Leading System Change: What is a System?

I’m excited to host my first Clubhouse (CH) conversation tonight. For those of you participating in the conversation, I’m sharing my foundational concepts for each conversation here so you can refer to handouts and/or revisit concepts whenever you like. I also realize that most people don’t have access to the CH app yet, so these posts are another way people can access the content I share.

It’s my pleasure to start my CH series, Leading System Change, with Dr. Aekta Malhotra. Dr. Malhotra is a psychiatrist in Texas who has recently opened her own practice, Apollo Psychiatry. She’s also a visionary change leader in healthcare, aspiring for a better healthcare experience for her clients and herself.

Foundational System Concepts

Every week I’ll share some foundational systems thinking concepts. Sharing concepts and language will make it easier for us to collaborate with and support each other. Check out my online programs and free resources to learn more systems concepts.

• system
• process
• systemic
• system change

A system is a whole made up of interdependent parts. Each part affects the others. When we change one part of a system, we impact the other parts.

Systems are natural. They’re all around us and within us. We live in the solar system, within an ecological system and a human, biological system.

Humans have also created many systems (e.g., government, healthcare, public health, education, social media, politics, work, finance, agriculture, etc.).

Sometimes people use the word system when they mean process. A process is something that has a starting place and an ending place. You can complete a process. You can make incremental updates to processes.

You cannot complete a system. It is ever-changing, ever-evolving. You cannot ‘fix’ a system and walk away. Instead, you use systems thinking to decide where to intervene and how to monitor the ripple effects of your intervention. Systems need to be designed to be responsive to their constituents’ ever-changing needs if they are to be life-affirming and health-promoting.

Systemic means that something is found throughout the parts of a system. Systemic racism (in any system) means that racist practices, processes, structures, beliefs and assumptions are embedded throughout a system.

System change requires intervening in multiple parts of a system to improve it in some sustainable way. Most system change initiatives fail because they aren’t grounded in systems thinking. Well intentioned, most change initiative plans underestimate the level(s) of intervention needed in multiple parts of a system at one time.

Because a system is made up of interdependent parts, it means that if we change one thing, we affect the other parts of the system – but also, the other parts of the system push back against the changes we’re trying to make. So intervening in only one part of a system is unlikely to bring about holistic change. In fact, discreet interventions might result in backlash or pushback from other parts of a system. Or they might cause dysfunctional, unintended consequences.

That’s why piecemeal or step-by-step change initiatives are difficult, and many times, ineffective. We improve one piece, as if it is separate from the others, such as granting scholarships to underrepresented groups. More students enter the academic system, but find it was not designed for a diverse student body. The other parts of the academic system are not changed by granting more diverse students access *unless* other interventions are made at the same time. New, responsive processes, practices and structures must be put in place at the same time so that the system can be transformed by its constituents.

Change Leader Conversation

Conversations on Clubhouse are live and are not recorded. I’ll list my questions for my guest in case that’s helpful for other change leaders as you expand your own system change conversations. These questions also give people who might join CH in the future a sense of the Leading System Change conversation. I hope you will join us whenever that is possible.

Questions for Change Leader, Aekta Malhotra, MD, MS

1. What does “the system of healthcare” mean to you? What do you see as the system you’re trying to change?
2. You recently chose to open your own practice instead of joining an established psychiatry practice. What went into that choice? How is being in private practice allowing you to change the system for yourself and your patients?

Find out more about Dr. Malhotra and her work at ApolloPsych.com.

If you’re leading a system change initiative (in any context) and would like more support, check out my membership group for change leaders, Leading System Change. I share new content each month, give discounts on my online programs, and most importantly, connect you with other change leaders so you can share resources, pose questions and learn from kindred spirits.