Getting to grips with whole system working for improved public health

The national drive to combat Scotland’s public health challenges and drive down equalities is promoting a new way of working. With a set of nine characteristics in place it’s hoped a whole system approach will help partners across the country make a decisive cultural shift. Dr Rachel McAdams, Public Health Priorities lead in the Public Health Reform team has more…

The idea of whole system working can seem daunting but in truth it’s a common sense approach designed to deliver the best possible results for communities. The whole system approach (WSA) aligns with the Scottish Approach to Service Design, but seeks to apply this to the re-design of the systems which interact to influence the health and wellbeing of communities. In a nutshell, WSA is applying systems thinking and tools that enable: 

“An ongoing, flexible approach by a broad-range of stakeholders to identify and understand current and emerging public health issues where, by working together, we can deliver sustainable change and better lives for the people of Scotland.”  

The underlying theme here is one of a cultural transformation using a whole system approach to deliver Scotland’s public health priorities. However, as helpfully explained in this blog by Emma Stace, transformation isn’t a programme, it’s about changing how we work, with a focus on our behaviours and our relationships. The WSA take on this is demonstrated through a set of nine characteristics:

Engaging and working collaboratively with communities, and appreciating that place both shapes local systems and our approach to re-designing them, is central to the whole system approach. WSA also informs our approach to monitoring and evaluating change, with a focus on a continuous and adaptive learning cycle. Leadership is important for supporting and sustaining collaboration across organisational boundaries, for creating the conditions which encourage innovation. You can find out more here.

Aren’t we doing this already?

I’ll admit that when I first read about whole system approaches I thought the ‘systems’ bit sounded new but that WSA was how I’d always worked, or tried to, in public health. However, the evidence from the Public Health Review and our recent engagement with national and local partners through Public Health Reform paints a different story.

We’ve also heard from partners that many of the structural conditions that would support the WSA way of working already exist, i.e. locally community planning partnerships already have a strong focus on partnership working, alongside some nationally supportive policy. However few demonstrate all nine WSA characteristics consistently through local and national collaborations and this is where we think the change needs to come.

So, where’s the toolkit?

Because the ‘systems’ bit appears to be new there’s an anxiety and assumption that identifying the system mapping tool is the key. But systems thinking and mapping tools are only one of nine characteristics we need to adopt to transform how we work, all of which are equally important. This isn’t a one size fits all approach and local areas will need to form their own ways of working, something a national toolkit could never provide.

What next?

The Public Health Reform team is interested in adopting and testing the whole system approach to delivering the public health priorities. Every single partner has a role to play. Public health reform will be a shared journey towards more effective delivery. To help inform decisions we’ve already confirmed some early adopters for priorities 4, 5 and 6. These partnerships will seek to test what these characteristics mean in practice and how the public health workforce can best support this. This learning will be shared with Scottish Government, Local Government, Public Health Scotland and widely across the system to ensure real change is delivered to communities. However, these only paint part of the picture, so if you’d like to get involved please get in touch.

Additional reading

Find out more about how we have developed our WSA here

Some introductory reading and information on whole system approaches developed elsewhere can be found in the links below:

• Health Foundation webinar with Prof Harry Rutter and Jim McManus
• Various resources produced by NPC.
• Health Foundation Webinar with Prof Steven Allender and Debra Richardson
• Public Health England Whole System Obesity Guide
• The Omidyar Group Systems practice workbook
• Australian Prevention Partnership