Systemic Design Approach

Systemic design integrates systems thinking and theory with advanced design methods to affect anticipatory change in complex social and socio-technical systems. It embraces pragmatism and multiple perspectives to describe a system and its problems and structures (Jones, 2014). The concept of systems thinking reveals the complexity, interrelationships, and many of the interdependencies that exist in our surroundings (Buchanan, 2019). The issue of weight bias in the Ontario healthcare system has multiple layers. It is not solely about a fat patient and the bias they face from their doctors. It involves other professionals in healthcare, as well.  It involves the subsystem of governance, both provincial and federal, and health policy-makers. The education sector plays a significant role, as does the research community. Since the issue is entrenched in social stigma and prejudice, there is high engagement from activists and advocates in the system, especially during these times of social justice movements via online channels.

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With a multitude of actors involved, there are many influences and tensions in the system. Proposal of change in one node of the system may bring instability to another. The problem may be committed by one subsystem, but its roots can be found in another. Solving the problem is not a one-off, stand-alone endeavour. It will involve years of collaboration and the analysis of several different perspectives. Therefore, the problem of weight bias can be categorized as a ‘wicked problem.’ These are ill-defined, complex problems that are difficult to solve through straightforward tactics (Glen et al, 2014). This wicked problem is part of a more extensive socio-technical system of healthcare in Ontario. It is important to note that wicked problems have no ultimate test of a solution, and there are no stopping rules (Jones, 2014). Some symptoms of the problem might get solved, but new symptoms may appear.

With that in mind, the most effective path of conducting a problem-solving research study of such a complex issue is by implementing a systemic design analysis. This ensures a thorough examination of all the different elements of the problem. It helps us understand how occurrences of weight bias between doctors and their patients in the healthcare system are influenced by governance, education, culture, and society and how the solution spaces can account for them all.

This project uses the Systemic Design Toolkit developed by Namahn in collaboration with Peter Jones (Systemic Design Association) and Alex Ryan (MaRS Discovery District) (Systemic Design Toolkit, 2020) as the framework for primary research, analysis and problem-solving. It is a seven-step process that involves firstly framing the system; listening to and understanding the system; defining the desired future; and ultimately intervening in the system through leverage points, an intervention model and a transition plan. Some steps of the toolkit employ foresight tools to stay aligned with the essence of problem-solving through design by taking into account future implications and scenarios. This is a necessary action to take in these unpredictable times.

The rest of the paper will follow the Systemic Design toolkit structure, going through each step in detail. The research methodology, findings and insights are all embedded in these steps.

The first step in the toolkit seeks to frame the system. It involves setting the boundaries of the system in space and time, identifying the hypothetical parts and relationships (Systemic Design Toolkit, 2020).

For this project, this step will consist of a high-level review of the healthcare weight bias landscape and the actors involved, using the Rich Context Tool and a knowledge versus power-based Actors Map. This will frame the direction of this study and introduce the system that the project will be working with.