Guest Lecture for systems thinking, leadership, and research. Includes discussion on mind grooves, mental models, feedback loops, and complex problems

1. SystemsThinking
Mikal “Mack” Giancola

2. As the Program Manager for
Comprehensive Cancer Control at LSU
Health New Orleans,Chair of the Louisiana
Healthy Communities Coalition (LHCC), and
outgoing Chair of the NationalAssociation
of Chronic Disease Directors – Cancer
Council, I have dedicated my 12+ years of
public health experience and expertise to
working alongside communities to improve
health outcomes. My vision as a citizen, a
leader, and as a researcher, is to develop and
sustain the structural and human
dimensions of systems such that they can
continue to adapt beyond a singular
complex problem.

3. Contents
• Systems Exercise
• Reflections
• SystemsThinking, What is it?
• Definitions andTheory
• Context for SystemsThinking
• Public Health, In Research & Science
• SystemsThinking in Planning and Evaluation
• Traditional Logic Models, Causal Decision Loops, Networks, etc.
• Public Health (1.0, 2.0, 3.0) in the United States
• Article Discussion: Complex Adaptive Systems (Boustani et al, 2012; Senge, P
The Dawn of Systems Leadership)
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4. Exploing Internal Systems
• Ourselves as a system, an instrument of research, and as leaders
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5. Mental Models: Exercise 1
1. Take out a notepad/something to write on.
2. When the list appears, write down the first word you think of for each or the
3 categories
Color
Furniture
Flower
5 7/14/2020 Sweeney, LB, Meadows, D. (2010). The Systems Thinking Playbook. Chelsea Green Publishing, White River Junction, Vermont.

6. Mind Grooving! Questions…?
“Unless the thinking involved in a system is developed or evolved, the underlying
structure, including the brain, remains unchanged.” – JohnWood
• Why do you think so many people have the same responses? And the differing
responses? How would this relate to working on team in a system (clinic, community,
etc.)
• Socialization may be stronger than we realize
• The more we think in a particular way, the deeper the rut or the mind groove
• Those without the habitual responses may be best at helping us look outside our mental models
• How do we encourage diverse perspectives?
• Purpose
• Demonstrates the effect of socialization on assumptions
• Raise awareness about habitual patterns of thinking
• Demonstrate how grooves in our brain impact reflective thinking
• Better understand our own thinking processes
• Demonstrate how automatic thought processes can obstruct learning, communications and
systems thinking
6 7/14/2020 Sweeney, LB, Meadows, D. (2010). The Systems Thinking Playbook. Chelsea Green Publishing, White River Junction, Vermont.

7. Look at the words, do not write anything down
Slumber Pillow
Dream Night
Bed Blanket
Quiet Pajamas
Nap Snooze
7 7/14/2020 Sweeney, LB, Meadows, D. (2010). The Systems Thinking Playbook. Chelsea Green Publishing, White River Junction, Vermont.

8. On your sheet of paper, write down all the words
you can remember….
• What happened?
• Humans brains can make lightening speed associations, which can be based
on fast, yet erroneous assumptions
• How do we develop the observer in ourselves so we more often have our
thoughts as opposed to being had by them?
• How do we become aware of the associations we are making, checking for
their appropriateness?
8 7/14/2020 Sweeney, LB, Meadows, D. (2010). The Systems Thinking Playbook. Chelsea Green Publishing, White River Junction, Vermont.

9. Mental Models
What are they:
”Deeply ingrained assumptions and generalizations …that influence how we
understand the world and how we take action.”- –Senge, P (The Fifth Disciple;
pg 8)
“Entrenched mential models can thwart changes that come from systems
thinking” –Senge, P (The Fifth Disciple; pg 188)
Why is that important?
“The problems that we have created in the world today will not be solved with
the same level of thinking that created them.” Albert Einstein
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10. Positionality in systems research, system leadership
• Systems research, leadership
• How do mental models play a role in
research? In leadership?
• How does might our vantage point in the
systems influence our ability to ask
probing question, to lead changing,
mental models?
• Traditional, objective (Post-
positivist) research as a gold
standard? (Y/N) When is it more or
less appropriate?
• How might the objective positions of
these fellows influence the questions they
ask?
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White house panel on women’s health, 2017

11. The ProblemType: Cynefin Model
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• Let’s name some examples
beginning with “Simple”

12. Which Public Health Problems, in principle are
complex, vs complicated?
What is the difference between:
• Baking a cake- simple
• Building a rocket ship-complicated
• Raising a child?- complex
• How is raising a child different from
building a ship?
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Add a footeSource: Cabaj, M. (2010). What we are learning about community-led development in Aotearoa New Zealand. Author: Inspiring Communities.

13. SystemsThinking
“The great challenge of our time is to build and nurture
sustainable communities and societies, designed in
such a way that our activities do not interfere with
nature’s inherent ability to sustain life”
- Capri & Luisi 2014

14. A brief history of science in public health as it
relates to systems theory
• Post Positivist, Reductionist Model (What most people know as “science”): Most of the advances in
Public Health emerged from the reductionist science (post-positivist, objective) of the time, largely
credited to the enlightenment philosopher Rene Descartes.
• Descartes spurned what we call the mechanistic world view, scientifically- breaking things down into
parts, looking at how they function, learning how to fix them.
• The biomedical model and the traditional academic/PhD research function largely on this basis.
Louis Pasteur and Robert Koch furthered germ theory. As I stated earlier, antibiotics and
vaccinations were largely built on this science and methodology. It is enormously valuable when
trying to isolate problem, and for working on problems in isolation. I would not want my brain
surgeon gathering diverse views on where to cut next. The problems are complicated where right
and wrong are clear, linear and the outcome is based on evidence.
• Pragmatic Model of Science (what you need to understand the system, the problems) However, in
the early 20th century, biologists began looking beyond biology and into ecology; (Karl von
Bertalanffy) General SystemsTheory. Looking at the whole. The holistic approach. They found that
the sum of the parts of the mechanism could not completely explain the phenomena of the “whole”
cell, animal, organism, ecosystem, etc… Are you simply the sum of your atoms and cells? Is a
painting the sum of the canvas and pigments alone?This thinking was later picked up by
cyberneticists as mathematics, especially non-linear mathematics (e.g. pattern sets). This is typically
the area where we talk about social determinants of health/health equity…
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15. Definitions
Greek,Wikipedia
Sunistanai
• For system meaning “to cause to stand together”
Williams & Hummelbrunner
• An understanding of interrelationships
• A commitment to multiple perspectives
• An awareness of boundaries
The Fifth Discipline Field book
Peter Senge
• “Encompasses a large and fairly amorphous body of tools and principles, all oriented to
looking at the interconnectedness of forces, and seeing them as a part of a common
process”
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SystemsConcepts in Action

16. SystemsThinking:ATool for Evaluation
“Thinking systematically is a means of making sense of not only a tree and the
forest that contains it, but also the landscape in which the forest is embedded,
and the soil, and the atmosphere, that provide important resources for the
tree’s functioning. And seeing the tree as a small part in global exchange
processes.” – Williams & Hummelbrunner, 2009
“…the art of systems thinking lies in seeing through complexity to the
underlying structures generating change. Systems thinking does not mean
ignoring complexity. Rather, it means organizing complexity into a coherent
story that illuminates the causes of problems and how they can be remedied in
enduring ways.” -Senge.The Fifth Discipline. P. 128
Systematic Reflection: Allows us to glimpse at the forest and the trees as
leaders
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17. FundamentalTools of SystemsThinking
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Source: Acaroglu, Leyla, Tools of a Systems Thinker (2017). Retrieved on 9/5/18 from: https://medium.com/disruptive-design/tools-for-systems-thinkers-the-6-
fundamental-concepts-of-systems-thinking-379cdac3dc6a

18. Traditional Public Health Logic Model
How is this presented (simple, complicated, complex?)
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Source: W.K. Kellogg Foundation Handbook (1998); Logic Model Development Guide

19. SystemsThinking Logic Model
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Source: http://comm.eval.org/HigherLogic/System/DownloadDocumentFile.ashx?DocumentFileKey=67ee1575-4646-45bc-b14d-
fd5d60694753&forceDialog=0

20. Balancing and
Feedback Loops
20 7/14/2020 Williams and Hummelbrunner, 2009

21. Causal Loop Diagram
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22. Network Mapping: Louisiana Healthy Communities
Coalition
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23. Louisiana Healthy Communities Coalition (LHCC)
Theory of Change
Louisiana Healthy
Communities Coalition
Mini-granteeTeams
Skill building,
Technical
assistance
Leading Structural Changes
Build capacity for the following:
• Effective Communication
• OverallVision Facilitation
• Collaborative problem solving (non-hierarchical
relationships)
• Adaptive, Strategic Management (identifying emergent
strategies, initial proposed strategy origins)
• SystemsThinking (Interconnectedness, Boundaries,
Perspectives)
• Partnership connections (Resource alignment, coalition
& constituency building, etc.)
• Reporting, monitoring and evaluation
• Other
Modify
FeedbackDo
Plan
Outcomes
• (Harvested) Outcomes
• Increased systems leadership
& connections
• Learning
• Structural changes
(deliberate, emergent, non-
realized)
• Other
RQ1: What changes resulted from
activities supported through the
mini-grants that contributed to
structural change in the local
communities in which they were
realized?
2a.What skills and
capacities of the mini-
grant teams
contributed to
successful outcomes?
2b. What challenges
were there to successful
outcomes?
RQ3: How did the overall (outside of the mini-grants) statewide team strategies and
activities (communications/social media, annual summit, coordination/TA) contribute to
the effectiveness and capacity of the mini-grant teams (in leading structural change)?

24. Public Health 1.0
Industrial Revolution
Scientific Advances
Vaccines,Antibiotics
Lab Science
Epidemiology
Public Health 2.0
Core Functions
10 Essential Services:
Government: Assessment,
Policy Development, and
Assurance
Falls short: social,
environment, economic
determinants
Public Health 3.0
Enhanced Leadership
Workforce
New, Cross Sector
Partnerships
Accreditation (Standards)
Tech,Tools, Data
New Measures of Success
Flexible Funding
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1. DeSalvo, K. B., O’Carroll, P. W., Koo, D., Auerbach, J. M., & Monroe, J. A. (2016). Public Health 3.0: Time for an Upgrade. American Journal of Public Health, 106(4), 621–622.
http://doi.org/10.2105/AJPH.2016.303063
The Public Health System: History, Present, and Future

25. • The 10 Essential Public Health Services
Where in the 10ES is/are your current
coursework?
Where do your personal interests fall
in this wheel? Why
Where is “Leadership” in this wheel?
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26. Q: How would you
describe the Public
Health System in the
US?
Q: Does it appear to be a
system?
26 7/14/2020 Source: https://www.cdc.gov/stltpublichealth/publichealthservices/essentialhealthservices.html

27. From PH 3.0 to SystemsThinking
3.0
• Leadership Workforce
• New, Cross Sector Partnerships
• Accreditation (Standards)
• Tech,Tools, Data
• New Measures of Success
• Flexible Funding
Leadership
• Culture of Leadership
• Culture of Learning
• SystemsThinking
• Strategic Management
• Personal Development
Systems
Thinking
“The [21st Century] roles that public
health departments play in improving the
health of populations:
• A convener, coalition builder, and
mobilizing force;
• A source of knowledge and analysis of
population health;
• A partner of the clinical care delivery
system; and
• A steward of community health assuring
policies are in place for a healthy
population.” –IOM,2012
27 7/14/2020 Source: Institute of Medicine. 2012. For the Public's Health: Investing in a Healthier Future. Washington, DC: The National Academies Press. https://doi.org/10.17226/13268

28. Where Does Health Come From?
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29. Bridging the Evidence Gap in Obesity Prevention
Obesity: Simple, Compicated or Complex? Why?
“A systems perspective helps decision
makers and researchers think more
broadly about the whole picture rather
than merely studying the component
parts in isolation”
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Source: Shiriki K. Kumanyika, Lynn Parker, and Leslie J. Sim, Editors; Committee on an Evidence Framework for Obesity Prevention Decision Making; Institute of

30. Socio-Ecological Model
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31. ComplexAdaptive
System
31 7/14/2020 Boustani et al 2010
VS

32. Questions: ComplexAdaptive System
• What is an open system?
• Would you describe most clinics as CAS’s? Has it always been this way? Is CAS
just a more sophisticated descriptive method?
• What assumptions are made about the traditional models of Healthcare,
generally?
• What role does leadership have in the model? Research? Where do you see
the leader(s)?
• Other comments?
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33. The Dawn of Systems Leadership
• Reflections?
• How does the article relate to the lecture so far? Deviate?
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34. Complex Problems
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Source: Gawande, A. (2010). The checklist manifesto: How to get things right. New York: Picador.

35. If we only focus on the gap we may miss the whole
elephant!
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36. How do we know when you have a “handle” on
systems thinking?
• You’re asking different kinds of questions than you asked before.
• You’re hearing “catchphrases” that raise cautionary flags. For example, you find
yourself refocusing the discussion when someone says, “The problem is we need
more (staff, revenue, etc)” because you recognize that is only one perspective and
the problems are many.
• You’re beginning to detect the archetypes and balancing and reinforcing processes in
stories you hear or read.
• You’re surfacing mental models (both your own and those of others).
• You’re recognizing the leverage points for the classic systems stories
36 7/14/2020 Source: https://thesystemsthinker.com/systems-thinking-what-why-when-where-and-how/

37. Questions?
Q&A Session
Thank you! Mack Giancola: mgianc@lsuhsc.edu
“One essential characteristic of modern life is that we all depend on systems—on assemblages of
people or technologies or both—and among our most profound difficulties is making them work.”
- Atul Gawande, The Checklist Manifesto

38. Exercise
• Instructions: Please assemble into 2 groups. The goal is to get the dark green
ball passed around the circle one time (passing through all 6 people’s hands)
Rules:
• 1. Everyone (6 holders) must be in possession of a ball as they pass them
• 2.Volunteers are prohibited from direct handoffs (2 hands cannot be on the same tennis ball
at the same time)
• Group 1: Fill in the boxes of the logic model
• Group 2: Create a systems picture of how you imagine achieving the goal
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39. Reflection
• How did the process go for your group?
• If you were to do this again, do you see where any positive or negative
reinforcing feedback loops may exist?
• How would each group include a +/- feedback loop into their logic model?
• How does learning relate to leadership?
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