Systems thinking

Health care is a complex system with many inter-related actions and consequences. This means that when we consider making a change to any part of the system we need to take account of the system in its entirety if we want to assess the full impact of implementing the change. Systems thinking allows us to identify and understand how changes over time affect all parts of the system, through the use of feedback loops.

Using the cost consequence tool allows us to articulate the strength of the relationships shown in scenario diagrams, and, given those relationships, determine how the various parts of the model interact with each other – to give an overall impact on the numbers of service users in the various parts of the system, and the overall costs.

The Cost consequence tool project report presents a series of influence diagrams that relate to some possible scenarios that commissioners and providers may want to consider. The aim of these influence diagrams is not to provide an answer as to whether a particular scenario or combination of scenarios should be implemented, but rather to instigate consideration and discussion of the wider aspects of implementing a change. By depicting the influences in this way, we are able to see a system-wide view, which allows consideration of more wider-reaching effects of changes. This effect is analogous to squeezing a balloon in one place and being able to predict where the balloon will bulge as a consequence.