Critical Systems Thinking: A post-hoc analysis of a Community OR healthcare project.

Abstract

This paper presents the findings of a post-hoc review of a Community OR healthcare project. The university-funded project’s purpose was to inquire into the effectiveness of cancer support services in the southwest of England, focusing on physical activity, health, and well-being interventions for those living with cancer. Over 16-months, the project engaged cancer patients, healthcare professionals, intervention deliverers, and policy collaborators, guided by Castle’s Systems methodology Circumstances, Values and Viewpoints, Activities, and Means. These system actors co-led the investigation of the interventions for cancer survivors and co-created a new referral process and Hub of Practice for cancer support services. They intended to double the cancer referral rate from its baseline of 10%. While there were notable successes, the system analysis by the actors proved challenging to facilitate, so to the operationalisation of the Hub of Practice. At different points during the methodology deployment, the workshop sessions stalled as the actors could not offer contributions to advance the interventions needing the facilitator and project team to backfill. We also found activities missing when attempting to operationalise the Hub of Practice. These deficiencies prompted the facilitator and the project team to action a post-hoc analysis of the project drawing on Ulrich’s Critical Systems Heuristics. The outcomes of the post-hoc review may be helpful to other systems researchers engaging in Community OR health projects.