Seite - 15 - in Applied Interdisciplinary Theory in Health Informatics - Knowledge Base for Practitioners

between system components can be competitive; in many systems, it is the dynamic tension of relationships between components that creates structures that stand the test of time. Similarly, Bertalanffy argues that GST also embraces decision theory, which analyses rational choices within human organizations, and network and graph theory, which can help GST develop models of the complex relations between system components in, for example, social networks. GST expanded from a theory into an ambitious project to join together disparate systems related ideas. Perhaps the best attempt to provide a useful synthesis of all the multiple systems theory perspectives comes from Ken Boulding’s (1956) paper titled “General systems theory: The skeleton of science”[4]. Boulding’s framework categorizes various types of system in terms of eight levels of increasing sophistication that could be seen as systems archetypes. Level 1 (Simple Structure) are borderline candidates for systems in that they have physical structure but are essentially static, for example a rock. In healthcare we might think of objects such as a scalpel, a bed or a room, such objects still have an emergent property of wholeness and, for human created artifacts, often some discernible purpose. Level 2 (Clockwork) are more sophisticated than Level 1 in that they have movement and may maintain an equilibrium but such movement is predetermined, most obviously a clock-work clock and other simple machines but also the solar system. In healthcare, such concepts underpin stochastic dynamic modeling of, for example, the seasonal rise and fall of demand. Level 3 (Control Mechanisms) are Level 2 systems that also have some element of information closed-loop control, the classic example being a thermostat which turns heating on or off based on comparing the feedback of the current temperature to the control setting3. These are the principles of cybernetics in computing and homeostasis in biology and in management underlie principles of stock control and resource planning now often encoded within enterprise resource management systems. Level 4 (Open Systems) are Level 3 systems that have a self-maintaining structure in constant interaction with its environment, such a definition might include a flame or a river but more generally is the essence of simple life, a cell or a virus where we can add in the property of being able to self-reproduce. Level 5 (Plant) are Level 4 systems which have an organized whole based on a structure of differentiated and mutually dependent parts, for example plants where roots, leaves, seeds etc are functional parts themselves composed of specialist cells (i.e. Level 4 systems). Level 6 (Animal) are Level 5 systems which display intelligence, typically with sophisticated information intake, processing and control including the construction of a knowledge structure that enables them to compete (Game Theory) and make informed decisions (Decision Theory). Level 7 (Human) is distinguished by adding self-consciousness and, one would hope, more intelligence, greater reasoning based on knowledge and a capacity for more complex processing of symbols such as in the use of language. Level 8 (Social Organization) are the complex collections of people in various roles that manifest as discernible systems. An individual may simultaneously be a mother (and a daughter) in a family, a surgeon in a surgical team, an employee within a healthcare organization and a researcher doing a part time PhD at a university. The family, surgical team, healthcare provider and university all fit the definition of Level 8 systems and are social networks of people. Experience tells us that all of these can be hugely complicated, constantly changing and yet somehow their structures persist and evolve through changing relationships and the arrival and departure of new people. In Boulding’s words, Level 8 includes “human life and society in all its complexity and richness” [4, pg 200]. 3 See also Chapter 14, “Control Theory to design and evaluate audit and feedback interventions”. O.Johnson /GeneralSystemTheoryand theUseofProcessMining to ImproveCarePathways 15