Consensus Building Through Systems Thinking: the case of policy and planning in healthcare

Abstract

This paper discusses a methodology and a case study using qualitative system dynamics to create consensus, team learning and shared vision in a public organisation. The case involves determining planning priorities for a Division of the Ministry of Health in New Zealand, leading to the creation of a business plan. The methodology involves Systems Thinking using Group Model Building (GMB) - A three-step process starting with structured brainstorming using the partial KJ (Jiro Kawakita) technique to identify priority areas and then clustering them into 'affinity' groups. Next, the priority clusters are used by the participants to construct causal loop diagrams representing 'systems of priorities'(in contrast with list of priorities). Finally, through a group process, leverage points or key priorities are identified as the basis for a business plan. While the above process was well agreed upon by the participants at the outset, strong group resistance was encountered when managers attempted to reduce the number of priority areas. Systems thinking approach was used to create consensus and the commitment to the outcome. The GMB approach offers significant promise in using qualitative system dynamics with non-systems experts. The methodology can be applied to change management initiative and complex decisions such as restructuring, reengineering, and supply chain design. The expected outcomes are greater commitment and shared vision.