Systems thinking to promote timely and equitable access to specialist outpatient services

8 July 2024

As a society, we are deeply embedded in systems and many of the challenges we struggle to solve have been created by how we have set up those systems. The system’s structure is the source of the system’s behaviour, yet we often don’t see it that way.

Profile photo of Dr Sue McAvoy standing in the UQ Great Court
Dr Sue McAvoy

We caught up with Dr Sue McAvoy from the Centre for the Business and Economics of Health (CBEH) to discuss how using systems thinking approaches can look beyond the obvious to see the relationships and feedback loops that define the behaviour of health systems over time. Dr McAvoy explores how having a better understanding of the underlying dynamics of healthcare systems can inform solutions that improve equity and access to specialist outpatient (SOP) health services.

As a systems thinking practitioner and researcher, what is systems thinking, and why is the approach needed in healthcare?

Before I jump into that, I’d like to preface by saying that systems thinking is life changing. It sounds dramatic, but it holistically changes the way you think about and see things.

While practitioners would answer this question in many different ways, I see systems thinking as a way to better understand a specific situation in the context of its wider system so that we can learn how to influence that situation over time more successfully and more effectively. Better outcomes are the goal.

It’s a sum of all parts rather than the parts of a sum approach to problem solving with huge potential.

It’s a multi-disciplinary philosophy, language, method and toolkit that allows us to connect the dots, see the parts of a system and how they’re interconnected within some notion of its whole. Once we have that understanding, we can design better interventions to improve outcomes.

Without argument, health is a complex and dynamic social system, and we cannot intuit how it’ll behave. If we want a stronger health system, we need methods that offer a way to look under the hood and beyond the event to collectively understand why a system behaves the way it does and how to change it into better more sustainable patterns of behaviour.

As more complex and ambiguous challenges arise in healthcare systems, how can systems thinking be used to create solutions for organisations across the sector?

Health systems administrators, clinicians and patients hold detailed and important knowledge for informing health and health policy – details that are often missed when we focus only on written and measured data. Systems thinking offers a way to tap into those reservoirs of knowledge that we call mental models.

Participatory System Dynamics (PSD) and Group Model Building (GMB) are powerful practical ST methods that involve stakeholders in problem conceptualisation and solution co-design processes. In our project work, we run group model-building workshops with a range of stakeholders from across the system, both providers and users, to conceptualise and better understand their system. This approach allows us to arrive at a shared vision, surface assumptions, and understand the feedback loops that are responsible for the system behaviour. We ask: what is the problem being faced, how did it originate, what are its root causes and how might we fix this?

Doctor and patient in post-xray consultation.
A specialist providing post-procedure advice. Image by NINENII/Adobe stock.

Last year, you worked with Metro North Health to co-design a strategic Referral Allocation Decision Support Tool that would improve equity and access to care. Can you tell us about the project and accompanying workshops?

Health systems provide many important services, such as specialist outpatient services (SOP), the purpose of which is to assess and manage conditions requiring a specialist clinician. It is a complex value chain. In the face of increasing demand for services, the number of touchpoints combined with cross-boundary processes, as well as institutional and structural constraints can make it impossible to intuit how to improve equity and access.

With our Metro North Hospital and Health Service (MNHHS) project, we focused on seeing the relationship between the outpatient system structure and patient waitlists. We wanted a robust way to understand when an intervention would improve patient waitlists.

By recognising inequity in wait times across specialities and locations, the purpose of this project was to:

  • Use a systems thinking approach to understand the structure and behaviour of the specialist outpatient management system operating in and across in-scope sites.
  • Provide MN with an extensible tool that serves as a testbed for virtually testing allocation algorithms to inform improved equity and consistency of access to outpatient services.

The goal of the tool was to make transparent the effectiveness of referral allocation strategies. The workshops focussed on the specialities of Cardiology, Orthopaedics, and Ear, Nose and Throat.

Working with the MN project team was a highlight. Our UQ and MN project team collaboration was a supportive, cooperative, and productive partnership.

Do you have any outcomes to share from the project and workshops at this point in time?

We delivered system and data insights, process architecture maps, and a systems dynamics simulation tool that allows MN to ask “what if” questions and compare different scenarios to see the impact of interventions on waitlists, as well as the capacity stress faced by the system.

These scenarios include changes in demand and acuity, intra-facility referral transfers, additional waitlist audits, and increased clinic capacity. In the workshops, shared mental models provided many insights into why the system struggles to deliver to expectations and why some fixes have failed.

Dr Sue McAvoy discussing system thinking solutions with Meat and Livestock Australia.
Dr Sue McAvoy discussing system thinking solutions with Meat and Livestock Australia.

What are some ways industry can partner with you and benefit from a systems thinking approach?

Please feel comfortable to reach out and connect. Whether that’s by email, LinkedIn or in person, it’s as simple as making contact to start a conversation and discuss a problem.

I have a long track record both in industry and in research, so I understand the value of co-designing solutions with those at the coalface of the challenge.

As someone with 28 years of industry experience, the industry-researcher collaboration model makes a lot of sense to me and brings together two different skill sets that need each other and that extend each other practically and theoretically.

You may just want to use ST approaches in combination with other methods, get some upskilling in systems thinking methods, or have us host a workshop to help explore a challenge in your organisation.

We can partner via service agreements, consulting-type projects, grants or simply doing one-off deep dives with you to shed light.

 Email Sue at
Connect with Dr Sue McAvoy on LinkedIn