Yuanrong Guo, Sarah Kettley, and Autumn Roesch-Marsh
Systems thinking is increasingly applied in healthcare and design to address complex challenges. Its application remains methodologically diverse, drawing on approaches that range from complex adaptive systems and system dynamics to sociotechnical theory and service ecosystem perspectives. Existing discussions of systems thinking diversity often remain at the level of general guidance, saying little about how systems thinking is put to work in specific healthcare situations.
Building on a prior scoping review at the intersection of design, systems thinking, and healthcare, this paper undertakes a secondary analysis of 35 empirical studies. Rather than classifying studies by their theoretical origins, the analysis asks a different question: what does each study use systems thinking to foreground within a healthcare situation? Through this analysis, three orientations are developed: Structural/Dynamic, which foregrounds interdependencies, feedback processes, variability, and systemic constraints; Sociotechnical/Relational, which foregrounds relations among actors, organisations, technologies, infrastructures, and responsibilities; and Value/Meaning, which foregrounds the values, meanings, and interpretations surrounding care and intervention. These orientations are then examined across four healthcare challenge categories: the evidence–practice gap, designing and sustaining complex interventions, contextual fit and adaptation, and system integration and collaboration.
The findings indicate that systems thinking is more readily recognised in modelling-oriented work, while relational and interpretive forms of systemic inquiry remain less visible. For designers working in healthcare, this study suggests that engaging with systems thinking is not only a matter of selecting tools or methods, but also of judging which aspects of a situation to bring into systemic focus. The study also calls for greater attention to the Value/Meaning orientation, which raises an important question about what kinds of knowledge are treated as relevant to understanding a system. Overall, the study contributes a healthcare-grounded perspective to ongoing discussions of systemic design pluralism.
Keywords: healthcare complexity, systems thinking, systemic design, secondary analysis, complex intervention, sociotechnical systems