combination with other interventions, may support better outcomes within our limited resources. In order to harness these insights, we need to understand the operating environments and competing priorities of our partners and think how we can best work together, harnessing the collective wisdom in the system. The challenge facing all of us is that there’s no way of knowing exactly the outcome of our policies into the future. The systems in which we operate, even in a small jurisdiction like Tasmania, are so highly complex that we are only ever addressing one small piece of the puzzle, hoping that it doesn’t have negative unintended consequences elsewhere. People’s behaviour is influenced by social, economic and environmental factors, each interacting with the others and changing dynamically over time. We have found systems thinking helps us make sense of this complex system, by exploring the relationships, boundaries and perspectives within it. Systems can help us identify where to intervene to make small gains that will help to shift the system. The simulation modelling that we’re using to inform our decision making in Tasmania brings systems thinking to life. It combines different systems science methods in an applied way, enabling us to quantify what will happen over time if we pull different policy levers simultaneously. But perhaps what’s more important is the participation across sectors that has arisen from this quantified modelling process. It brings together research evidence, expert advice, real-world datasets and practice experience from key stakeholders and different agencies responsible for implementing policies and programs. The process has engaged those from other sectors. They have realised that the policies implemented in Justice or Premier and Cabinet can have a real impact on public health. None of us is working in isolation. This is perhaps the greatest advantage of systems tools. They get us all on the same page, engaging those from other sectors and backgrounds and guiding our thinking to see the big picture.