Hello there, and welcome to Prevention Works, the podcast of The Australian Prevention Partnership Centre. I’m Gretchen Miller, and today an appropriately multidisciplinary conversation around systems thinking. We’re still recording under COVID-19 distancing requirements so joining us from Canberra down the line, are two guests, Dr Melanie Pescud, a Senior Research Fellow at the School of Regulation and Global Governance at ANU. Melanie’s working with the Prevention Centre, investigating how chronic disease research draws on systems approaches.
These have been key to our work over time. Melanie is using comparative case study analysis to understand how we can continue to incorporate systems based research on an ongoing basis.
Also with us, Matthew Vela. Matt is a qualified Aerospace Engineer and an experienced Systems Engineer working at Shoal. For the past five years, he’s been applying his expertise to conceptual design, supporting the development of major defense systems.
A conversation outside their professional lives sparked an ongoing cross-disciplinary engagement between the two of them, about systems thinking informally contributing to Melanie’s work. It’s been so fruitful we wanted to bring a snapshot of that engagement to you here on Prevention Works
Let’s get to it, Matt. I think we have to start with a definition, what systems thinking is. So can we come to you first? Can you give us a starting position,
Matt: Yes, thanks Gretchen. I think it actually might be surprising to know that systems thinking as it’s own concept actually isn’t something that most systems engineers, myself included, really dwell on. I can ask many of my colleagues, what systems thinking is to them and can they define it? They’ll scratch their head and they’ll use words like a holistic approach, and they’ll use things like, it’s a perspective, and things like that.
Gretchen: So are you saying that a systems approach allows you to break down the elements of a problem and consider each one separately but interweave them. Would that be correct?
Matt: Yeah, exactly. So, there are many parts to a problem and there are many parts to a solution to a problem. And each of these needs to be considered, holistically. We can’t ignore or focus on one too often. So, systems thinking, as a construct that my discipline would apply is kind of pulling us up and making us have a broader view of the world and to see a problem through all these different lenses.
Gretchen: Melanie, one of the things that you’ve pointed out in your work and your writing is that there’s actually no agreed definition in public health of systems thinking, can you outline a few of the ways that the term is being used.
Melanie: Yes, I can Gretchen. I think in its most simple form we’ve thought about it in the field as big picture thinking. It’s the big picture, rather than getting down into the tiny little details of something. It’s looking at a whole system, which involves lots of different variables and lots of different relationships, and it’s looking at the ways that they interact. And then some people extend that definition to talk about how they behave or interact over time. So, there’s a time dimension.
Another definition that comes into it is this idea that systems thinking is a way of thinking that enables you to look for root causes of problems as opposed to proximal causes, so you are really digging down into what led to what, led to what, you know. And another way that it’s described as, as a world view. And you know, this is something that Matthew touched upon as well, or it’s a conceptual lens. So, I look at the world, through my big picture lens, I see everything. Other definitions that bring [00:04:00] in alot more technical terms. People start talking about complexity or complex adaptive systems, and then go on to explain some of those features of a complex adaptive system and how systems thinking enables you to work within a complex adaptive system to solve problems.
Gretchen: How do you prefer to use the term yourself?
Melanie: Well, I think my preference has evolved over time as my understanding has grown. I’ve really found that basic idea of looking at the big picture, how different variables interact over time as a generally helpful definition for systems thinking but I think as I’ve moved deeper into my study within the field, I really like the idea of bringing in complex adaptive systems because it brings in those technical elements and that’s been really useful for me to add those extra details. So, I think let’s just start with an overarching broad definition that we can all agree upon, in this broad sort of sense, but then let’s get [00:05:00] down into the details. I think the problem with that though is that because we know there’s so many different disciplines and lineages who use systems thinking, it raises the question of, well, which one’s right?
Gretchen: The thing is that systems thinking isn’t even really tied down in engineering, is it? Is it yet to become a discipline with a formerly defined theoretical basis at all?
Matt: So yes, and no, to that one. So, systems engineering is more practice led so unlike other disciplines of engineering we’re not theory led. We might start with common, best practice in how to solve a problem and we’ll go off and try something and when we encounter a challenge we’ll find a way to get around that roadblock. We will see if it’s successful or not, and then look to document the results of how our new approach impacted the likelihood of success. So that’s part of it but a systems approach really does have an accepted place in engineering and that’s when we’re required to solve the bigger, more challenging problems, [00:06:00] often the types of problems that haven’t really been solved before.
So, if you’re going to Mars for the first time, that’s a perfect time and is when systems engineering and systems approaches are really used. If it’s making a house for the 10,000th time in a city, you wouldn’t use a systems approach. It’s really when we come into problems that we haven’t solved before, problems that require, multi-disciplinary solutions to solve and I think when you do use it in this way, it is a great methodology and it’s an accepted methodology.
Gretchen: In public health, it’s only been a thing, since the 1990s which to me feels like a long time ago, 30 years or so. Can you tell us a little bit about where it all started in engineering?
Matt: Yeah. I believe systems engineering began in the thirties in Britain – thinking wartime stuff, creating an air defense system. And look, I think systems engineering has found a niche in that space. It’s typically, evolved alongside defense and aerospace since then but if we’re think of things like modern trains, they’re all using digital [00:07:00] networks, you know, digital control, passengers need power for their phone devices, passengers are getting told timetable information, and while they’re commuting from stop to stop, the surveillance systems inside, the train itself as part of a wider transport network in the city as well. So you can see that like this one problem that train engineers have been solving in a very similar way for a long time is now so different and it needs to be solved in a different way in different techniques.
Gretchen: Matthew, I’d be interested to understand just in terms of the work that you do, how you use systems thinking at the moment. What are you doing? What are you working on?
Matt: Yes. Ah, look, I mostly work on, on defense systems in Australia and most of my work is in what’s called the conceptual design phase of engineering so that’s like really early in the journey of design. But when working on these systems, say a new ground transportation system, I’m not an expert in the field. As a systems engineer, my role is as a [00:08:00] methodologist. So here kind of bring it all together, take people on a journey and it’s my job to take the broader view of a problem so others can really focus on their speciality, their deep expertise, and it’s this partnership that makes it work.
Melanie: Just hearing Matthew talk there, Matthew’s role is actually how I’ve begun to think about what a systems thinker is. I feel like it is this person with the ability to draw together experts with deep expertise across a range of different topics or fields or methods, whatever it is, to hear all those views, allow them to be expressed, and then collectively come up with a solution. They just have this ability to look across lots of disciplines and experts and pull them together to find a solution.
Matt: You hit the nail on the head because that’s almost exactly how we think of it ourselves.
Gretchen: Melanie, let’s go back a bit, not too far back, before systems thinking was even a twinkle in the eye of your field, [00:09:00] what were some of the approaches being used, for example, in preventing chronic disease?
Melanie: It seems that the approach traditionally is to look at problems in a linear fashion, X leads to Y sort of thing. And not looking back to what even led to X? So I think we’ve typically worked in a very reductionist manner, whereas now, over time, we’re beginning with the introduction of systems science methods to start thinking about problems in a more messy fashion. It’s not just a uni-directional arrow, it’s a bi-directional arrow and that can bring in the idea of feedback where one variable leads to the next and it feeds back on itself. And then that links back to this variable and we can look towards root causes to solve problems rather than proximal causes, which seems to be the orientation around more linear ways of working. And I’ve definitely done a big over generalization there. I think there’s definitely [00:10:00] a continuum of approaches, but within the field of epidemiology that emphasis has been on these more linear style models and that’s sort of dominated the field of public health.
Gretchen: Yeah. So I love your alphabet analogy there. You know, A to Z or X, Y, Z and instead of X, Y, Z we’re looking at actual words, so the way letters can combine to create different meanings, quite a rich one. How does systems thinking improve work with complexity in chronic disease prevention?
Melanie: I think, you know, the first thing that springs to mind is this concept of emergence, that the sum of a system is greater than its parts. I don’t know if I’ve technically said that correctly maybe Matthew can help me there, but it’s just this idea that one plus two plus three equals six might be the way that you’d look at it if you’re just adding up different parts of the system but emergence brings this idea that the sum is greater than the parts so you can’t add the variables together and actually get the answer, perhaps you’ll get close, but you won’t be as precise as you could be, by using system science methods. An example is dynamic simulation modeling so that can take into account emergence and you can get a lot closer to a precise answer then you would with those methods that don’t consider that concept.
Matt: I have another one of those little number analogies from way back, you think, because you understand one, you understand two, because one and one equals two. And what you’re missing there is the “and” right? So it’s a good little one as well.
I think it’s a Confucius code or something. Emergence is an interesting one and I kind of disagree with Mel here in that you can design for emergence, actually we almost always we do design for emergence when we talk about a complex system. If I was to say, [00:12:00] think about an aircraft and tell me which part of the aircraft gives me the phenomenon of lift, which is required to get the air part of an aircraft, you couldn’t do it because no one part actually gives us lift. It’s the interplay between many different components all coming together that this effect emerges. So, we can predict emergence, we can design for emergence but I mean obviously there are times where emergence appears that we don’t predict, we don’t understand, and that’s where we need to have systems in place to, detect that and it ended up your system accordingly, depending on what the system is.
So, feedback and adoption, there’s this idea that, a problem is true in a particular context. So once we go and we design a solution to that problem, that solution will be a little bit different once we actually put it in the real world and we deploy that solution, but when we also have that solution deployed it’s in a new context, right? It’s not the same as when we first measured that problem and that this solution itself actually might introduce additional problems. Hopefully, the new problem is a smaller problem or a more manageable problem than the original one that we introduced this system for.
But this is just another consideration that we have to have systems in place to check and measure for feedback and to be able to adapt the system. So, in defense and in the worlds that I work in, we have sustainment systems so we are constantly updating modifying our system as it meets new challenges in the world because the world’s not a static place, right? It’s always changing and it’s always going to require adaption and feedback mechanisms.
Gretchen: And I think that what occurred to me as you were speaking there Matthew, and you said, I can plan for emergence, I know what it is that I want to emerge from the approach that I’m taking here and that is that the airplane does actually take off, you’re talking about a concrete object. Melanie’s talking about a much more fluid social structure when when we are talking about public health. So we may not be able to predict exactly what’s going to emerge once we add one plus one, we might not actually get two because people are quite unpredictable. Whereas, metal and, moving parts are quite predictable.
Matt: It’s interesting that you say that because I agree that there’s no one formula for public health problems. And there might be for an aircraft and flight but we’re talking maybe there’s a dozen formulas, maybe there’s a hundred formulas. These are solvable problems, just scale introduces a complexity of its own here.
Gretchen: Which is why I think in health and in many other sectors, climate adaption, for example, experts are consulting a great deal more with the constituents, the public, that need to actually work within and move within and live within the system. So, Melanie, I wanted to ask you, there is a lot of talking the talk with systems thinking in public health. It’s been 30 years now, but your concern is that there’s not a lot of walking the walk.
Melanie: Yes. That is my concern. I mean there is walking the walk. It’s just perhaps not happening as fast as we might like. I mean, there’s probably several reasons for that, but the two that I’ve been thinking about this idea of to use systems thinking it’s a worldview if you want to use that definition. And it was the famous Donella Meadows herself, who said the paradigm level is the hardest place to intervene in a system so it is inherently difficult to change the way that we see problems or even begin to think about problems but another thing that I’ve been thinking about is this concept of an idea versus an ideal. And I think that what’s happened is that systems thinking has come to public health and chronic disease prevention as this really wonderful idea. And yet somehow over time it’s shifted to an ideal. It’s like the idea has been suddenly cloaked in all this shiny substance and it’s become this elitist, special, unattainable way of thinking and working that only a select few can actually attain or be. And I think that that’s actually creating a dichotomy or a, an us and them battle within chronic disease prevention because it’s almost like the reductionist versus the systems thinkers. And I really think that that’s hugely problematic because there has been this idealism around systems thinking and naturally, a lot of people have turned away from it and some people have even said it’s a cult thatt the way that we’re approaching it is trying to shift people along this continuum from reductionist thinking up towards systems thinking is not necessarily the most respectful or tactful.
Gretchen: It doesn’t need to be either raw does it? Because systems thinkers need experts in order to create the system?
Melanie: You need both. You can’t have all the systems thinking and then not get down into the details at some point. We have to move along this continuum rather than dichotomy between reductionist thinking to systems thinking and use our discernment to pick where should I be positioning myself to choose the best way of solving this problem.
Matt: Gretchen, and I have to admit that this is one of the other main areas that I’ve had plenty of conversations to Melanie about is that reduction word and that reduction techniques are not your enemy here and that they’re often a necessary tool in the toolbox to make progress. If you keep thinking of the problem as a big elephant, where do you take your first bite? And I think that when you, as Mel said, when you start thinking of these two camps, you alienate the other viewpoints, that breaks down trust, which as we know is not a good thing when you’re trying to overcome these big complicated problems.
Gretchen: With your discipline as an engineer which has incorporated or naturalized systems thinking as kind of essential into the practice, what kind of crossovers do you think there could be between diverse disciplines? Does engineering have [00:18:00] something to offer here to public health fiven that engineering is about all kinds of problem solving, including social.
Matt: Yes and I’ve spoken with Mel about this one a few times as well. Like I said before, broadly speaking my job is to help understand and describe the complete problem, integrate work across many disciplines, take a holistic approach and really focus on the success of the system for a given problem, right?
So not any little bit, it’s the whole system. Now, when you think about the types of work that I do and then I think about chronic disease prevention specifically any sort of solution to problem, I’m not hearing too many differences. You know, the similarities are there and I don’t think we should be approaching this problem in very different ways. As I said, the scale of the problem, there are many more formulas, but I think the general approach should be similar and secondly, why I think it may be fun to reinvent the wheel, it really isn’t necessary here in the sense that systems engineering as a practice has had many [00:19:00] successes and failures in trying to address these big socio-technical problems and success against those problems has really been dependent on how the system approach met the real world. So it makes sense to not have to relearn the same lessons that we’ve learned the hard way.
Gretchen: What thoughts do you have to help health researchers really embody and take up systems thinking? And we could use the example of obesity as a complex social problem and health problem.
Matt: First of all, I am not actually sure that every health researcher needs to take up systems thinking that might be a bit controversial as well. So, I think as we said before, it really is that partnership of depth and breadth. We shouldn’t be making every researcher answer these big questions. So I think the health research community does need a cohort of people who are focusing on that systems methodology implementation and that will help the community solve the right problems rather than just solving a given problem right. There’s a little bit of a difference there. I think the thing is, if we use obesity or childhood obesity as an example, one of the other differences that I think the health research community has is that there’s no clear system owner. So all of the systems that I’ve spoken about before and aircraft transportation system, going to Mars, there really is a single system owner that controls that entire boundary or close to controls that entire boundary if you go high enough up the food chain,
Who owns the problem childhood obesity? Who owns the solution to it? We know that there isn’t one person, there’s multiple people that hold the leavers for this problem. So I think if you can’t identify a system owner who is the one that has an interest in solving that problem and who is going to seek the right answers to solve that problem, then I think we can hit similar outcomes by looking for or trying to achieve a shared intent. So I think there needs to be a big focus on getting the community to have a shared intent and we can even look recently things like COVID, having a shared intent into how we’re combating that a disease, [00:21:00] has yielded good outcomes, and I think there’s still things to learn that.
Gretchen: There are things to learn. COVID I think has taught us and will continue to teach us so many things. okay, so Melanie, let’s get down to nuts and bolts here. What are the blockages and concerns that seem to be sitting there undiscussed in the field that prevent researchers from genuinely embracing systems thinking.
Melanie: I’m going to use an analogy here Gretchen. I think the thing is we haven’t mapped the terrain, you know, it’s like swinging the pendulum from reductionist thinking all the way to systems thinking like we can just click our fingers and magically we’re there. So I think a nice analogy to speak to this point is a mountain. Imagine you’re at the bottom of a mountain and you’re down in the details there. You can’t say too much from the base of the mountain and you could think of that as the reductionist sort of thinking perhaps, but you want to get all the way to the top of the mountain and stand at the peak and look out from that vantage point. That’s systems thinking. That’s where you can [00:22:00] see all basically, but you can’t just think yourself up to the top of the mountain. You need to map the terrain. So that’s like an implementation plan and it’s probably a multi-tiered, multistage implementation plan. Just like climbing the mountain might need to get a team together. You need the right shoes, you need the right backpack, you need supplies, you need to know the weather conditions to slowly make your way up. And then you might fall down and then you might walk up a little bit more. But I think it’s going to take time training, which I think translates to capacity building within the field, especially as it relates to the different tools and methods.
So we really need to get together and map the pathway to move along the continuum instead of just thinking we can snap our fingers and move there. And I think that, again, to come back to this idea of the idea versus the ideal, that’s definitely a [00:23:00] blockage.
Gretchen: Melanie, does that apply to things like research funding and research activity, being skewed towards simplistic, short term, individual level health outcomes rather than population actions and outcomes.
Melanie: Yes, absolutely. And I think, you know, funding bodies are so used to seeing the same old methods that they know are tried and true and so there’s less receptivity or it takes a longer period of time for people to, who are reviewing journal articles or reviewing funding applications, understand or even trust in the validity of these new systems science tools. So that’s a problem in itself. That’s definitely a blockage. So we really need to build capacity from within the field and also outside of it to just enable people to have greater receptivity and understanding of the many other ways of solving problems.
Gretchen: Is there any one field of health care leading the [00:24:00] charge in adapting to systems thinking.
Melanie: I know from my reading that the field of community psychology is really doing well here with their interventions at the community level, definitely systems thinking is very much embedded within that field, and I’m certainly using a lot of frameworks and models from that field to inform the work that I’m doing within the Prevention Centre, but, to think about a really great local example, I really love the work of Professor Steve Allender, who’s down at Deakin University, and he’s been working with lots of communities using community based systems dynamics, so group model building processes, bringing communities together to solve the problem of child obesity, mapping the system, bringing lots of different people in from lots of different areas within the system to understand what’s producing child obesity. But then he’s working with people across the system who have the remit to make changes, to take actions and many actions across that system and [00:25:00] seeing some really great results with child obesity rates lowering, so it’s definitely happening within our field.
Gretchen: I wonder if it’s worth considering bringing in systems thinkers from the field of engineering, say, or from unrelated disciplines to workshop how systems thinking could really take off like a meta systems thinking approach to the problem. Matt, if you were called in to assist with such a workshop, where would you start?
Matt: Well, I think with the problems that we work on, I’m always talking to operators to maintain it and to the person who pays for the system and so on and so forth. So that’s exactly what you need to be doing. You need to get lots of different views, the users of the system who touches your system and those people are who we need to hear from. So I think, if I was brought in to run or support a workshop, the first thing I’d be looking to do would be to cobble together a representative system owner in the first instance.That’s a big one.
It’s important to work out who is and who isn’t in your systems boundary as well. We don’t want to have the wrong stakeholders in the room. [00:26:00] We want to make sure that the right views are heard and I think what is always the first step in looking to solve these problems is really trying to understand what success looks like and understand what is. And look at the mission of a solution that will solve that problem and honestly, if we could get into that in a first workshop that’d be a pretty good workshop. But, it’s reaching that shared intent on these high level goals allow you to build and explore forward and tie things to those higher level goals and go from there.
Gretchen: Melanie, in the field of public health, is there an owner? I mean, I’m trying to work out who that owner is. Is it the state government who pays the hospital bills of those who have fallen through the system, or is it the individual, who is affected by the system? Who owns the problem in public health ?
Melanie: I think we all own the problem. I think we collectively own the problem, but of course there are people with a lot more power and influence in, you know, [00:27:00] levels of government, whether it’s at the Commonwealth level or state level. There’s people within industry so there’s people across all the different departments of, government. We say a lot of the time it’s not just a problem to be solved within the health department because there’s so many systems, subsystems involved within the larger system that create chronic disease. So it’s hard to pinpoint an owner. But, one of the things that I see a lot is we as public health researchers often it’s like we’re stepping outside of the system and pointing in at it going such and such needs to fix this problem. And it’s like we haven’t stepped in and I’m making a gross overgeneralization here, taking responsibility for our role as well. And I wonder how many people have paused and asked themselves, what is the change I’m seeking to make? Me as an academic, me as a policy maker, me as an [00:28:00] individual, what is the change I’m trying to make and am I taking responsibility for that change?
So I feel like collectively we all have a role to play here. We just need to know what our role is within the system. And of course there needs to be much more onus on those people who have more power and influence to create policies that enable us to be healthier.
Matt: System owners is a bit of a weird construct when we talk about things like health, but potentially who stands to benefit the most and who has the leavers of change. I think you’re right. You know, we were talking state governments, federal governments, if it’s childhood obesity, we might be talking about schools, parents, yes, the individual themselves. I think if we just say everyone a stakeholder in this, we need to scope that down. We need to make sure that we’re hearing from the right representative users. We need to make sure that we’re getting the right views heard and it’s really is the who stands to benefit the most and who has those leavers of change.
Gretchen: Hmm. But benefits socially benefit [00:29:00] financially, the government stands to benefit financially. The individual stands to benefit socially.
Matt: Most certainly, but if we were to say something like, actually if we redirected, billions of dollars of hospital funding into early programs in schools. I mean, I’m not in the health field, so I’m making crazy statements here, but, that’s unthinkable for a hospital system to be thinking about those kinds of changes. But there is a high enough level I’m sure that could consider those kinds of changes that need to happen. And I think that’s where the fields that I normally work in and health differ is that the problems that were tackling are known to be, ‘Oh, we have no idea what we’re doing here we better explore’ and everything is up for grabs. And if it means we need to retire a policy or a particular way of doing something, then so be it. If that’s what we have to do, it’s harder in health, right, but not impossible.
Melanie: That’s it. There’s a balance between prevention activities and then service activities on the ground. You know, those more downstream services versus the upstream [00:30:00] services. And it’s about getting the balance right when it comes to distribution of funding. And of course, we in prevention say that we always need a lot more money for prevention, but unfortunately you don’t necessarily see the benefits of that investment for many, many years and they don’t typically fit the election cycles as governments.
Matt: Of course, and there’s no one solution either, right? There’s going to be many solutions and we need to prioritize them and they need to integrate all together and it sounds like a mess, but I think it’s a solvable mess.
Gretchen: I’m just thinking about where in our education system we should be looking at introducing systems thinking across any discipline, whether it’s engineering or public health? Do you introduce it as a subject? Do you incorporate it into every aspect of every course? Where do we bring systems thinking into the education system?
Melanie: I would say we [00:31:00] need to bring it in as early as we possibly can. And so perhaps it does begin in primary school or secondary school, before people even get to university. And whether it’s a particular unit or course that’s perhaps the way of beginning. And then over time it could be something that is just the way of working and thinking and learning. So I think it’s something we where again, we’d have to map the terrain. We need to say, well, what is the best entry point in? How should we go about doing this? But definitely as a broad concept, I can say for myself that I feel like the ability to be a systems thinker, I lost that through the schooling system and I feel like I’m relearning it as an adult more and more and more. And I really value being able to think in this way and perhaps it is an innate way of thinking that, you know might get knocked out of us, through, various education systems.
Gretchen: It’s [00:32:00] something to consider. Matt, what do you think? When should we introduce the idea of systems thinking? Should it be siloed as a concept? Should it be both a subject that you study and integrated? How should we approach it.
Matt: Yeah, look that’s even a question my discipline is grappling with and how best to grow systems engineers in the university sector. Look, personally, I think the systems concepts are actually not that difficult. I don’t think that a whole unit systems thinking, you know, what, what would that even be about? But I think we want to really get these concepts sprinkled over a whole bunch of other subjects, right? So we want it to appear in lots of different places.
Gretchen: Melanie to end where we began. I think you’ve got a set of things that you feel need to happen in public health to make systems thinking more embedded in the process and we’ve discussed some of those, but let’s talk about, you know, where all that begins?
Melanie: So I really think, Gretchen, that we need to begin with a clear set of agreed [00:33:00] definitions for the field of what systems thinking means or is for chronic disease prevention. We need a glossary of key terms that people can refer to so we can all be on the same page and then we just need to move beyond that.Then we can just move forward. We also do need to work with people like Matthew. We need to bring in people from different disciplines who are a lot more mature and who also have a greater breadth of methods that we can learn about and draw upon to expand our repertoire as it is for solving complex problems.
Dr Melanie Pescud and Matthew Vela. As always, listeners do share us around. Leave us a review on iTunes, drop us a note. We love to hear from you.
This is Prevention Works from The Australian Prevention Partnership Centre I’m Gretchen Miller. I’ll see you next time.
Join Prevention Centre Senior Research Fellow, Dr Melanie Pescud and Senior Systems Engineer, Matthew Vella as they go back to basics to discuss the fundamentals of systems thinking across their respective disciplines of public health and engineering. They reveal similarities and differences in perspectives and share lessons learnt and next steps for systems thinking in chronic disease prevention research.