Module 1.1 – What is systems thinking?
In the video below, Tari explains how systems thinking can help you think differently about how to create change.
Welcome to the Practitioner Training Package you are receiving as part of the CREATE Study.
(Ethics approved by Metro North Project ID: HREC/2023/MNHA/92364)
We have worked with health promotion practitioners from across Australia to develop a series of videos and activities aimed at upskilling practitioners to support retailers to implement changes to their food offerings. We have found that supporting practitioners to take a ‘systems lens’ approach to implementation benefits the way they approach implementation planning, and assists in understanding retailer perspectives – and seeing the “bigger picture” overall.
Deakin University has specially designed this training package to support the implementation of ‘A Better Choice’ in Queensland healthcare facilities. This training is designed to be used alongside the Healthy Retail Toolkit which has been provided to the retailers taking part in this study.
In this training, you will be introduced to the concepts of ‘systems thinking’ and how it can be used when thinking about implementation in your own context. Short videos from systems and food retail experts are accompanied by activities that support the direct application of learnings.
This package starts with an introductory video and resource section, followed by four training Modules. Please work through these in order.
This training should take about 2-3 hours to complete.
Please do not share this website or the Toolkit with others until the conclusion of this study.
Test your knowledge
Question 1: How does systems thinking contribute to understanding complex issues and unpredictable system behaviour?
- It simplifies complex issues by breaking them down into smaller components.
- It ignores unpredictable system behaviour and focuses on isolated factors.
- It captures complexity by considering interrelationships and feedback loops.
- It isolates individual perspectives to analyse the system effectively.
Question 2: Why is systems thinking a useful approach to address complex population health issues?
- It helps identify policy leverage points, challenges our mental models, and provides a holistic approach to analysis.
- It challenges our mental models, integrates multiple perspectives, and helps to ensure predictable outcomes.
- It integrates multiple perspectives, ensures linear and straightforward solutions, that are iterative and responsive to change.
- It ensures predictable system behaviour by identifying potential unintended consequences and supports evidence-based decision-making.
Module 1.2 – How to read a systems map
In the video below, Tari explains how to read a causal loop diagram so you can understand system maps and use them in your work.
Test your knowledge
Question 1: Read the causal loop diagram and choose which of the following statements are true:
- An increase in the number of healthy changes being implemented will result in an increase in outlet staff, manager or owner time and resources required
- A decrease in the number of healthy changes being implemented will result in an increase in outlet staff, manager or owner time and resources required
- An increase in the time and resources required by outlet staff, manager or owner will cause a decrease in the number of healthy changes being implemented
- An increase in the time and resources required by outlet staff, manager or owner will cause an increase in the number of healthy changes being implemented
Question 2: Is the causal loop diagram (above) a balancing or reinforcing feedback loop?
Module 1.3 – Key concepts in systems thinking
In this video, Tari will introduce you to two key concepts in systems thinking – levels of systems thinking, and leverage points.
Test your knowledge
Question 1: According to the Systems Pyramid (a.k.a. the ‘iceberg model’), which pyramid level involves making reactive decisions based on symptoms?
- Events
- Patterns
- Structures
- Mental models
Question 2: Which level of the Systems Pyramid provides the most effective leverage point for creating transformative change?
- Events
- Patterns
- Structures
- Mental models
Module 2.1 – Systems thinking approach for retail transformation
Watch the video for an introduction to the origins of the Systems Thinking Approach for Retail Transformation (START) map and its five prominent narratives, then test your knowledge with the activity.
Activity:
Looking at the five narrative loops of the START map, consider each of the following:
- How might you interpret the loops based on your understanding of systems thinking?
- How do these align with your experiences of changing the food environment so far?
- How might you use these in your own work?
Loop R1:
Loop B1
Loop R2
Loop B2, R3, R4
Loop B3, R5
Details of the START map and each narrative loop can be found in the following paper:
Boelsen-Robinson, Blake et al. 2021 Mapping factors associated with a successful shift towards healthier food retail in community-based organisations: A systems approach. Food Policy 2021 Vol. 101 DOI: https://doi.org/10.1016/j.foodpol.2021.102032
Module 2.2 – Case study and activities
Watch the video on ‘Key uses of the START map and the systems pyramid’, then test your knowledge by watching the case study video and apply your learnings in the activity below.
Test your knowledge
Choose one of the case studies from the video (see transcripts below), and use the START map narrative loops to help you work through the following different levels of the systems pyramid.
Scenario: Sports & recreation centre
Scenario: Health service / hospital in rural area
Question 1: What are the events in your scenario?
Question 2: Use the narrative loop(s) to identify patterns of behaviour
Question 3: Looking at the structure of the START map (i.e. the feedback loops), what are some key challenges you may encounter?
Question 4: Who are the key stakeholders? What could be their perspective/mental model? How will you gain an understanding of their perspective(s)?
Question 5: Based on this information, can you identify potential leverage points for intervention?
Module 3.1 – Systems thinking and program logic
Here we explore how you can use systems thinking to develop a comprehensive program logic framework to enhance outcomes
Program Logic
The program logic framework, also known as the program theory or program impact theory, is commonly used in program evaluation to help stakeholders clarify the logic of a program’s design, implementation, intended outcomes and how those outcomes will be achieved. It typically consists of a series of linked boxes that represent the program’s objectives, inputs, activities, outputs, outcomes, assumptions, and threats.
Here are 3 examples of program logic templates (click on the image below for the PDF):
1.
2.
3.
A copy of these templates and more information can be found at the following:
- Queensland Government Program Evaluation Guidelines
- The Australian Government Department of Health and Aged Care Healthy Food Partnership – Program Logic
- The Australian Institute of Family Studies How to develop a program logic for planning and evaluation
By using the program logic framework, program designers and evaluators can:
- Identify the underlying assumptions and theories of change that guide the program’s design
- Clarify the program’s goals and intended outcomes
- Identify potential barriers or challenges to achieving the program’s outcomes
- Determine the data needed to evaluate the program’s effectiveness
- Develop a shared understanding of the program among stakeholders
Overall, the program logic framework can help to ensure that programs are well-designed and implemented, and that they are effectively meeting the needs of their intended beneficiaries.
How can you use the START map to create and inform program logic?
By using the START map in conjunction with the program logic framework, you can create a more comprehensive understanding of the food retail system and the potential impacts of your program. This can help you to design and implement a program that is more effective at achieving its intended outcomes while minimising unintended consequences. It can also help you to evaluate the program’s effectiveness over time and to continuously improve the program’s design and implementation. An example of how to do this is provided in the table below which follows a program logic template.
Here’s an example of how you can use the program logic framework and the START map within the context of a food retail system where a café owner is trying to make healthy changes to their menu. Let’s say the retailer wants to replace high-calorie, low-nutrient foods, like deep fried foods, with healthier options, such as those based on fruits and vegetables. Click here to view a copy of the CREATE Program Logic example.
Step 1: Define the program objectives
| Objective(s) | To increase the availability and sales of healthy food options in the café retailer. The underlying issue is that the retailer is resistant to making changes as they are worried that customers will not like the new healthier offerings, and that they will lose money. In this situation, we see the narrative loops of “Get started now” and “Focus on the customer” potentially playing out. |
Step 2: Identify the program inputs
Inputs are the resources needed to deliver the program. For this example you could consider the following:
| Inputs / resources |
| People: Retailer, staff, customers (different kinds of customers) |
| Funding: What resources might you have to support changes? E.g. accessing existing materials that communicate changes to customers |
| Time: Looking at the Focus on the Customer narrative loop, we can see that customer behaviours won’t change instantly, and we might get some initial backlash when making changes, that recede over time. How might that impact your approach? |
| Knowledge: The retailer and retail staff will have a good understanding of who their customers are and how they are likely to respond to change. By getting staff on board with the changes, they can help persuade customers to try new options. |
| Networks: Who do you need to establish partnerships or connections with? This could be suppliers of healthy products, local health organisations or focus groups to engage customers in real-time feedback on changes. |
| Places / spaces: This could include locations to hold workshops or seminars as well as space in the cafe for new healthy items, and storage space if the retailer is introducing more fresh produce that may require different storage needs than current stock. |
| Equipment: What equipment will you need to deliver the program? This could be hardcopies of the Healthy Retail Toolkit, electronic notepads to help the retailer in real-time. Other equipment to consider could be display refrigerators for pre-prepared fresh foods, kitchen equipment or promotional displays highlighting new/healthier choices. |
| Partner organisations: Who else has made these changes before and what can you learn from them? Do they have resources or approaches that you can use? |
Step 3: Identify the activities and their associated outputs
What activities will be part of your program? What will be done by the time the program is finished? Will these activities lead to outcomes? Be mindful that outputs are those things that are delivered, while outcomes are the changes that will occur.
| Inputs / resources | Activities | Outputs |
| People | Build a relationship with the retailer and their staff to understand their perspectives, interests and concerns. | Building of trust with retailer and staff. |
| Funding | Seek to understand what small changes they would be willing to make. | Understanding of each others perspectives. |
| Time | Conduct a customer survey or interview to understand what the cutomers like about the retail outlets, what could be improved, and what healthy options they would be interested in. | Options for creating small changes in the retail outlet. |
| Knowledge | Plan how you would feed back changes to the retailer. | Increased healthy options for staff. |
| Networks | Develop or access marketing materials to promote healthy changes to customers. | Customer feedback on healthier options. |
Step 4: Identify key outcomes
Think about the short, medium and long-term outcomes of your program. Outcomes, or impacts, are what is different as a result of your activities and should be linked to your objective(s). By identifying the key outcomes you can evaluate the success of the program and assess whether it has achieved its intended goals. You can also use this information to make adjustments to the program if necessary, to ensure that it is having the desired impact. Here are some short-medium and long-term outcomes for the example.
| Outcomes Short-Medium | Outcomes Long-term |
| Increase in healthy options being purchased. | Continuous movement towards healthier options. |
| Increased buy-in of retailers on healthy changes. | |
| Interest of retailer in making further healthy changes. | Staff and retailer on board with healthy options and new staff are trained accordingly. |
| Support of customers for healthy options. | Expectation of customers for healthy and varied options. |
| No profit impacts on retail outlet. | Ongoing financial stability of retail outlet. |
| Considerations for future changes and improvements to communications with customers. |
Step 5: Identify assumptions and external factors
Assumptions come from our mental model of how the system works. What are your assumptions about how or why the program will work? What could be the assumptions of other stakeholders? It’s also important to be aware of external factors, those things that fall outside your control but can impact your program.
| Assumptions |
|
| External factors |
|
Click here to view a copy of the above CREATE Program Logic example
Identifying unintended consequences
To help identify potential unintended consequences you may encounter, you can use the START map to see where the reinforcing feedback loops are (R); this is where an action leads to a reinforcing cycle that strengthens the outcome. Now look for the balancing feedback loops (B); this is where an action leads to a counterbalancing cycle that works against the outcome. Click here to review how to read a systems map or here for the five narratives of the START map.
One potential unintended consequence in this example is that the healthy options may take more staff time to prepare than the less healthy options, which could lead to a decline in sales and profitability. This could lead to a reinforcing cycle where the retailer reduces the amount of healthy options available or promotes less healthy options to maintain profitability. Another potential unintended consequence is that the fresh produce may spoil quickly, which could lead to waste and a decline in profitability. This could lead to a reinforcing cycle where the retailer reduces the amount of fresh produce available or stops stocking it altogether.
By looking at the feedback loops, you can identify potential unintended consequences of the program, and design the program so they are minimised. For example, the retailer could work with suppliers to negotiate better prices for healthy options or invest in more effective refrigeration to reduce waste. This can help to ensure that the program has a positive impact on the intended beneficiaries while minimising any unintended negative consequences.
Module 3.2 – Create your own implementation plan
Apply what you have learnt from the training modules in the design of your own implementation plan
Download a copy of the CREATE Implementation Plan – Program Logic Template and use the prompts below to help develop your own implementation plan.
Use the START map to help you clearly define the problem or challenge you’re addressing, and to identify the underlying issue(s), who is affected and what are the root causes. From this problem statement you can clearly state your program objective(s).
Look at each section of the START map and its narrative loops to help identify the resources you’ll need for each step of the program, and who you’ll need to involved.
Use the Systems Pyramid and your learnings from Module 1 Key concepts in systems thinking to help you identify the activities, outputs and outcomes for your program.
As you work through each step in developing you implementation plan, use the START map and the Systems Pyramid to help you identify assumptions that you and others may make, and to be aware of those external factors which have an impact on your program but are outside of your control.
Module 4.1 – Additional systems thinking tools and information
This final module provides you with a selection of external resources for systems thinking tools
While there are limited resources available on the use of systems thinking tools within the context of healthy food retail, the following websites and short videos may help you gain further understanding of these tools and how they can be applied.
WEBSITES –
- The Systems Thinker provides a broad overview of systems thinking tools, articles, case studies and guides.
- Untools provides a collection of systems thinking tools and frameworks
VIDEOS –
VIDEO: What is systems thinking? Health perspective (5.11 min)
VIDEO: Causes of systems behaviour – the iceberg model (4.51 min)
VIDEO: Behaviour over time graphs (1.46 min)
VIDEO: Introduction to connection circles (3.56 min)
VIDEO: Introduction to causal loops (3.48 min)
VIDEO: Unintended consequences – operation cat drop (3.08 min)
VIDEO: Systems Thinking and Complexity in Health: A Short Introduction (5.01 min)
Module 4.2 – Publications
Here you will find a range of publications specific to the use of systems thinking within the healthy food environment and more broadly within public health, along with a selection of general publications to help you better understand how you can use a systems thinking approach in your work
Systems thinking for healthy food environments
- Mapping factors associated with a successful shift towards healthier food retail in community-based organisations: A systems approach
- Using systems science to understand the determinants of inequities in healthy eating
- Exploring the dynamics of food-related policymaking processes and evidence use in Fiji using systems thinking