Friday, August 4, 2023

Real Systems Pursue Goals

System Model Control Panel
System Model Control Panel
On March 10, 2023 we posted about a medical journal editorial that advocated for incorporating more systems thinking in hospital emergency rooms’ (ERs) diagnostic processes.  Consistent with Safetymatters’ core beliefs, we approved of using systems thinking in complicated decision situations such as those arising in the ER. 

The article prompted a letter to the editor in which the author said the approach described in the original editorial wasn’t a true systems approach because it wasn’t specifically goal-oriented.  We agree with that author’s viewpoint.  We often argue for more systems thinking and describe mental models of systems with components, dynamic relationships among the components, feedback loops, control functions such as rules and culture, and decision maker inputs.  What we haven’t emphasized as much, probably because we tend to take it for granted, is that a bona fide system is teleological, i.e., designed to achieve a goal. 

It’s important to understand what a system’s goal is.  This may be challenging because the system’s goal may contain multiple sub-goals.  For example, a medical clinician may order a certain test.  The lab has a goal: to produce accurate, timely, and reliable results for tests that have been ordered.  But the clinician’s goal is different: to develop a correct diagnosis of a patient’s condition.  The goal of the hospital of which the clinician and lab are components may be something else: to produce generally acceptable patient outcomes, at reasonable cost, without incurring undue legal problems or regulatory oversight.  System components (the clinician and the lab) may have goals which are hopefully supportive of, or at least consistent with, overall system goals.

The top-level system, e.g., a healthcare provider, may not have a single goal, it may have multiple, independent goals that can conflict with one another.  Achieving the best quality may conflict with keeping costs within budgets.  Achieving perfect safety may conflict with the need to make operational decisions under time pressure and with imperfect or incomplete information.  One of the most important responsibilities of top management is defining how the system recognizes and deals with goal conflict.

In addition to goals, we need to discuss two other characteristics of full-fledged systems: a measure of performance and a defined client.* 

The measure of performance shows the system designers, users, managers, and overseers how well the system’s goal(s) are being achieved through the functioning of system components as affected by the system’s decision makers.  Like goals, the measure of performance may have multiple dimensions or sub-measures.  In a well-designed system, the summation of the set of sub-measures should be sufficient to describe overall system performance.  

The client is the entity whose interests are served by the system.  Identifying the client can be tricky.  Consider a city’s system for serving its unhoused population.  The basic system consists of a public agency to oversee the services, entities (often nongovernmental organizations, or NGOs) that provide the services, suppliers (e.g., landlords who offer buildings for use as housing), and the unhoused population.  Who is the client of this system, i.e., who benefits from its functioning?  The politicians, running for re-election, who authorize and sustain the public agency?  The public agency bureaucrats angling for bigger budgets and more staff?  The NGOs who are looking for increased funding?  Landlords who want rent increases?  Or the unhoused who may be looking for a private room with a lockable door, or may be resistant to accepting any services because of their mental, behavioral, or social problems?  It’s easy to see that many system participants do better, i.e., get more pie, if the “homeless problem” is never fully resolved.

For another example, look at the average public school district in the U.S.  At first blush, the students are the client.  But what about the elected state commissioner of education and the associated bureaucracy that establish standards and curricula for the districts?  And the elected district directors and district bureaucracy?  And the parents’ rights organizations?  And the teachers’ unions?  All of them claim to be working to further the students’ interests but what do they really care about?  How about political or organizational power, job security, and money?  The students could be more of a secondary consideration.

We could go on.  The point is we are surrounded by many social-legal-political-technical systems and who and what they are actually serving may not be those they purport to serve.


*  These system characteristics are taken from the work of a systems pioneer, Prof. C. West Churchman of UC Berkeley.  For more information, see his The Design of Inquiring Systems (New York: Basic Books) 1971.