Welcome to the National Maternal and Child Health

Workforce Development CenterSummer Seminar Series!

July 15, 2020

Please introduce yourself.We are currently on “Mute” and will be with you shortly. In the meantime, please:

1. Find the Chat Box on your screen.2. Adjust your Chat Box setting to select:

“All Panelists and Attendees” or “Everyone”

3. Sign into the Chat Box with your first name and state.

For example: (Amy, NC ** Alex, WA ** Robert, AL)

Launched in 2013, the National MCH Workforce Development Center was funded to advance the skills and capacity of public health professionals working in organizations serving the maternal and child health population. The Center delivers training and consultation to teams of Title V professionals, partners, and family leaders in: • Change management and adaptive

leadership• Systems integration• Evidence-based decision making to facilitate

implementationFamily engagement and health equity are embedded in all Center services, reflecting the Center’s commitment to inclusion and family-driven practice.

Background

• Students from MCH Training programs funded by the federal MCH Bureau are paired to work on projects within Title V Programs.• Projects are designed by Title V staff, and focus on a variety of projects

related to their state MCH priorities.

• All students participating in the Title V MCH Internship receive leadership training and coaching.

Title V MCH Internship Program

State Projects

• 12 participating Title V agencies within state and territorial health departments

• Examples of State Project Topics: • New Jersey - Evaluate a shared decision-making tool to

improve pregnancy outcomes and reducing racial disparities in maternal and infant morbidity

• Tennessee -Collect qualitative data to identify programmatic progress and opportunities for improvement for the Baby & Me Tobacco Free (BMTF) program

• Florida - Identifying and proposing two state-added questions to add to the Phase 9 Florida Pregnancy Risk Assessment Monitoring System (PRAMS) survey on long acting reversible contraception use (LARC) among women

*Northern Mariana Islands is not pictured

Students in the 2020 Title V MCH Internship

Introduction to Systems Thinking

Kristen Hassmiller Lich, PhDJess Cohen, MSW

•Understand the importance of systems thinking•Learn and apply one system mapping method

Learning Objectives

Systems Thinking Overview

Balance of Petals

Overview, Example, & Practice

Wrap-Up & Resources

Agenda

What is a

“System?”

a collection of parts that interact with each other to form an interdependent whole

A System is

• A set of interconnected components• With a definable boundary• That interact• And produce a set of outcomes• By accepting inputs, collectively, and producing outputs• Through a transformation process

A System is…

• No matter what your challenge is, it is affected by a system of interconnected elements

A Systems Perspective

Photo source: http://sagarkitchenware.in/services.php

• In our work, we rarely create something new, but rather change something about the system so it produces better outcomes

A Systems Perspective

Photo source: http://failblog.cheezburger.com/thereifixedit/tag/hall-of-fame/page/8

• We want to expand the way you see “the system” affecting your focal challenge, starting with learning how to “scope” your frame appropriately over time

A Systems Perspective

Complex Systems as Icebergs

Events

What happened?• Headlines in a

newspaper• Urgent emails• Fires to put out

The Iceberg

Events

Patterns of Behavior

The Iceberg

What’s been happening?• Past behavior over time• Anticipated future

behavior• By race? By geography?

By…

Events

Patterns of Behavior

Systemic Structures

The Iceberg

What structures generatethe patterns of behavior?• Roles and responsibilities• Rules, norms, policies,

incentives• Relationships between the parts• Dynamics reinforcing/resisting

change

Events

Patterns of Behavior

Systemic Structures

Mental Models

The Iceberg

What drives individuals’ actions?• Vary based on experience,

training• Our simplified rules about how

the world works• Reflect norms, biases, gaps in

experience

Detail Complexity

Used with permission of Cristin Lind, durgastoolbox.com. For more information on care mapping, visit http://www.childrenshospital.org/care-coordination-curriculum/care-mapping

Features :• Things change over time

• Lag time between cause and effect

•Nonlinear relationships

• Feedback loops

Dynamic Complexity

•Tapping into your and others’ mental models, and…•Seeking to “see” wholes, and •Developing and testing models – qualitative or quantitative – representing critical components of the system that determine outcomes

Using Systems Thinking

Balance ofPetals

Clarifying needs from & benefits to stakeholders

• Which stakeholders need to be engaged for your initiative to succeed?• What do you need from each? (political support, data, funding,

effort, etc – be specific and complete)• What does each stakeholder have to gain from your initiative?• What might they lose? (a loss they would need to be willing to

accommodate)

Clarifying needs from & benefits to stakeholders

Balance of Petals Example

Balance of Petals Example

Keeping the Lich House

Clean During COVID

Keeping the Lich House

Clean During COVID

Oliver

Felix

Steven (Dad)

Keeping the Lich House

Clean During COVID

Oliver

Steven (Dad)

Felix

Keeping the Lich House

Clean During COVID

Oliver

Steven (Dad)

Felix

Cleaning up after all animals

Sweeping the stairs & downstairs

floors

Sweeping bedroom

and hallway

Loading & unloading dishwasher 2-3 times/day

Managing food supply

Taming the outside jungle

Keeping the Lich House

Clean During COVID

Oliver

Steven (Dad)

FelixSweeping bedroom

and hallway

Loading & unloading dishwasher 2-3 times/day

Managing food supply

Taming the outside jungle

Cleaning up after all animals

Sweeping the stairs & downstairs

floors

Keeping the Lich House

Clean During COVID

Oliver

Steven (Dad)

FelixSweeping bedroom

and hallway

Loading & unloading dishwasher 2-3 times/day

Managing food supply

Taming the outside jungle

Free time (he’s a teenager)

Manageable tasks (he’s the youngest)

Cleaning up after all animals

Sweeping the stairs & downstairs

floors

Regular appreciation

Praise for his garden

Clear and bounded tasks

1. Pick an initiativeThink of something ongoing – could be related to your work, your service/volunteer work, or something in your family

2. Think about three key stakeholders that the initiative needs something from3. What is each stakeholders’ contribution to the initiative?4. What is the value each stakeholder gets from the initiative?5. How well-balanced are the petals? Which petals are more or less balanced?

Balance of Petals Practice

1. Pick an initiativeThink of something ongoing – could be related to your work, your service/volunteer work, or something in your family

2. Think about three key stakeholders that the initiative needs something from3. What is each stakeholders’ contribution to the initiative?4. What is the value each stakeholder gets from the initiative?5. How well-balanced are the petals? Which petals are more or less balanced?

Let’s share insights!

Balance of Petals Practice

• Connections between components of the system• Uncovering system structure, e.g. who gives what to the initiative • Uncovering mental models, e.g. what stakeholders' value in general and

specific to initiative• System constructs (like petals) and the big picture (like the whole

flower)

How is this systems thinking?

Tool Name Tool Overview 5 Minute Video to Learn More

Network Mapping

A way of visually displaying connections between individuals or organizations in a system

https://media.sph.unc.edu/adobe/mch_ole/Workforce_Development/network_mapping/

System Support Map

A deep dive map depicting an individual's responsibilities, needs, resources, and wishes -- can be used to support meeting MCH consumers' needs, setting your team up for success, or defining and strengthening a system of individuals (e.g., developmental screening and referral to services)

https://media.sph.unc.edu/adobe/mch_ole/Workforce_Development/system_support/

Causal Loop Diagram

Depictions of feedback loops between variables, which can help decision makers identify leverage points for change

https://media.sph.unc.edu/adobe/mch_ole/Workforce_Development/causal_loop/

5 R’s

A conversation guide that will help you see the system in which you are working, following a series of prompts about what success looks like (results), roles, resources to support change, and rules and relationships that must be understood or changed to improve outcomes

https://media.sph.unc.edu/adobe/mch_ole/Workforce_Development/five_Rs/

Whole System Mapping

A set of question that help you inventory programs, services, or resources within the system you want to strengthen

https://media.sph.unc.edu/adobe/mch_ole/Workforce_Development/whole_system_mapping/

Process Flow Diagramming

A visual method for documenting the steps in a complex process you want to improve or imagine

https://media.sph.unc.edu/adobe/mch_ole/Workforce_Development/process_flow/

Circle of Care Framework

A qualitative method for mapping the services available to a particular population across a system

https://media.sph.unc.edu/adobe/mch_ole/Workforce_Development/circle_of_care/

Concept Mapping

Depictions of constructs and relationships between them that are critical to guiding your improvement efforts

https://media.sph.unc.edu/adobe/mch_ole/Workforce_Development/concept_mapping/

Tool

box

of S

yste

ms M

appi

ng R

esou

rces

The systems integration core offers guidance on a variety of system mapping approaches.Reach out to learn more:

National Maternal and Child Health Workforce Development Center• Kristen Hassmiller Lich: klich@unc.edu• Jess Cohen: jcohen@amchp.org

MCH Navigator – Systems Integration (SI)• https://www.mchnavigator.org/trainings/systems-integration.php

MCH Needs Assessment Toolkit• https://www.mchneeds.net/

Where to Learn More

Thank you!