Systems Thinking Bob Feroli, Pharm.D., FASHP Medication Safety Officer Johns Hopkins HospitalOutline  Creative Thinking  Analytical Thinking  Systems Thinking  Understating a System  Implications of System Thinking Acknowledgment: Russell AchoffNew Approach  Without changing our patterns of thought, we will not be able to solve the problems we created with our current patterns of thought Albert EinsteinNew Approach  Without changing our patterns of thought, we will not be able to solve the problems we created with our current patterns of thought Albert Einstein Think out of the boxEducation  How did you succeed in school?  Tell the teacher what they want to hear  Trigonometry Class Problem  You have a protractor, a long tape measure and a watch to see how long it will take you to find the height of a building.Analytic Thinking  Comes to us naturally  Analysis – to break into constituent parts  Basis of scientific method for 400 years  Has taught us a lot about how our world worksAnalytic Thinking  Comes to us naturally  Analysis – to break into constituent parts  Basis of scientific method for 400 years  Has taught us a lot about how our world worksAnalytic Thinking 1. Take the thing apart 2. Explain the behavior of each part 3. Combine the explanations of individual parts into an explanation of the wholeAnalytic Thinking  Linguistics  phoneme  Chemistry  molecules  Biology  cells  Nuclear Physics  subatomic particles  Quantum Physics  stringsAnalytic Thinking  Analytic theory has limitations  Ludwig von Bertalanffy: General Systems Theory (1949c)  The whole is more that the sum of its parts  The whole is not explainable from the characteristics of its isolated parts  System ThinkingCar Power System Drive Train Fuel Pump Engine Transmission Differential Spark plugs Carburetor Nuts Bolts Why does an average car contain room for 6 passengers?Shortcomings of Analysis  First step in analysis is to take the system apart  As soon as this is done, the system loses its essential properties and so do its parts  You cannot understand the behavior of a system by taking it apart (i.e., by analyzing it)  Analysis provides answers to HOW questions  Understanding WHY a system functions as it does requires a different approachSystem  A system is defined by its function within a larger system  A medication-use system is defined by its function within the healthcare system  The function/property of a car is defined by its function within the larger transportation system  Move people from point A to point BSystem  A system  is made up of at least two essential parts, and  is defined by its function within a larger system  Essential system parts must satisfy these conditions:  Each part or part subset affects the behavior or properties of the whole  World does not revolve round a single part (RPh, RN, MD)  No part can independently make the “whole” function  All essential parts are connected (directly or indirectly)Car As a System  Essential parts (all are connected)  Battery, Fuel Pump, Engine, Transmission  All essential parts can affect the function of the car  No one part can independently make the car work  When a car (system) is taken apart it is no longer a car, it looses its essential (defining) functions  None of a system’s parts (taken alone) perform the defining function of the whole (e.g., moving people from A to B)Understanding the System  Explaining why a car functions as it does (understanding) requires a different approach  Explanation lies in the understanding of the car’s place in the larger transportation system – not by leaning how each part works in isolationSystem Thinking Method for understanding the behavior of system without taking it apart. 1. Identify the larger system that the car is part of (transportation system) 2. Explain the behavior or properties of the larger system 3. In the context of the larger system, look at the function of the part you are trying to understand  Answers why it works the way it does (understanding)  Why dose the average car seat 6 passengersCar Power System Drive Train Fuel Pump Engine Transmission Differential Spark plugs Carburetor Nuts Bolts AnalyticUS Transportation System Travel by Sea Travel by Land Travel by Air Rail Car Foot Power System Drive Train Fuel Pump Engine Transmission Differential Spark plugs Carburetor Nuts Bolts SystemSystem Thinking  A system is defined by the interaction of its parts, not by the sum of the function of individual parts  Consequence of synthetic thinking  The performance of a system is not necessarily improved when the performance of each part (taken separately) is!  If the performance of each department in the organization is improved, the organization may not be improved!Make The “Best” Car Take the best parts form different cars and put them together Best engine from the Rolls Royce Best transmission form the Mercedes Best fuel pump from the Lamborghini Body from a great classicCritical Question How is the system affected when a part is modified? Sounds obvious, but we often don’t consider thisOptimizing the System  When changing an essential part of a system, what is the effect on the function or properties of the system?  Traditional (all to often current) approach  Managers focus on and manipulate only those things within their control  Leadership expects each department head to make their department as good as it can be (silo thinking)Optimizing the System Capacity: cogs/hour System Output A B C 300 200 700 200/hour  Three departments needed to process a cog  Department C has the best capacity  System output is limited by department BOptimizing the System Capacity: cogs/hour System Output A B C 300 100 800 100/hour  C gets event better (causes B to get less good)  Essential parts are connected  System output decreases !Optimizing the System Capacity: cogs/hour System Output A B C 400 400 400 400/hour  Move resources from C