ABCi Skills for Improvement - Understanding your system

- July 29, 2020

Understanding the System - Resources

Before you undertake any type of improvement, you will need to understand how things currently
function. For instance, how do any processes work? who does what in that process? or what
resources are needed? You will need to understand what is going well and what is not going so well,
where the problems are, what these problems are and their root causes. To truly understand the
current system you will need to see it from different perspectives and the tools and techniques
outlined here will help you to do this.

Useful Links

Shhh...Leaders Don't Talk about Systems
Thinking David Williams PhD - Scholar/
Practitioner Science of Improvement
(Examples illustrating importance of
understanding systems)
The habits of an improver. The Health
Foundation (Systems Thinking a key skill)
Understand System NES Scotland

Why is it so important to understand the system?

W.E.Deming wrote much about the 'System of Profound Knowledge' (SOPK), knowledge

that is core to to any work around improving systems. The SOPK is roughly arranged across

four areas (see figure below) and is key to thinking in systems...systems thinking. Knowledge

of the system is an essential component of SOPK. Paul Batalden is widely quoted as saying,

'Every system is perfectly designed to deliver the results it gets'.

But what does this actually mean?

'A system is an interconnected set of elements that is coherently

organised in a way that achieves something' (DH Meadows).

All systems have an aim or purpose, and will deliver outputs or

outcomes that will, to an extent, achieve the purpose of the system.

Any system will be made up of many different processes, departments,

people, resources etc. However, when thinking in systems, it is the

relationships between these components that are at least, or as

equally important, as each component itself. This interconnectedness

means that when you change something 'over here', the effects may
be felt 'over there' at a distant place or time. Or conversely an output or outcome, that you are
observing, may be the result of something that is happening far away.

Also, the cause and effect relationship may not be linear, but the result of an amalgamation of
components within the system. This is why understanding your current system is so important when
you make any changes. If you do not understand your current system or the level of complexity
within it, you may waste time and effort changing the wrong thing and in doing so, may actually
make things worse!

So whatever the outcomes are that you are observing, they are the result of the wider system which
produces them. If you are happy with these outcomes then leave things as they are, however if you
or your service users want better outcomes then you will need to change the wider system, hence
the need to thoroughly understand it.
If you are interested in learning more about complexity, take a look at the Cynefin framework.

Where does this fit with quality improvement?

Knowledge of systems is key to any quality improvement endeavour as illustrated above. The
Model for Improvement is the framework with which we structure our improvement work, however
you will need to understand your system at the outset of your improvement work, whilst you are
thinking about the aim of your work, measuring progress and developing ideas for change.

How do I understand the current system?

There are a lot of tools out there that can help you to understand your system, and it can be a bit
overwhelming when trying to understand which tool is helpful in what circumstances. It really
depends on the question you are trying to answer or what do you need to find out about your
system. There are also useful frameworks that can help you understand your system from a number
of perspectives eg. Five P's framework, or to think through a problem eg. A3 Problem Solving.

Many of the tools that are used as part of quality improvement are included in the grid below, the
grid is arranged to help orient you to the different tools that are available, when you would use them,
and provide links to more information around how to use them.