Skip to main content

Table 2 Places to intervene in a system (adapted from [25]

From: Systems change for the social determinants of health

  Intervention point Description
Information & control parts of system 1. Transcending paradigms To keep oneself unattached in the arena of paradigms, and stay flexible, in order to see that no paradigm is ‘true’ (i.e., to know that paradigms exist).
2. Paradigms The mindset of a system refers to the deepest held beliefs of its members. From them, come shared social agreements about system goals, information flows, feedbacks, stocks, flows and other system components. Societies resist challenges to paradigms harder than any other types of change.
3. Goals The goals of the system can direct the behaviour of all the above system components. The goals of a system can be deduced by what it does. Often, people within systems do not recognise the overarching system goal.
4. Self-organization The power to add, change or evolve system structure. Systems change themselves (i.e., they are self-organising). The ability to self-organise is the strongest form of system resilience, as a system that can evolve can survive almost any change.
5. Rules The incentives, punishments or constrains in operation within the system. The rules of a system define its scope, boundaries and degrees of freedom.
6. Information flows The structure of who does and does not have access to information. Changing the structure of how information flows in a system means creating a new feedback loop, delivering new information to a place where it wasn’t going before and therefore changing behaviour as a result.
A missing feedback loop is the most common cause of system malfunction.
7. Reinforcing feedback loops The strength of the gain of driving loops (i.e., virtuous or vicious cycles)
8. Balancing feedback loops The strength of the feedbacks relative to the impacts they are trying to correct. A complex system usually has numerous negative feedback loops, so it can self-correct under different conditions and impacts.
Physical structure of systems 9. Delays The lengths of time relative to the rates of system change.
A system cannot response to short-term changes if it has long-term delays. Delays are relative to the rates of change in the system state that the feedback loop is trying to control.
10. Stock-and-flow structures Physical system systems and their notes of intersection
10.a Social systems Networks of actors
10.b Phsyical system Build environment
11. Buffers The sizes of stabilizing stocks relative to their flows
12. Numbers Constants, parameters such as subsidies, taxes and standards