As the healthcare field continues to struggle with workforce shortages, it is imperative that nurse leaders seek other effective systems of care delivery. Re-imagining a more purposeful collaboration between nursing and other healthcare professionals may provide strategies for the future. Systems Theory or Thinking (ST) offers a process to encourage these collaborations and provide benefits for patient care quality and safety. Nurses interact frequently with other health professionals from a variety of disciplines. Often, nurses’ roles and goals for patients and their caregivers overlap. As Director of the Health Sciences Program at Wilmington University, I have the privilege of teaching students who have diverse allied health practitioner roles as well as those beginning a new career in healthcare. There are many health professionals who can assist nursing to bridge the gaps in care. It is imperative that nurse leaders recognize the benefit to patients and seek out these interprofessional partnerships.

Systems Theory has been studied in many types of frameworks – engineering, biology, sociology, psychology and healthcare. The underlying assumption of systems theory is that the sum is greater than its parts. Systems Thinking encourages nurses to focus holistically on our patients and our organizations. Nurses need to seek out opportunities to collaborate with non-traditional disciplines for problem-solving (Thelen, 2022). Systems Theory can provide guidance in the application of its principles for current healthcare problems. Systems thinkers have the capacity to evaluate a problem and consider how its solution is both connected to and dependent upon different factors. Bui (2022) noted that leaders who incorporate Systems Thinking work collaboratively to both examine all the factors that may cause issues as well as recognize the interrelationships among the workforce who are involved. Within Systems Theory, specific leverage or pain points are defined as those areas that typically require only minimal effort but may achieve a large impact, especially when collaboration outside normal networks occurs. Nurses are excellent at identifying areas of needed change, including all levels of staff and patients in this identification, as well as the development of solutions may provide a greater willingness for change and actionable ideas.

Trbovich (2014) suggested that systems thinking can provide an understanding of the underlying forces that intersect among people, processes, and technology. Likewise, interprofessional connections can be identified that can lead to improved solutions. It is not unusual for problems that seem unique to one area within healthcare to be part of “an interconnected network of related issues” (Trbovich, 2014, p.32). Sharing stakeholders who are familiar with different parts of the system can identify both the problems and the solutions that might not be considered by a single entity. Trbovich further observed that leaders who represent true systems thinkers share a variety of valued characteristics. Among them are: “an acute awareness of the current system in the organization, willingness to challenge the current system boundaries…the ability to speak to players at all levels of the hierarchy and understanding how relationships play out before making a decision” (Trbovich, 2014, p.33). These traits can lead to improved problem-solving strategies.

If nurses foster the incorporation of systems thinking into daily leadership strategies, how will the healthcare systems and the patients benefit? What might systems theory look like in leadership – daily huddles that more readily cross the lines between units, between diagnoses, between staffing personnel levels modalities? Taking time for reflection to identify leverage points – those barriers that one nurse leader pushes against and another leader has found benefit from, can support shared governance. Singer et al. (2020) developed a theoretical model that adds interpersonal integration to the common system frameworks. Interpersonal integration includes healthcare professionals, as well as nonprofessionals, patients, and caregivers. More importantly, it emphasizes both the value of each person’s awareness of the quality of their relationships with others as well as “shared perceptions of teamwork, conflict resolution, and diversity acceptance” (p.199). Piquer-Martinez et al. (2024) suggested that integrated care should be viewed as a way to enhance health outcomes in a complex healthcare system.

Nurse leaders can influence the success of such integrative relationships by supporting training and mentorship opportunities between these personnel. Many universities, such as Wilmington University, recognize the need for interdisciplinary integration. Opportunities to share materials, resources, and entire courses are encouraged among programs within and outside of colleges. The Health Sciences students share courses with the Nursing division and our Colleges of Business, Education, Social and Behavioral Sciences, and Technology. These collaborations were purposefully designed to generate graduates who not only have more familiarity with other disciplines’ thinking but also have experience in collaborative work and problem-solving. It is imperative to begin training for these viewpoints during the educational process. Nurses need to think beyond nursing roles and embrace the value and contributions others within healthcare (including the patients) can bring. Trbovich (2014) maintained that “to increase systems thinking within an organization, individuals must be trained to think systematically. The most important task of systems thinking is to create more systems thinkers” (p.34).

Nurses must begin to challenge themselves in their nursing leadership roles to think more broadly. Nurses should continue to look beyond current paradigms. Bansal (2023) encouraged nurses to recognize that “getting too attached to a paradigm creates systemic inflexibility” (Deep Leverage Points for Dummies, para .15). The theory of relationships of integration types by Singer et al. (2020) can guide nurse leaders to integrate organizational structures, processes, and people to implement approaches to improve patient outcomes as well as patient and provider experiences. Just as both nursing and health sciences students are prompted daily to consider “What is the evidence behind our interventions,” nurses should prompt each other to also ask with every problem AND every success “How would systems thinking apply here – what do other leaders need to know”?
Interested in promoting this in your hospital system? The World Health Organization (WHO) offers support in the form of a Hospital Solution Hub: (https://www.who.int/teams/integrated-health-services/clinical-services-and-systems/hospital-solution-hubs ).

References

Bansal, N. (2023, November 3). Deep Leverage Points for dummies. AG Community. https://www.anticipatorygovernance.community/post/deep-leverage-points-for-dummies

Bui, H. T. M., & Galanou, E. (2022). Translation of systems thinking to organizational goals: A systematic review. Journal of General Management, 47(4), 233-245. https://doi.org/10.1177/03063070211035749

Piquer-Martinez, C., Urionagüena, A., Benrimoj, S.L., Calvo, B., Dineen-Griffin, S., Garcia-Cardenas, V., Fernandez-Llimos, F., Martinez-Martinez, F., Gastelurrutia, M.A., (2024). Theories, models and frameworks for health systems integration. A scoping review. Health Policy 141,104997 https://doi.org/10.1016/j.healthpol.2024.104997

Singer, S. J., Kerrissey, M., Friedberg, M., & Phillips, R. (2020). A Comprehensive Theory of Integration. Medical Care Research and Review, 77(2), 196–207. https://doi.org/10.1177/1077558718767000

Thelen, J., Sant Fruchtman, C., Bilal, M., Gabaake, K., Iqbal, S., Keakabetse, T., Kwamie, A., Mokalake, E., Mupara, L. M., Seitio-Kgokgwe, O., Zafar, S., & Cobos Muñoz, D. (2023). Development of the Systems Thinking for Health Actions framework: a literature review and a case study. BMJ Global Health, 8(3), e010191. https://doi.org/10.1136/bmjgh-2022-010191

Trbovich, P. (2014.) Five ways to incorporate systems thinking into healthcare organizations horizons. Biomedical Instrumentation & Technology. 48(s2), 31-36. https://pubmed.ncbi.nlm.nih.gov/25244335/