Adopting Systems Thinking Into Your Implementation Science and Implementation Practice Efforts
By Dr. Sobia Khan, Director of Implementation
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What makes implementation successful? There is a myriad of factors that can make or break implementation, particularly when we are working in complex systems rife with uncertainty and difficult-to-predict outcomes. Sometimes a small amount of effort is enough to tip the scales towards substantial adoption and uptake of change, and at other times, it feels like the scales won’t budge despite the intensity and rigour of our initiatives. This rude reality is why we are shifting towards approaches to implementation that address complexity; here, we find a space in which we attempt to merge our learnings from systems thinking and implementation science.
We have discussed at great length what implementation science is and how it can inform implementation practice. But what is systems thinking? At its most essential form, systems thinking describes how systems operate. A system is a group of components that have to interact in some way, shape or form in order to make something happen. Depending on how many components are in the system and how they are connected, systems can operate at a varying degree of complexity. We do have simple systems, but we rarely talk about these. In simple systems, there is more certainty about what will produce the results we want. Complex systems are the ones that we struggle with the most. Complex systems often have complex or “wicked” problems; they have many different components, with many connections between these components. Sometimes we aren’t even aware of how things are connected. It is unclear what action will lead to what outcome.
In implementation science and systems science, we have theories, models and frameworks that help us identify what we are experiencing, categorize it in some way, and help us make sense of this complexity so that we have a shot at reaching the outcomes we want to reach. These theories, models and frameworks are incredibly helpful in the practice realm, because this sense making process is all too important and can turn something that would otherwise be daunting, much more manageable. We have spent much time in past bulletins describing the application of theories, models and frameworks because we believe these can really help us be more strategic rather than implementing and praying and hoping that things will go well. What we don’t talk about often enough are the other key ingredients we need to have in place in order to implement well in a complex system. These include being nimble and flexible to the contextual challenges we face in real life – in other words, understanding system pressures and being adaptive to these. These can also include aspects of building relationships and meaningful engagement, the foundations of fostering functional connections between actors and components of a system. Finally, there is the subject of motivation, the driving force behind real systems change.
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