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higgoo
Systems thinking: but whose 'system and who's 'thinking'?
Nov 7 2008, 7:14 AM EST | Post edited: Nov 7 2008, 7:14 AM EST
Sociotechnical change may be about appreciating the whole, the integrated sum of parts rather than concentrating and reducing to individual components. Prof Clegg put that point, in common with the UK Strategy Unit and many others involved with complex situations.

But systems are an abstraction. It depends whose summary and interpretation you're prepared to accept when different groups have different perspectives, levels of knowledge and motivations. Complexity increases when the 'systems' we're reviewing are also hit by multiple initiatives from outside (Darzi, HI, etc). Systems then become much wider and even more difficult to understand.

I look at this as a disabled researcher. Those with disabilities (and long term conditions) apparently place the biggest burden on the NHS. Yet an expert at the Masterclass described diagnostic data in primarycare records as "a disaster". I personally have difficulties using Wikis and Discussion Boards via assistive technologies. Note also this from the Equality Impact Assessment accompanying the HI Review:
"2.8.1 There are no current nationally-agreed NHS code-sets for disability".

We call for clinical leadership. But does 'clinician' mean 'doctor' or all involved in direct care? Look too at the structure of medicine. Do you see multiple specialities who, like my eye and ear specialists, rarely talk to each other? Do you sense some contradictions emerging?

So the sociotechnical approach based on systems thinking is laudable. The problem may be turning the mantra into true systems thinking and realistic systems practice by all involved from top to bottom.
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