Welcome to course 1, module 2, part 1, Systems Thinking, the Distinctions, Systems, Relationships, Perspectives, DSRIP Theory. My name is Dr. Daniel Pesut, I'm an emeritus professor of nursing at the University of Minnesota School of Nursing. I appreciate your interest and commitment to social determinants of health and your enrollment in this specialization. In part 1 of this module, we explored the value of systems thinking for understanding the complexities of determinants of health. In part 2, I introduced the data to action hourglass model, to explain different perspectives related to determinants of health. The specific objectives for this module include the following; define systems thinking to support learning about the complexities of determinants of health, explain the DSRP theory of systems thinking to understand data to action implications regarding social determinants of health, describe principals of knowledge management and translation to inform the interpretation of data to action, explore references and resources to learn more about Systems Thinking and Knowledge Management. As noted in the first module, systems thinking is an essential skill to support understanding the complexities of determinants of health. The National Cancer Institute Monograph titled Greater Than the Sum, Systems Thinking and Tobacco Control provides a great example of systems thinking in action, this resource define system thinking and illustrates how systems thinking was used for understanding system dynamics and knowledge management translation principals in regard to tobacco control. Completing these learning activities will give you the knowledge you need to master concepts, principles, and practices associated with a systems thinking mindset. To start, I suggest you watch the film, Systems Thinking; a little film about big idea. As the film notes, the essence of systems thinking is attending to distinctions, system dynamics, relationships, AND perspectives. Any system of activity is a subsystem embedded inside of another system, which is embedded inside of another system, and so on. This relationship between systems produces various perspectives and each perspective in forms and influences the other systems of which it is apart. As noted in the film Systems Thinking, a little film about a big idea, Systems Thinking emerges through the mix and match of four combinatorial rules, making distinctions, organizing systems, articulating relationships, and taking perspectives. Each of these factors is made of two elements. Distinctions relate to differences between Identity and others, systems ARE comprised of parts and wholes, relationships involve action and reaction and finally, perspectives consist of a point and a view. Let's explore the four rules of the DSRP theory. Rule number 1, distinctions, identity and other. Humans make distinctions between what something is and is not between self and other, between characteristics and their opposite. Distinctions help us name things, classify things, and understand similarities and differences between things, we're always making distinctions. Systems thinkers consciously use distinctions to challenge existing norms, labels, and definitions, and to identify biases in the way information is perceived and structured becoming aware of distinctions, challenges, bias, and informs decision-making. We make distinctions with data and levels of measurement, for example, data is coded in a series of ones or zeros, such coding supports descriptive analysis and our clustering. Levels of measurement are forms of distinction and include nominal, ordinal, interval and ratio scales. Structural discrimination, whether it's racism, sexism, ableism, or classism influences laws, which in turn affects political processes, statutes, budgetary decisions, regulation, and enforcement. These distinctions and dynamics affect and influence systems of health care, neighborhoods and built environments, education and economic stability. Becoming aware of distinctions with data supports insight and evaluation of action. Rule 2: Systems, part and whole. Systems thinkers constantly consider context by asking, "What is this a part of?" In order to see how things fit into larger wholes. For example, children exist within families, families within communities and neighborhoods within countries, within the World and the planet. In terms of data, consider relationships between and among metrics that describe a sample or a population, like range, mean, median, mode, standard deviation. These distinctions help describe a sample, group, population or a normal distribution. Social determinants of health concern economic stability and access in quality to education, health, neighborhoods, and built environments. Children are part of families and communities and live, work and play in social community contexts. As one thinks about data, consider statistical tests that acknowledges a nested mental model and or a step wise hierarchical multiple regression analysis. Characteristics of individuals may be modeled in the first step, their family characteristics in the second step, community characteristics in the third step, and so on. Supporting analysis and synthesis of part-whole dynamics and relationships. Rule 3: Relationships, action and reaction. Systems thinkers understand the effects of dynamic interaction between and among things and ideas. Including feedback loops to show reciprocal relationships. As noted earlier in the introduction, there are positive and negative system archetypes that help describe and analyze system dynamics. These archetypes make explicit the balancing and reinforcing loops of interactions. We review the work of Marilyn Herasymowych and Henry Senko, who describe and explain positive and negative archetype dynamics and consider how to apply these archetypes to the social determinants of health. Rule 3: Pollen policy. Balancing and reinforcing loops in the system dynamic are examples of actions and reactions. Such interactions can be described and modeled. In this picture, we see a reaction sneeze in response to the action of pollen release. How are humans reacting to climate change policies and practices? Statistically a test that acknowledges these interactions might include analysis of covariance in which actions and reactions can be quantified as interaction effects. Rule 4: Perspectives, point and view. Systems thinkers use perspectives to rethink distinctions and relationships and or systems. They move beyond human perspectives with eyes by taking conceptual perspectives. That is seeing a phenomena from a perspective of an idea or a thing. Systems thinkers take a balcony view and examine and analyze behavior over time. They see complex cause and effect relationships and find where unanticipated consequences happen. For example, hierarchical data models, network models, entity relationship models, all provide different perspectives given the topic of study. Perspectives help us see there's always another point of view and each point of view is a mental model. Data is situated in an interactive dynamic reality from a perspective or worldview. Data exploration and statistical analysis provide different perspectives. Practicing an ethic of identifying perspectives applied to part whole systems leads to better understanding of mental models, moral systems, and scientific facts constructed around discrete taxonomies that require an algorithm vigilance of categories and hierarchies created. DSRP supports a Systems thinking mindset about social determinants of health. Each course in this specialization will help you understand and apply a systems thinking in relationship to the determinants of health. Consider distinctions as data and variables that are nested in ecological frameworks that build on relationships as data is transformed into knowledge so that people can act with a perspective and point of view. Each course in this specialization will help you make distinctions, appreciate systems, understand relationships, and activate your perspective as you build your data to action project. Next, let's turn to some more perspective taking with the data to action hourglass model.
