Short Abstract

We present the practical application of systems thinking to address complex health problems. This serves as a methodological evaluation exemplar for complex system challenges and public health inequalities, which require ‘non-linear’ solutions to enable systems-level change and influence policy.

Description

Introduction

There has been an increase in healthcare problem and clinical presentation complexities in the NHS. The NHS-long-term plan sets out ways to address these challenges by shifting the focus from hospital to community, analogue to digital and sickness to prevention. The role of healthcare evaluation has become more crucial to inform decision-making and influence policy. In view of greater recognition of the ’context’, there is a need to adopt new evaluation approaches that use holistic ways of complex problem solving. We present a case study, as part of developmental (and relational) evaluation that used systems thinking for a complex health project/initiative.

Aim

We aimed to use principles of systems thinking (and co-design) for a complex project aiming to explore and provide suitable support to survivors of sexual violence and abuse, in Suffolk, England.

Methods

We used participatory evaluation methods, starting by using an overarching evaluation framework (co-developed as part of initial guidance on healthcare evaluation, published on the NHS Suffolk and North East Essex Integrated Care System website). We used systems thinking – both as a mindset and methodology, to address a complex healthcare priority area that has a wide range of stakeholders involved.

Initial steps consisted of the need to understand the current ‘system’. This included identifying the main problem or systems challenge, who are the stakeholders, if and how are the service pathways connected, and where can we intervene to bridge any gaps in accessing support services? We used existing evidence, local research reports, lived experience feedback, and stakeholder discussions to inform the problem and stakeholder mapping. This was done as a collaborative process comprising of stakeholder workshops, including feedback discussions between the evaluator and the project team lead. A sequence of steps was applied to the mapping process, as a systems thinking tool. This involved identifying several enablers and ‘barriers’ to access support (among sexual violence and abuse survivors), clustering into themes to form feedback loops and analysing cause-effects.

Results

The results showed a systems map visualising the current state of the defined system with interconnections between stakeholders and service systems. These included sexual violence and abuse survivors and their families/carers, specialist health and care service providers, the police and justice, and the voluntary sector. In addition to awareness building, the system map highlighted the need for making the support system easier to navigate by having a trauma-informed ‘pathfinder service’ that could also facilitate support access and choice to the ‘right service at the right time’ within a better integrated health and care system.

Conclusions

We present the practical application of systems thinking to address complex health problems. This serves as a methodological (developmental) evaluation exemplar for complex system challenges and public health inequalities, which require ‘non-linear’ solutions to enable systems-level change/service improvement and influence policy.