Blog Post

August 7, 2018 Katie Guidera

Making Systems Thinking Part of our DNA

D-Rev’s commitment to closing healthcare quality gaps for underserved populations is no secret, nor is our commitment to rigorously measuring our impact as we make strides towards this goal. A clear, data-driven understanding of our impact helps us to see where we are succeeding and where we need to try something new. To date, our impact measurement has focused on quantifying the reach of our products and the direct impact that they have on patients’ lives.

However, over the years, our team has heard anecdotes from the field that indicate our influence might be more far-reaching than the direct impact we have measured to date. We have seen our competitor’s prices drop in one market, and in another, we have seen procurement officers improve their quality standards in tenders. These anecdotes and others have led us to think more critically about the system in which we operate and seek to understand how we might support positive change across that system.

Over the last two months, I have been working as a fellow with D-Rev to develop our understanding of systems change in greater depth. Our exploration has been guided by three main questions:

  1. Why would we want to think about D-Rev in the context of a system?
  2. How can we define and understand the system in which D-Rev operates?
  3. What steps can we take to test and measure our influence on a system?

After speaking with nearly two dozen stakeholders and reviewing many more publications on the topics of creating and measuring systems change, we have developed insights that we are delighted to share. We hope that these interim insights will shed some light on how D-Rev and organizations like it can begin to develop a language and process for making systems thinking a part of their DNA, and we welcome the chance to speak with others who are thinking about systems impact as we continue to refine our own theory and approach.

Systems thinking and why it matters for an organization like D-Rev

As an organization that designs and delivers medical devices to some of the most under-resourced parts of the world, we are keenly aware that our approach cannot be characterized by the phrase “build it and they will come.” Instead, we must design products that work within a complex set of actors and functions: our devices need to be manufactured in facilities that put a premium on quality, we need to partner with distributors who can reach last mile health facilities in Uganda, and the clinicians who use our products need to have training and support to feel confident and capable in using our products. So we started by defining the system in which we operate: the “health product market system”, which interacts with dozens of players and overlapping systems, as visualized below.

Above: Map of the health product market system in which D-Rev operates, including its overlapping systems, players, and functions. Credit: Katie Guidera.

Next, we sought to understand where and why this system may not always work in the best interest of patients. Too often, the system that enables our products to make it into the hands of the doctor and patient is broken. As an organization, then, we must understand where the system has shortcomings and how positive progress can be made so that a system works for our products and ultimately, for patients.

We realized early in the process that adopting the mindset of seeing D-Rev as an agent of systems change served two purposes: First, it would give us a more robust model for decision-making as we evaluate products and projects. By answering “where is the system broken, and how can D-Rev play a role in fixing it?”, we could naturally make smarter decisions around how we invest time and resources in new product ideas and what activities we prioritize throughout our product development process. Second, it could help us tell our impact story in a more comprehensive and meaningful way. If we can articulate the positive influence we want to see at a systems-level, we will be better positioned to work with partners and others to drive that change collaboratively.

D-Rev’s framework for conceptualizing systems change

In order to establish a common language for speaking about systems change, we adapted a framework originally developed by the USAID Center for Accelerating Innovation and Impact (CII) in their 2014 report Healthy Markets for Global Health: A Market Shaping Primer.

We agreed that a healthy market system could be characterized by five main attributes: affordability; availability; assured quality; appropriate design; and awareness, evidence, and training. and by diagnosing the “health” of each attribute we might begin to understand gaps and opportunities in the system. The five attributes are defined below:

Above: “5As” framework detailing the characteristics of a healthy market. Adapted for D-Rev from USAID-CII’s “Healthy Markets for Global Health: A Market Shaping Primer”. Credit: Katie Guidera.

By developing a common understanding of what these attributes are and how we might assess their level of “health”, we can more easily monitor and measure the overall health of the system before, during, and after we bring any new product to market.

Integrating systems change measurement into our organization

Once we established the 5As framework, we developed a structured process for D-Rev to apply the 5As throughout its product development process to diagnose the system, define actions, and measure change over time.

We aligned our systems change measurement approach closely with the stages of our product development process so that at each stage of product development we can integrate tools that help us measure systems change. These integration points allow us to embed systems thinking into our existing processes, data collection mechanisms, and fieldwork efforts over the lifecycle of each new product.

Above: Steps for integrating systems measurement into D-Rev’s product development process. Integration allows us to embed systems thinking into our existing processes, data collection mechanisms, and fieldwork efforts over the lifecycle of each new product. Credit: Katie Guidera.

Next Steps for D-Rev

As a next step, our team will begin piloting the process and tools we’ve developed. We are eager to put them into practice so that we can continue to adapt and mature our systems-thinking approach.

Above all else, this process has informed us that systems thinking is not a new or revolutionary concept to our team—we have been operating with a systems mindset in many ways already. However, taking these steps to formalize our understanding and approach to systems thinking has helped to mature our perspective, patch holes in our impact thesis that we didn’t realize were there, and increase our awareness of how we play into a much larger ecosystem of actors.

We ultimately hope that our efforts will lead to more holistic solutions and greater impact as we continue on our mission to close the healthcare quality gap for underserved patients globally.

About the Author: Katie Guidera is a 2018 Summer Associate at the Draper Richards Kaplan Foundation, which supports D-Rev and other high-impact social enterprises. Outside of her work with DRK and D-Rev, Katie is pursuing her MBA at the Harvard Business School where she is exploring the intersections of social impact, innovative financing, and technology. Katie received her BA from Duke University where she studied Global Mental Health, and is the co-founder of One Sun Health, a non-profit which promotes sustainable, locally-driven solutions to public health challenges in South Africa.

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