Shhh…Leaders Don’t Talk about Systems Thinking

in Improvement Science, Systems
by David M. Williams, PhD





















Photo by Jeremy Philemon on Unsplash

As New York began its response to the COVID19 outbreak, a journalist asked Governor Cuomo why he had not closed the schools and stopped public transit to reduce spreading the illness. His answer? If he closed them, who would watch the children of the healthcare workers treating the patients? How would they get from their homes to the hospitals? Governor Cuomo was acutely aware of the risk and he knew that closing down these essential services had a ripple effect; there was an interdependence between one service and another. He’s a systems thinker.

There’s a classic exercise called Triangles that’s excellent at helping to appreciate systems. In this exercise, people spread out across an open space. Each individual is instructed to pick two people they can clearly see but don’t make it known. Now the challenge…move and keep the same distance between you and each person. Everyone starts moving. As people try to adjust their position, it’s chaotic. Everyone wishes people would just stop moving. It’s not long before you see the people you are following are also following two people who are also moving. Any movement creates shifts somewhere else. This is an interdependent system. Everyone has the freedom to act independently in their own interest, but everyone is linked, resulting in a ripple effect–mostly unintended.

Derek Feeley (outgoing Institute for Healthcare Improvement CEO and former head of the National Health Service Scotland) and I used to meet monthly when I headed up IHI’s work in leadership. I reflected one day on a need I saw for leaders — people were not appreciating systems thinking. He agreed but responded unexpectedly saying, “Systems thinking is something every leader needs to understand AND nobody wants to talk about it.” Derek’s response surprised me. If it was so important, why wouldn’t they want to learn more? What held them back from a key insight for leading complex health systems, school systems, or any organizational system?

What is systems thinking? Peter Senge called systems thinking the “fifth discipline” (in the book of the same name) of a learning organization. It’s the ability to see wholes instead of parts. It’s built on purpose and interconnectivity versus siloes. Organizations are complex and only through understanding the systems can you make sense of them and improve them to get the desired results for users.

Dr. W. Edwards Deming introduced appreciation of a system in The New Economics as one of the four core lenses of the science of improvement and included a figure depicting organizations viewed as a production system. Every system has an aim (a purpose) and is in service of its users. It’s a network of interconnected components. Leaders need to manage it toward its aim or it’ll take on a life of its own and destroy the system.

Why does this matter to me? How would this change the way I lead day-to-day? Dr. Paul Bataleden at Dartmouth coined the phrase “every system is perfectly designed to get the results it gets.” Systems are designed and led by leaders like you. It’s your role to improve the system (or your part of it) to achieve your aims. This requires all of the parts to work together. No part or leader can act only in the best interest of a department or process; they must act as a whole to meet the aim together. You need to be able to see the system, understand how all its parts fit and work together, and improve it everywhere it needs change.

Processes are the ground level starting place. Process maps are a tool to help understand how an isolated process works. We test changes, develop standard work, and implement what works to reduce variation and deliver reliable results. Improving any process reveals other linked together processes. The janitor’s work processes to clean classrooms affects the teacher’s classroom readiness the next day. The deployment of the buses and following the planned routes affects the arrival of students ready to start the school day. You can look at any process in isolation but fail to see how it links to other processes, and the result can be mistakes, misalignment, and rework.

Leaders need to understand their work. What are the core processes we regularly use to do our work for users? Do we have a theory of what good looks like for each? How predictable are they? How are they connected to other processes? Is there stuff we need in order to do our work? When we do our process, where is the resulting work handed off? What processes like customer input, evaluation, or research and development influence changes we might make? What processes from IT, supply, or human resources support doing this work.

Nothing happens in isolation. Understanding your work, developing reliable and predictable processes, and understanding the organizational system they link into is a core leadership skill for managing and continuously improving for those you serve.

How do we change leaders’ comfort with systems thinking? Move from a theoretical appreciation to a practical, tactical operational mindset. People who run stuff understand operations. Standard processes nested together in a system of activities is highly operational. Seeing your work as a set of processes and all processes as part of an organization helps you do your work, figure out where improvement is needed, and appreciate the impact of changes.

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