Hot Health Evening (Last Monday of every month except Esfand and Farvardin)

The Health System and Systems Thinking Meeting Series

Introduction: From Everyday Firefighting to the Architecture of a Sustainable Health System

Imagine it’s 2 a.m. You, the emergency department chief of a large hospital, are facing a bed shortage crisis for the umpteenth time this month. Patients are waiting in the hallways, exhausted medical staff are running around, and the pressure from worried families is mounting. What’s the immediate and familiar solution? Add a few temporary beds, call in the emergency room, and perhaps expedite the discharge of more stable patients. These actions will put out tonight’s fire, but we all know that it will flare up again tomorrow, next week, and next month, perhaps with greater force.

Now, consider the same scenario on a larger scale. You are a senior manager in a health system facing the challenge of nurse migration. The conventional, linear solution is to offer a small salary increase or incentive package. This policy may reduce attrition rates in the short term, but does it address the deeper roots of the problem—burnout from high workloads, lack of clear career paths, and poor organizational culture? It is possible that raising salaries without reforming the infrastructure will only raise expectations and lead to more dissatisfaction in the long term.

These two examples are just a small part of a larger, pervasive reality in the health system: we are caught in an endless cycle of “solving immediate problems” and “fighting everyday fires.” Policies and solutions designed with the best of intentions often have unintended and sometimes counterproductive results. Plans to increase access to services drive up costs out of control; efforts to reduce wait times in one area create new bottlenecks in other areas; And the indiscriminate prescription of antibiotics for short-term patient satisfaction will bring a crisis of antimicrobial resistance to future generations.

Where is the root of the problem?

The problem is not a lack of expertise, a lack of information, or a lack of intentions. Our doctors are among the most skilled, our managers are hardworking and compassionate, and there is a lot of data available. The root of the problem is our “mental paradigm”; in the way we have learned to analyze problems in a linear, discrete, and static way. We have been trained to find a specific treatment for every ailment, and a direct solution for every problem. This approach is effective in treating a simple infectious disease or managing a specific process. But the health system is a living, complex, and dynamic organism; an intertwined network of patients, doctors, nurses, pharmaceutical companies, insurers, policymakers, and social culture, in which the behavior of each component affects and is affected by the whole system.

In such a system, cause and effect are not easily separated. Time lags between an action and its outcome can last months or even years. Hidden feedback loops amplify (reinforcing loops) or dampen (balancing loops) the effects of a policy, often leading to outcomes that no one had anticipated. It is this “dynamic complexity[1]” that makes simple, intuitive solutions ineffective and sometimes harmful.

A New Paradigm: Systems Thinking and Systems Dynamics

But there is another way to look and act. “Systems thinking” is a paradigm and a common language for understanding and analyzing this complexity. This approach moves us from focusing on single events (the emergency room crisis tonight) to identifying patterns of behavior over time (the gradual increase in wait times over the years) and, ultimately, to uncovering the underlying structures of the system (how resources are allocated, admission and discharge processes, incentive policies). Systems thinking teaches us to seek to understand processes rather than to find blame, and to find “leverage points” [2] rather than providing piecemeal solutions; points where a small intervention can create large, lasting improvements in the entire system.

If systems thinking is “the art of seeing the forest for the trees rather than focusing on the individual trees,” then “systems dynamics” [3] is the science and precise tools of this art.

Developed at MIT, this discipline allows us to visualize our hypotheses about how a system will work through computer modeling, calibrate it with real-world data, and, most importantly, create a “virtual laboratory” or “flight simulator” for policy making.

Imagine being able to run a new drug control policy in a simulated model before it is implemented nationwide and see the long-term effects on insurance costs, public health, and physician satisfaction over the next ten years. Imagine being able to test different scenarios, such as “increasing the nursing workforce by 20 percent” or “changing the triage process,” in a computer model of your hospital and find the best policy mix to reduce emergency room congestion without increasing burnout. This predictive and analytical power is the essence of what systems dynamics offers health system leaders.

Health and Systems Expertise: (Health Hot Evening)

Today, health is no longer limited to medical treatment and care, but has become a multidimensional and complex field that requires the participation of various specialties. In our country, this field faces numerous challenges such as the high burden of chronic diseases, lack of resources, inequality in access to services, and inefficient management. These conditions require the creation of an interdisciplinary cooperation space to better understand the real needs, and to design and implement systemic and management solutions to improve people's health. Since there are many complex and numerous issues in the health sector, our primary goal is to purposefully examine the common problems of the health system and scrutinize them with systems science and systems thinking from different angles, through a series of Health Hot Evening meetings, in order to create a common perspective on the necessity of creating systemic approaches in the health field. Sessions Vision: To create a bridge of communication and a common language between health professionals and systems science experts to gain a deeper understanding of health system challenges, in order to create integrated and innovative solutions to improve community health.

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1. Key objectives and achievements of the Hot Health Evening Scientific Sessions Series[1]

Overall objective 1: To create a space for sharing experiences and enriching the collective understanding of a health challenge (presented by a health expert)

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Expected achievements:

Drawing a comprehensive and comprehensive picture: The challenge presented from different angles (clinical, managerial, financial, educational) is discussed and completed by other experts present at the session.

Discovering hidden connections: Participants realize the connection between this challenge and other parts of the health system and realize that this problem is not an "isolated island".

Empathy and mutual understanding: The systems team gains a better understanding of the depth, complexity, and human importance of the challenge presented.

Key Goal 2: Inspire and demonstrate the power of a systems approach in analyzing and solving health challenges (led by a systems scientist)

Expected outcomes:

Introducing a new “lens” for viewing problems: Attendees will be introduced to how systems thinking looks at a problem (emphasis on relationships, causal loops, and leverage points).

Opening a window to new solutions: By pointing to other successful examples, the system presenter creates the belief that “this challenge is solvable” and that a systems approach can be the key.

Establishing an initial common language: Participants will be introduced to some key systemic terms (e.g., “feedback loop,” “leverage point”) that will serve as a basis for future discussions.

Key Goal 3: Encourage constructive dialogue and create motivation for continued collaboration

Expected outcomes:

Establish the first dialogue: Create a space for question-and-answer and discussion in which people from both groups exchange their opinions, ideas and concerns in a common language for the first time.

Create a sense of urgency and enthusiasm: Participants conclude that “collaboration between these two areas is not a choice, but a necessity” and that they need each other to solve problems.

Determine a clear path forward: The final conclusion answers the key question: “What is the next step to turn this dialogue into action based on a focused and practical training course?”

Executive program of the series of Asraneh Dagh Salamat meetings

HMERC Conference