Conference organized by:

Center for Biosecurity of UPMC

World Health Organization Communicable Disease Surveillance and Response Office

Conference sponsored by:

The Nuclear Threat Initiative

Building Robust Response Systems for Epidemics: An Organizational Approach
Presenter: Jean-Marc Choukroun, Ph.D.

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"Systems thinking" is a management tool that has evolved over the last 30 years, but its roots can be traced to biological principles. As an analytical tool, systems thinking represents a shift from traditional analysis which tends to break down an organization or a network into smaller, seemingly more manageable elements, to one which evaluates the system as a whole. This approach is based on the belief that the performance of a system depends more on how its parts interact than on how they act independently of each other. Therefore, using a systems approach to optimizing the efficiency of a system, one cannot simply improve the efficiency of each of the parts separately. Rather, all of the subsystems must be optimized in relation to each other. In this manner, no one subsystem takes responsibility for the failure of the larger system; rather, responsibility is shared among all.

Before a system can be optimized, the entire organization and its subparts must be defined and their interdependencies understood. Doing so, however, requires the understanding that solutions to inefficiencies in the system may give rise to additional problems which will require additional solutions. Therefore, the organization's definitions and the interdependencies must be constantly reevaluated.

In the context of large systems such as public health networks, a systems approach suggests that:

• Problems and their solutions are socially defined.
• Stakeholders (representing subsets of the larger system) may have multiple, often conflicting, perspectives.
• There may be different priorities and senses of urgency for each of the subsets
• Crises often require acting before learning; therefore, models for "learning in action" are needed.

Using this analytical tool could help a public health system understand its interdependencies and identify critical weaknesses that potentially stand in the way of a robust response to crises.

- Summary by Jennifer Nuzzo, M.S.

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