To Drive Systemic Change, Find the Root Cause

Treat the cause, not the symptoms

If your phone turns off and you plug it into a charger, most likely, it turns back on. If it doesn’t, you now have to consider other potential issues in order to get it to work again. As human beings, we use linear, event-focused, cause-and-effect thinking as our go-to mental strategy for making sense of the world around us.  This works in simple situations – like when your phone’s battery dies. But, when linear thinking will not solve our problems, we have to turn to systems thinking. 

Systemic change – change that is fundamental and impacts how an entire system functions – requires systems thinking. The healthcare system in the United States is a good example, and a relevant topic to today’s political discussions. It’s easy to say that high costs are the most important problem in our healthcare system. But, if you only tackle reducing healthcare premiums, and ignore the poor quality of services or the unintended consequences of costs rising in other areas, you have not improved the healthcare system as a whole.  

In order to improve healthcare in our country for all citizens, we must define the improved state, recognize the variety of barriers at play (e.g. high costs, poor quality, lack of access, etc.) and then look to identify and address the true root of the problem. We also have to understand related issues and relationships that play a role  in the system (e.g. the structure of for-profit insurance companies and the historic context and factors affecting health, such as a lack of access to healthy foods and safe public spaces). In order to have deeper, lasting positive impact on complex social systems like healthcare, we must do everything we can to understand how these systems actually work—and what our own roles are in them. 

So, how do we start using systems thinking? 

Stepping back from our own theories and experiences, systems thinking requires you to understand three things about the existing system that perpetuates the issue you want to solve:

  • Components of the system (e.g. poor hospital management, poor access to healthy food, insurance restrictions, high-cost premiums, discriminatory health care policies, lack of public awareness/understanding, lack of health education, overcrowded hospitals, poor government relations, etc.) 
  • Interconnections/Relationships between the components in the system (e.g. lack of health education increasing the number of emergency room visitors and leading to overcrowded hospitals, etc.)
  • Outcomes reliably produced by the system (e.g. large parts of the population who are uninsured, high medical debt, higher rates of diabetes, poorer health outcomes, etc.)

At Building Impact, we work with new clients to conduct a landscape analysis aimed at exactly this purpose. It guides our own systems thinking and helps us gain clarity, illuminating deeper factors at play, unexpected feedback loops, and other counterintuitive dynamics.

To do your own mini-analysis for the issue you care about, we suggest you start by completing a 5 Whys analysis:

1. Write a problem statement for the issue you care about. 

  • E.g. “Many people in disadvantaged communities don’t go to the doctor.”

2. Ask yourself why this problem exists from the perspective of those most affected, focusing on the choices that led to the current problem. Write these causes down. 

  • E.g. “Because it’s too expensive, because they don’t have access to a good doctor, because their doctor is too far away, etc.” 

3. For each cause, again taking the perspective of those most affected, ask yourself why the answer you came up with exists. Repeat this at least four times, which should help you identify the key components of the system.

  • E.g.: “Because it’s too expensive. Why? Because they do not have insurance coverage. Why? Because they don’t understand how to enroll. Why? Because the enrollment process is confusing. Why? Because the enrollment information is not available in the language they speak. 

4. Look for similarities throughout the different causes. Similarities tend to be logical root causes. For each logical root cause, brainstorm a solution. 

  • E.g.: If lack of information in multiple languages appears throughout different causes’ 5 Whys, a solution could be: Publish enrollment information in multiple languages. Investigate translation services and provide as able. 

To use this approach to drive effective, creative, and comprehensive strategies requires change agents to recognize and push through the limits of their own perspectives. Engaging in this type of exercise is a powerful first step in systems thinking, putting you on the path to meaningful impact.