Working Interdependently: How Individuals Constitute Effective Systems

A system's ability to function-its "systemness"-depends upon the mindsets and behaviors of its people, but what exactly is it that individuals do to constitute effective systems? Systemness requires three kinds of ongoing conversations devoted to (1) developing and maintaining a shared purpose or goal, (2) developing and maintaining a systems perspective-understanding how all the various parts fit together in service of the shared purpose and integrating many unique, diverse perspectives to gain a more complete understanding of the situation at hand-and (3) managing the myriad interdependencies of all the people involved in the work. These conversations are needed across all levels of scale, from one patient's care plan to the implementation of strategy for a whole organization. The three conversations of systemness will only be effective to the extent that people are willing to express their unique perspectives and to be responsive to and influenced by what they hear from others. The skills of personal reflection, self-differentiation, attunement, and multiple perspective-taking are particularly important. Understanding the conversations and individual skills on which systemness depends offers new directions for health professions education and quality improvement, and may be relevant to societal challenges beyond healthcare.