Leadership Learning for Systems Thinking and Practice.

Still looking for leadership – Who is responsible for student nurses’ learning in practice?

Systems Thinking (ST) has recently been promoted as an important approach to health systems strengthening. However, ST is not common practice, particularly in Low- and Middle-Income Countries (LMICs). This paper seeks to explore the barriers that may hinder its application in the Eastern Mediterranean Region (EMR) and possible strategies to mitigate them. A survey consisting of open-ended questions was conducted with a purposive sample of health policy-makers such as senior officials from the Ministry of Health (MoH), researchers, and other stakeholders such as civil society groups and professional associations from ten countries in the region. A total of 62 respondents participated in the study. Thematic analysis was conducted. There was strong recognition of the relevance and usefulness of ST to health systems policy-making and research, although misconceptions about what ST means were also identified. Experience with applying ST was very limited. Approaches to designing health policies in the EMR were perceived as reactive and fragmented (66%). Commonly perceived constraints to application of ST were: a perceived notion of its costliness combined with lack of the necessary funding to operationalize it (53%), competing political interests and lack of government accountability (50%), lack of awareness about relevance and value (47%), limited capacity to apply it (45%), and difficulty in coordinating and managing stakeholders (39%). While several strategies have been proposed to mitigate most of these constraints, they emphasized the importance of political endorsement and adoption of ST at the leadership level, together with building the necessary capacity to apply it and apply the learning in research and practice.

Globalization and technological advancements pose challenges to educators, demanding continuous professional development (CPD) to support institutional growth. Transformations in higher education reveal gaps in governance, organizational structures, and educational models. HeXie Mindset, a framework blending systemic thinking with Eastern and Western philosophies, equips educators to navigate uncertainty, complexity, and change. When combined with Syntegrative Education—an approach emphasizing interdisciplinary, student-centered, and practical learning—this framework fosters adaptable, innovative educators. By integrating workplace learning, technology, and collaborative leadership, these models empower educators to address global challenges and drive institutional innovation. This paper explores how the synergy of HeXie Mindset and Syntegrative Education offers sustainable pathways for CPD, enabling educators to thrive in transnational contexts and ensuring institutions remain agile, inclusive, and forward-looking in an interconnected and competitive higher education landscape.

Systems thinking has dominated debates and policy discourses on inclusive education, resulting in an almost exclusive focus on children and formal schooling. Based on the BAICE Presidential Lecture 2019, this paper considers the limitations of systems theory in framing discussion and research on inclusive education, introducing instead alternative theoretical starting points to analyse vignettes of from Ethiopia, Nepal, the UK and the Philippines. In place of systems theory, the paper takes the lenses of culture as performed, literacy as a social practice and informal learning, to explore inclusive education and analyse intercultural and literacy learning in everyday life. It argues the need to move beyond systems thinking – particularly closed systems – with its default position of school as providing the solutions. Whilst cultural stereotypes can be challenged in school curricula, inclusive education cannot rely on formal institutions alone to initiate changes in attitudes held by teachers, students and the wider community.

BackgroundMedical education should ensure graduates are equipped for practice in modern health-care systems. Practicing effectively in complex health-care systems requires contemporary attributes and competencies, complementing core clinical competencies. These need to be made overt and opportunities to develop and practice them provided. This study explicates these attributes and generic competencies using Group Concept Mapping, aiming to inform pre-vocational medical education curriculum development.MethodsGroup Concept Mapping is a mixed methods consensus building methodology whereby ideas are generated using qualitative techniques, sorted and grouped using hierarchical cluster analysis, and rated to provide further quantitative confirmation of value. Health service providers from varied disciplines (including medicine, nursing, allied health), health profession educators, health managers, and service users contributed to the conceptual model’s development. They responded to the prompt ‘An attribute or non-clinical competency required of doctors for effective practice in modern health-care systems is...’ and grouped the synthesized responses according to similarity. Data were subjected to hierarchical cluster analysis. Junior doctors rated competencies according to importance to their practice and preparedness at graduation.ResultsSixty-seven contributors generated 338 responses which were synthesised into 60 statements. Hierarchical cluster analysis resulted in a conceptual map of seven clusters representing: value-led professionalism; attributes for self-awareness and reflective practice; cognitive capability; active engagement; communication to build and manage relationships; patient-centredness and advocacy; and systems awareness, thinking and contribution. Logic model transformation identified three overarching meta-competencies: leadership and systems thinking; learning and cognitive processes; and interpersonal capability. Ratings indicated that junior doctors believe system-related competencies are less important than other competencies, and they feel less prepared to carry them out.ConclusionThe domains that have been identified highlight the competencies necessary for effective practice for those who work within and use health-care systems. Three overarching domains relate to leadership in systems, learning, and interpersonal competencies. The model is a useful adjunct to broader competencies frameworks because of the focus on generic competencies that are crucial in modern complex adaptive health-care systems. Explicating these will allow future investigation into those that are currently well achieved, and those which are lacking, in differing contexts.

Systems-based practice is a core competency for physical therapy residents, best acquired through experiential learning. Peer health professions are further along than physical therapy in implementing curricula that support systems-based practice. Clinical and practice data in residency programs could provide for education in high-value care (HVC) as a foundation for systems-based practice. Our purpose was to develop and assess a HVC curriculum incorporating reflective practice to help residents achieve competency in systems-based practice. The Logic Model, which evaluates key components needed for success and sustainability, was used to identify resources for a curriculum in HVC. Two orthopedic physical therapy residents and 5 faculty mentors participated in didactic and mentoring sessions. A practice dashboard for each clinician was developed to facilitate resident-mentor discussions. Focus group input was used to refine the curriculum. The validated Systems Thinking Scale, the Quality Improvement Knowledge Application Tool Rubric, and the American Physical Therapy Association Residency Core Competency Score were used to assess residents' progress and to make comparisons to prior years' residents. The residents demonstrated increases in systems thinking and quality-improvement knowledge and improvements in clinical outcomes and practice efficiencies. Three themes emerged from semistructured interviews: challenges to HVC, current approach in HVC, and future-oriented thinking in HVC in practice. This study demonstrates that HVC activities and a personalized clinical dashboard in a physical therapy residency program can facilitate experiential learning of systems-based practice, a core competency for value-centered, inclusive practice.

Systems thinking involves attempts to understand and improve complex systems, examines systems holistically, and focuses on the way that a system's constituent parts interrelate. This essay provides examples of how systems thinking can enable principals to demonstrate instructional leadership and nurture learning-focused schools in the current era of complexity, diversity, and accountability. These examples illustrate how systems thinking contributes to developing school curriculum, empowering professional learning communities, and fostering performance data interpretation. Overall, systems thinking offers a comprehensive way of both conceptualizing and practicing leadership for learning within the entire school setting, which leads directly to enhancing the quality of instruction and raising students' achievement.

Mejora escolar, liderazgo y reforma sistémica: una retrospectiva (School improvement, leadership and systemic reform: a retrospective)

Purpose The purpose of this chapter is to document how a new learning technic may create transformative learning in leadership in an organisational practice. Design/methodology/approach The learning methods developed in the learning in practice (LIP) project include aesthetic performances combined with reflections. The intention has been to explore how leadership may be transformed, when leaders work as a collective of leaders. The learning methods developed and tested in the LIP project are art-informed learning methods, concepts of liminality and reflection processes carried out in the leaders’ organisational practice. Findings One of the most important findings in the LIP project in relation to transformative learning is a new learning technique based on guided processes rooted in aesthetic performance combined with reflections and separation of roles as performer and audience. Reflection processes related to aesthetic performance serve as argument for the impact of ‘the audience wheel’. Originality/value Leaders who perform and reflect in a collective of leaders can better deal with complex organisational problems and enhance growing of welfare-in-the-making from an inside and out perspective. Moreover, the separation between classroom teaching and practical intervention will diminish when leaders learn aesthetic performance and reflections as a practical technique.

Blended Learning, Systems Thinking and Communities of Practice

Abstract. Efficient management of the health care system is essential to ensure the high quality of health care facilities, both public and private. The expected results of work to improve the efficiency of health care system involve the introduction of modern complex systems, among which digital technologies play a leading role. The value of digitalization will help healthcare organizations overcome the challenge of limiting the use of resources to meet growing healthcare needs. The digitalization of domestic healthcare, which covers electronic prescriptions, electronic referrals and the exchange of electronic medical records, has been implemented on the platform of the Integrated State Information System since 2018. According to forecasts, its implementation and maximum use should be completed and implemented to the maximum by 2025. The success of this implementation is closely related to the level of digital skills of both healthcare providers and users of healthcare services. It is believed that the widespread introduction of electronic technologies in healthcare will solve many current problems in this industry. However, at the present time its use is not yet very well developed, and its potential is little used. There are many reasons that promote or limit the spread of digital transformation in the healthcare sector. This is, first of all, knowledge, opportunities for learning, the ability to interact, systemic thinking. Good managerial responsibility is critical to transforming healthcare. Implementing eHealth requires new and innovative workflows. At the same time, both the medical staff and the administrative link must be aware that their work will change radically. It will evolve from a routine to an activity of learning, skill development and constant change in work practices.

Steps towards systemic innovation require a new understanding of professionalizing leaders on all levels of the school system. We need “system thinkers in action” (Fullan, Leadership and sustainability: System thinkers in action. Thousand Oaks: Corwin Press, 2005) who interact with larger parts of the system both horizontally and vertically in order to bring about deeper reform. Their collective wisdom in thinking and acting shapes future steps in national school reform. Three Austrian national development initiatives are presented which work together towards leadership for learning: The Leadership Academy creates a learning context aimed at influencing the pattern of how professionals in leading positions think and go about change. The New Middle School, a reform project fostering as well as challenging all children, irrespective of their social, cultural, and language background or their individual performance, is driven by the emphatic policy goal of raising academic achievement. This requires a fundamental reorientation of the instructional and organizational system of teaching and learning for 10–14-year-olds in heterogeneous groups. The third initiative, Hierarchy Meets Network, brings the Minister of Education into dialogue with innovative actors across Austria and removes structural barriers to fostering networking and cooperative activities among innovators.

We offer a reflection on our own praxis as designers and developers of a learning system for mature-age students through the Open University (OU) UK’s internationally recognised supported-open learning approach. The learning system (or course or module), which required an investment in the range of £0.25–0.5 million to develop, thus reflects our own history (traditions of understanding), the history of the context and the history of cyber-systemic thought and praxis including our own engagement with particular cyber-systemic lineages. This module, “Managing systemic change: inquiry, action and interaction” was first studied by around 100 students in 2010 as part of a new OU Masters Program on Systems Thinking in Practice (STiP) and is now in its fourth presentation to around 100 students. Understanding and skills in systemic inquiry, action and interaction are intended learning outcomes. Through their engagement with the module and each other’s perspectives, students develop critical appreciation of systems practice and social learning systems, drawing on their own experiences of change. Students are practitioners from a wide range of domains. Through activities such as online discussions and blogging, they ground the ideas introduced in the module in their own circumstances and develop their own community by pursuing two related systemic inquiries. In this process, they challenge themselves, each other and the authors as learning system designers. We reflect on what was learnt by whom and how and for what purposes.

Living and learning processes involved in managing systemic change in the context of sustainability are explored. We write as designers of a UK Open University module first studied in 2010 as part of a new MSc in Systems Thinking in Practice. Our mature students were practitioners from a wide range of domains who through online discussions and blogging grounded the module materials in their own circumstances and developed their own community. Students challenged themselves, each other and the authors as learning system designers and developed critical appreciation of systems practice and social learning systems, drawing on their own experiences of change. Issues of learning system design and facilitation of learning are addressed; we reflect on what was learnt by who and how and for what purposes. Two conceptual strands incorporated into the design are highlighted: (i) Wenger’s idea of a landscape of practices used to map what learning for sustainability in times of accelerating change looks like and (ii) systemic inquiry, an institutional innovation and antidote to living in a projectified world, used for organising praxis in contexts of uncertainty. If our climate-changing world is unknowable in advance there is a need to take more responsibility for systemic effects of our actions. The case study shows how this can be done through designing and participating in learning systems that generate effective systems practice.

Summary. The importance of the interdisciplinary approach in teaching the professional discipline «Technology of medicinal products of industrial production», which is a key element of the modern paradigm of higher medical and pharmaceutical education, is analyzed. It has been established that the integration of knowledge from chemistry, biology, pharmacology, engineering and economics forms systemic thinking and contributes to the development of professional competence of future specialists. The influence of the interdisciplinary approach on improving the quality of personnel training adapted to the rapidly changing requirements of pharmaceutical production and the modern labor market is revealed. The key pedagogical tools that ensure the effective implementation of an interdisciplinary approach in the educational process have been identified. Such tools include project-oriented learning, which promotes the development of skills for analyzing and solving complex tasks, simulation of production processes that simulate real working conditions in the pharmaceutical industry, as well as team case tasks that stimulate collaborative thinking, professional interaction and integration of knowledge from different disciplines. Practical cases and learning models that provide a connection between theory and practice are highlighted. The use of modern educational technologies to improve the professional competence of students is motivated. Recommendations for the integration of an interdisciplinary approach into educational programs, as well as methodical approaches for their adaptation to the modern challenges of pharmaceutical production, have been developed. The experience of using the interdisciplinary approach in foreign education is summarized and its application in the national context is proposed. It is recommended to implement joint educational projects and master classes with the participation of representatives of the pharmaceutical industry. The prospects for improving the educational process, taking into account the requirements of the labor market, are summarized.