Complexity and Strategy in Public Health Systems

Web 2.0 and Public Health Systems

gdownie — Fri, 01 May 2009 15:50:25 +0000

Last week I had the opportunity to give a presentation with Cynthia Lamberth to the National Public Health Leadership Development Network (NLN) on the use of Web 2.0 tools in public health training and adult education. While the term “web 2.0″ is quickly becoming a cliche, collaborative uses of web technology are in their infancy in public health, local government, and in public health workforce development. The following tools and links were mentioned in the presentation:

Web 2.0 Literacy

Sloan Consortium: blended learning in higher education

Connectivism and connective knowledge online course

Resources for facilitators

Digital Democracy

Online course design

Knowledge ecology

Syndemics Prevention Network

First Monday

Online tools mindmap

Web 2.0 index

Mapping the Terrain: Public Health Systems Research

gdownie — Sun, 19 Apr 2009 00:52:17 +0000

I was fortunate to be able to attend the Keeneland Conference on public health systems and services research (PHSSR) in early April, and to meet colleagues from around the country interested in building a research base in public health systems. One interesting dynamic in this emerging field is the role (as yet undefined) of the systems sciences in PHSSR. There are a number of researchers that bring methods and techniques from health services research, and the methodologies tend to focus on quantitative methods of research design and data analysis. While the health services research field can do much to inform a public health systems research agenda, a comprehensive understanding of the dynamic complexity between population health and institutional structure requires the application of systems sciences. This may include network analysis, agent-based modeling, systems dynamics modeling, or other related methods. This map of complexity science provides a hyper-linked diagram of the evolution of complexity science. The challenge for new researchers in PHSSR is to find opportunities to build some of these methodologies into an emerging public health research agenda.

A Framework to Understanding Systems Sciences

gdownie — Mon, 09 Mar 2009 00:41:39 +0000

One fascinating aspect of the public health field relates to the dynamic complexity between the systems that link social determinants of population health and the institutional organizations that determine the collective response to threats to community health. Since the late 1980s, a number of national practice organizations have sought to describe the institutional systems (the “public health system”) and others have focused on the many factors that interact to impact population health. One particular area of emphasis described as a critical skill area for leaders in public health practice has been an understanding of “systems thinking.”

A common point of entry for public health workers into this subject area (usually in the form of a leadership institute or other continuing education program) is Peter Senge’s, “The Fifth Discipline.” First published in 1996, this book describes the characteristics of “learning organizations,” and includes systems thinking as one skill leaders need to foster learning organizations. While learning organizations translate tacit knowledge into higher levels of performance or competitive advantage, the role of systems thinking (one of the five critical disciplines) in public health relates to the ability to recognize the interconnectedness of system agents, as well as the multiple layers that represent linked systems (sub systems, nested systems). But more specifically to the experience of public health practice, an understanding of systems provides insight into the relationship between biological, behavior, economic and institutional systems that interact, and provide an understanding why some groups are more vulnerable to violence, economic distress or poor health.

The Association of Schools of Public Health, the Centers for Disease Control and Prevention, and the National Leadership Development Network have described systems thinking as a basic leadership competency. But what does “systems thinking” mean…really? In order to begin to understand the systems sciences as academic disciplines, one place to begin is with a conceptual framework contained in a recent publication of the National Cancer Institute, “Greater Than the Sum: Systems Thinking in Tobacco Control.” While the practical illustrations were specific to tobacco control, this work contains a very useful model to understand four disciplines that fall under the rubric of systems sciences.

These four areas each represent disciplines in themselves. Perhaps more important is the understanding of how the academic disciplines relate to each other. These include:
(1) Systems Organizing
(2) Systems Dynamics
(3) Network Analysis
(4) Knowledge Management

Taken together, these four categories encompass the various fields that comprise systems sciences. Each of these in turn are applied differently to specific discipline areas. The National Institutes of Health, Office of Behavioral Health and Social Sciences Research is coordinating an interdisciplinary approach to building the systems sciences within social science research. A series of conference proceedings are available for download, and offer a good place to start:

Systems Methodologies for Solving Real-World Problems: Applications in Public Health
To view videocast with Real Player follow this link: http://www.videocast.nih.gov/ram/ss032207.ram
To download Video or Audio Podcast follow this link: http://www.videocast.nih.gov/Summary.asp?File=13712

Network Analysis: Using Connections and Structures to Understand and Change Health Behaviors
To view videocast with Real Player follow this link: http://www.videocast.nih.gov/ram/ss061207.ram
To download Video or Audio Podcast follow this link: http://www.videocast.nih.gov/Summary.asp?File=13878

Agent Based Modeling: Population Health from the Bottom Up
To view videocast with Real Player follow this link: http://www.videocast.nih.gov/ram/ss071307.ram
To download Video or Audio Podcast follow this link: http://www.videocast.nih.gov/Summary.asp?File=13931

System Dynamics Modeling: Population Flows, Feedback Loops and Health
To view videocast with Real Player follow this link: http://www.videocast.nih.gov/ram/ss083007.ram
To download Video or Audio Podcast follow this link: http://www.videocast.nih.gov/Summary.asp?File=14005

Complex Systems Approaches to Population Health
DAY 1:
To view videocast with Real Player follow this link: http://www.videocast.nih.gov/ram/complex053007.ram
To download Video or Audio Podcast follow this link: http://www.videocast.nih.gov/Summary.asp?File=13867

DAY 2:
To view videocast with Real Player follow this link: http://www.videocast.nih.gov/ram/complex053107.ram
To download Video or Audio Podcast follow this link: http://www.videocast.nih.gov/Summary.asp?File=13869
If you experience difficulty accessing these videocasts, contact Patty Mabry at mabryp@od.nih.gov.

My own interest relates to public health systems research, and how organizations are linked together as a network; how variety in network structure across public health systems impacts the ability of our institutions to assure that the public health essential services are adequately being addressed; and how institutional systems incorporate learning and knowledge into organizational practice.

Chaos, Complexity and Leadership in Public Health Systems

gdownie — Mon, 06 Oct 2008 22:55:08 +0000

Terms such as “chaos” and “complexity” have deep roots in the science of complex adaptive systems, and the recent string of large-scale, catastrophic events have made these concepts disturbingly immediate for most people. In public health organizations, most of your colleagues likely have an innate sense of the larger system that both defines their daily job responsibilities, and the individual and organizational relationships across the public health system. While political stakeholders compel us to maintain “stability” at all costs, effectively dealing with change in light of emerging threats and larger-scale chaotic events is critical.

Crisis events and chaotic situations, from localized political conflicts to natural disasters, require that leaders be credible, and able to command the appropriate level of response to a crisis. This recognizes the nature of crisis as a set of interrelated problems (See Ian Mitroff, PhD). Conceptually related to the ecosocial model of public health, understanding that most problems are part of a larger mess can lead to more effective identification of strategy.

In the recently released second edition of the text, “Public Health Leadership: Putting Principles into Practice,” Dr. Louis Rowitz describes the term “meta leadership” as a methodology for working across organizational boundaries, requiring a systems perspective so that the leader can both promote positive change in the larger system, and serve the interests of the organization and its stakeholders. This implies that leaders need to develop skills for both working within and across organizational boundaries, and to appropriately apply these skills when dealing with crisis events. An article by Henderson, Dorn and Marcus, “Meta Leadership and National Emergency Preparedness,” provides a framework for understanding the leadership implications of large-scale emergencies. An often overlooked component for public health practitioners, whether in routine practice or during a chaotic event, concerns the political component of any crisis. As a problem escalates in its complexity, it inevitably becomes important to external political stakeholders of the organization. The meta leadership framework provides an understanding of the interaction between individual-level emotional intelligence (or lack thereof), organizational effectiveness, and system-wide response. Although many public health practitioners, highly trained in a specialty scientific discipline, tend to resist the political aspects of routine and crisis problem solving, developing these skill would undoubtedly make for more effective implementation of strategy.

The major crises of the last eight years provide many reasons to be pessimistic about the current state of national leadership, and there are as many examples at the state and local level to support a cynical outlook. Despite these seemingly unsurmountable barriers, the ability to overcome our natural inclinations towards judgment, cynicism and fear will help us to become better leaders- and to demand the same in those that would place themselves in such a position.