Johnson, James A., Douglas E. Anderson, and Caren C. Rossow. Health Systems thinking: a primer. Burlington, MA: Jones & Bartlett Learning, 2020. 138 pp. ISBN 9781284167146 (original) (raw)

Theoretical Medicine and Bioethics

In an era of a dynamic, uncertain, complex, and ambiguous health challenges [sic] at all levels and in every setting, this Primer on systems thinking, as it pertains to health, is urgently needed" (p. vii). Thus begins Johnson and colleagues' Primer and it certainly appears at a propitious time as we continue to investigate the COVID-19 pandemic. Why propitious? Specifically, the pandemic has revealed how dysfunctional the global healthcare system is and how badly it needs repair. One such means is through systems theory and thinking. Rather than the reductive approach which exemplifies traditional biomedical thinking and results in fragmented healthcare, systems thinking provides a holistic approach to meet the dynamics and complexities requisite to deliver quality and safe healthcare. After a brief preface, which frames the authors' motivation for the Primer, they discuss systems thinking and its application to the healthcare system throughout five chapters. The first chapter is an introduction to systems theory and thinking. The authors initially discuss systems theory and its foundations, most notably Ludwig von Bertalanffy's general systems theory. Rather than uniting the sciences via their reduction to physics, Bertalanffy strove to unify the sciences by integrating them as a dynamic and complex system. The authors then turn to complex adaptive systems (CASs) as the paradigm for understanding the functioning of healthcare systems. They discuss the various components and attributes of CASs, including agents, interconnections, self-organization, emergence, and co-evolution, among others. Next, the authors cite the World Health Organization (WHO) regarding the requirements of systems thinking: "a deeper understanding of the linkages, relationships, interactions, and behaviors among the elements to characterize the entire system" (p. 9). The authors then explore systems thinking by reframing a problem from a perspective of the "whole"