Enmeshed in Systems? Change the Gears
To make change, recognize the interdependencies across all the systems.
The world is burning and churning; wicked problems are everywhere. They are formidable because the gears mesh on multiple levels, keeping multiple systems entrained. We maintain the challenges we are facing in our thoughts and in the ways we think about our world. We act them out socially in group behavior and norms, sustaining them by collective force.
As a natural result of our behavior, individually and in groups, wicked problems get established in the systems we operate in. They get carved in the stone of the laws and policies we generate, ensuring that these problems continue to wreak their havoc on society without the need for human agency.
Unsuspecting individuals perpetuate these wicked problems simply by following the policies of our organizations, professions, and trades, and complying with the legislation we pass at the state, local, and federal levels.
All of this contributes to the great difficulties we face when we try to change society.
Systems Within Systems
I think of a wicked problem as a complex system of systems in which at least one aspect has stabilized in an undesirable state. This undesirable state is being held in place by all the other forces acting on it, so it cannot be dealt with in isolation. The aim of a Grand Challenge’s Common Agenda is to resolve the undesirable state into something better.
Consider a hanging object on a mobile. In the picture below, what happens if you move the moon 12mm to the left? The whole mobile becomes out of balance, and every other rocket ship, cloud, and star, including the string they are hanging from, pushes back to its original location, taking the moon with them. After a little bit of bobbing and wobbling, each object including the moon is right back where it started. The only way to move the moon 12mm to the left permanently is to move the entire mobile 12mm to the left. In this example, the rockets, clouds, stars, and even the circular frame from which everything hangs are the other forces that must be addressed to succeed in moving the moon. This is how systems operate. But keep in mind that we are dealing with a world much more complex than a simple mobile, which, for example, does not contain beliefs and traditions, as human systems do.
Consider this example, drawn from the HMHI mental health stigma initiative, which I have written about earlier.
If we consider substance use disorder to be a character flaw, then we punish people for having them. We send them to prisons. The vast majority of the US’s institutionalized seriously mentally ill individuals are being held in jails and prisons. That is being perpetuated systemically by society. The judge who sends a person to a penal institution is just following a law written by people who believed that addicts were bad people.
Treating drug addiction as public health problem rather than a criminal issue changes the entire system. Police have to change their viewpoints, courts have to revise their options in sentencing, social service organizations begin providing support, the healthcare system offers recovery opportunities. Other systems kick in to offer jobs training, child care, basic health needs, housing, transportation, and so on. “Moving the moon” is tackling drug addiction, while the rockets and stars are all those other components of the system that also have to change.
In the Systems Model for Change, each element is itself a system, as shown in the infographic above. One system consists of personal beliefs; another is made up of the social systems in which the individual moves. A third system is structural, consisting of local, state, and federal policy. If you are going to move the needle on your Grand Challenge, each system will need an intervention explicitly designed to adjust it so that each supports the desired change.
Today I unpack the systems in the model just a bit.
For an example of how these systems mesh with each other, consider a nurse whose health is poor.
Blaming a nurse for a bad diet is unfair when family, hospital, friends, and professional communities are all constantly exerting pressure to eat in unhealthy ways. The nurses’ station on the ward makes junk food easily available and the hospital’s cafeteria fare isn’t much better. Visitors bring sweet treats. Poor scheduling makes exercise and stress release difficult. Blame can even cause intransigence at the personal level, as the nurse reacts by fighting the systemic pressure. Yet, when it’s easy to do the right thing — when there’s a healthy meal in the cafeteria at midnight, and time in the day for self-care — because the system-of-systems has aligned to support the desired change, we can look for that nurse’s health to improve.
And that’s the key reason I emphasize how the Systems Model for Change works. The strategic plan for a Grand Challenge must tackle getting each gear in the enmeshed system-of-systems to shift in ways that support the desired change.
I adapted this model from the intervention model used by the Center for Disease Controls. That model comes from Kenneth R. McLeroy and his team at the CDC. They wrote about it in their publication, An Ecological Perspective on Health Promotion Programs.