BEST ET AL.,
2007
ISIS: Initiative on the
Study and Implementation
of Systems
Systems Thinking in
Tobacco Control
Examines synthesis of four key systems
approaches applied to tobacco control
• Systems organizing
• Participatory, complex, and adaptive collaborative systems
• System dynamics
• Complex dynamic interactions among influencing factors
• System networks
• Collaborative relationships among stakeholders
• Systems knowledge
• Dissemination, evolution and maintenance of scientifically credible,
evidence-based practices
Early population-level projects
• North Karelia Project
• 1972 – comprehensive, multi-level approach – strong effects
• Led to 1980’s projects in the US - Stanford 5-city Project,
Minnesota Heart Health Program, Pawtucket Heart Health Program
– all w modest effects
• Community Intervention Trial for Smoking Cessation
(COMMIT)
• A community-based RCT – multi-channel effort - modest impact on
light smokers quitting
• ASSIST – extended COMMITT strategy across states
• Multiple interventions, using a variety of channels to reach multiple
populations – 3D cube illustration – modified (next slide)
• States that participated experienced greater decrease in smoking
prevalence than states that did not.
Application of systems thinking
• A transdisciplinary approaches in both research and
•
•
•
•
practice
Transcending or integrating diverse organizational
cultures and missions
Accelerating transfer from discovery to development to
delivery (Translation)
Setting evidence-based priorities (on prevention rather
than treatment)
Creating a federation of systems (e.g., Defense Dept.)
• WHO’s Framework Convention for Tobacco Control
• Organized setting long-term goals
Systems Thinking
• Systems methods –
• specialized approaches to understanding complex systems
• Systems approaches –
• broader theories that use systems methods to address systems
• Systems thinking –
• Use of systems approaches to view the world - used to understand
system behaviors and to identify systems principles such as:
• feedback loops, stocks and flows, open vs closed systems, decentralized
versus hierarchical systems, self-organization, autopoiesis (selfproduction), nonlinear systems, complex adaptive systems (CAS),
boundary conditions, scaling and power laws, silo effects, small-world
phenomena, emergence, cellular automata, and fractal self-similarity.
• A worldview than balances part and whole, and focuses on complex
interrelationships and patters from multiple perspectives
Chapter 3 is a fun read!
Chapter 4 – Systems Organizing
• An adaptive systems perspective for management across
organizations
• Four major interrelated dimensions that are transformative
• Vision –
• From leading and managing to facilitating and empowering
• Structure –
• From organizing to self-organizing
• Action –
• From delegation to participation
• Learning –
• From discrete evaluation to continuous evaluation
Concept maps for organizing
Chapter 5 – Anticipating Change
• Explored use of
system dynamic
modeling to
develop:
• A causal map of
tobacco control
variables
• Formal
simulation
models
• Simulations of
tobacco use
prevalence and
consumption
A simple SDM with feedback loops
Following development of models like the
preceding, develop “stock and flow” models
then simulate data
This relates to the “smoking as a social norm” portion of Fig 5.10. For example, every year,
some fraction of the undecided population moves (“flows”) from the undecided “stock” to
public support of tobacco use or public support of control of tobacco use.
Validating simulation of SDMs
Chapter 6 – Network Theories
• Example network
map illustrating
many of the
network concepts
discussed in this
chapter, including
centrality,
cliques, and
referral networks.
Contact networks: 2 states with strong and 2 with weak
financial and political climates re tobacco control
Indiana
Michigan
Mississippi
Oklahoma
Chap 7: Managing the Knowledge Content
Four Ps of Knowledge Management and
Translation
• Purpose –
• Agendas, relevance timelines and a business case
• People • Knowledge champions, brokers/managers, and architects
• Communities of practice
• Process –
• Building consensus and capacity
• Developing knowledge and networks
• Products
• Groupware, knowledge repositories, knowledge development tools
and knowledge navigation/access tools
• Plus infrastructures of:
• Organization, technology, information and finances
Conclusion
• Simply stated,
• with more inputs, more stakeholders, and better evaluation and
adaptation,
• the infrastructure of
• knowledge, networks, and analysis methods
• needed for the support of this adaptive environment
• will be the key to transforming the state of public health in
the future.
• It is a philosophy that reflects the basic engine of change
in life, whether it is in the form of biology, economic
competition, democracy, or nature itself.