Public Health

A system approach to

We are going to take a whole system approach to xxxx

Some thoughts on this based on observations

This is the fourth of a series.

Blog 1 – brief notes

Blog 2 – responses to complex problems

blog 3 – influencing SYSTEMS

Starting out

• Have you set out a mission and vision.

• We talk complex adaptive systems. All three words matter – complex, adaptive, system. Think about it

• Have you mapped the system, all of the constituent parts, how they interact, who are the key actors and their role, whether they share the broad vision.


• There may be no single controller. Or no single person knows all of the things that are going on to achieve the broad goal 

• command and control is (probably) impossible. If you must adopt command and control mindset, seek to command and shift the most important leverage points in your system (see below)

• Read Team of Teams on this


• Of course there will be delivery of activity, that might be across many different areas of service delivery, policy, or across many different institutions

• There will be silos. This is arguably impossible to avoid 

Measurement, indicators and metrics

• Measurement and attribution is high on impossible. Yes, of course measure the impact of individual activities within the system.

• But you may never be able to attribute activity x to outcomes y.

• A number of reasons – 1) The messy background, 2) Baseline trends and counterfactuals, 3) Other factors in the system beyond your sight or control

• Metrics that pertain to how the context or environment is changing to support the overall aim your are seeking to shift. Arguably as, or more, important than metrics that pertain to micro level interventions, or individual behaviours. So KM of segregated bike lane per 1000km of road vs % of people who regularly cycle. 

• we also think we need to stop thinking about measuring interventions and services in isolation but overall measures that think people, lives and systems (cc @emmacarers)

• Though we may have a basic set of principles setting our view of the way the system operates, We wont always hold true to those principles 

Role of the system lead

• The aim should be to continually nudge the system to refocus it’s efforts to improve the trajectory of the critical metrics.

• The aim of the “controller” should be to 1) set mission and vision, 2) orchestrate the response across many actors. Setting the rules and conditions vs specifying plan

• We under invest in connection and coordination

Micro or macro

• we focus on micro stuff of delivery. This is important, but we ignore big system shifts at our peril. And this we shouldn’t be surprised when we don’t get big shift in the metrics we want to shift

• On this I come back time and again to Donella Meadows on system leverage points and this 18 ways to change a system.

• For the system you are responsible for, what IS your story about how to shift the most important system levers


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