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Developing systems for health using boundary critique

Reynolds, Martin and Wilding, Helen (2017). Developing systems for health using boundary critique. In: de Savigny, Don; Blanchet, Karl and Adam, Taghreed eds. Applied Systems Thinking For Health Systems Research: A Methodological Handbook. Maidenhead: Open University Press, pp. 38–56.

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Abstract

The popularity of contemporary evidence-based practice (EBP) approaches in health care research have a long and well-documented history which tends to prioritise the factual world over the world of values. It comprises a conventional linear mechanistic understanding of ‘research’ informing ‘practice’; an understanding described elsewhere in the arena of public administration as the Received View. In the arena of health care, the importance of values is paramount; particularly in setting priorities of health systems research in low-income countries. An alternative approach to the Received View is what we might call a praxis-oriented approach. Here, the continual integral dynamic between research and practice is acknowledged, recognising also that research is essentially value-driven. Praxis can be described as practice-informed-theory and/or theory-informed-practice; or alternatively, ideas-in-action or thinking-in-practice. In praxis, the activities of research and practice are not seen as an either/or dualism, but regarded rather as a continual both/and duality. One significant expression of a praxis-oriented approach in the systems thinking tradition is Werner Ulrich’s notion of boundary critique; an ‘eternal triangle’ of interdependence between judgements of fact and value judgements, mediated through boundary judgements.

In this chapter, Section 1 describes boundary critique and a particular manifestation of it - the systems thinking in practice (STiP) heuristic - developed amongst systems practitioners at the UK-based Open University. STiP provides a framework for using multiple methods or techniques – systems-based or otherwise – through a sequence of activities involving (i) understanding inter-relationships, (ii) engaging with multiple perspectives, and (iii) reflecting on boundary judgements. Two sets of systems tools have been found particularly helpful in these activities, as experienced by the authors – tools associated with soft systems methodology (SSM) and critical systems heuristics (CSH). These are briefly outlined. Section 2 describes an application of the STiP heuristic in developing systems for health partnerships. Whilst the case study is situated in a UK context – specifically Newcastle upon Tyne, in North East of England, the wider context of enabling partnerships through the application of boundary critique is one that has universal relevance.

Item Type: Book Section
Copyright Holders: 2017 Open University Press
ISBN: 0-335-26132-9, 978-0-335-26132-1
Keywords: boundary critique; critical systems heuristics; health research; praxis; soft systems methodology; systems thinking; systems thinking in practice
Academic Unit/School: Faculty of Science, Technology, Engineering and Mathematics (STEM) > Engineering and Innovation
Faculty of Science, Technology, Engineering and Mathematics (STEM)
Interdisciplinary Research Centre: Innovation, Knowledge & Development research centre (IKD)
Design and Innovation
Item ID: 51569
Depositing User: Martin Reynolds
Date Deposited: 16 Oct 2017 08:47
Last Modified: 17 Nov 2017 11:52
URI: http://oro.open.ac.uk/id/eprint/51569
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