Published: 20/06/2002, Volume II2, No.5810 Page 43

Systems Thinking, Systems Practice By Peter Checkland

Publisher John Wiley and Sons.

ISBN: 0471986062. 416 pages£21.95

There is a danger of being glib about the management of change. Phrases like 'wholesystems approach'are often wheeled out, but real-systems thinking, of which this book is a primer and hidden gem, requires a different approach.

Healthcare is a complex organisational system because of its combination of treatment, technology, processes and people. In Checkland's book, awareness of how systems work goes beyond who the main players are.Consideration is given to the paradigms and the relationships that animate them.The patterning of behaviour produces the unwritten rules that, often unconsciously, guide those inside the system.

Recent comment on why US intelligence services failed 'to join the dots'before 11 September has focused on how that system was fixated with technology rather than people.At best, this system collected lots of data.There was relatively limited and disparate analysis.

Sound familiar?

Checkland shows how a 'systems thinker'sees the system in relation to the rest of the world, or other actual systems that might yield insight.For example, the NHS paradigm around adverse events is that of 'blame'- who is wrong rather than what is wrong.But the 'safety'paradigm in the aviation industry prompts open reporting and appropriate corrective action.

Checkland describes systems thinking as continual and iterative learning that avoids a rush to judgement.As Mark Twain once said: 'If we always do what we always did, we'll always get what we always got.'

Though it highlights limiting factors to improvement, the systems-thinking process encourages creative thinking by reformulating the real issues.The problem-solving that follows is participative - and all the more creative and realistic for that.The value of this out-of-body approach has been demonstrated at government level by the Demos pamphlet, System Failure (www. demos. co. uk).

Policy makers'and public service managers' ignorance of systems thinking is said to shore up false assumptions about action and outcome in reforming public services.

The pamphlet contains examples of 'unintended consequences' from within the health service.

It is time to get real about the management of change.This book will help.