Systems Thinking Training Rolling Out in New England

NEPHTC is excited to provide Systems Thinking training in four states.

  • The first Systems Thinking live training was held April 11, 2018 in Burlington, VT at the Vermont Department of Health, with the help of Heidi Klein, Director of Planning and Healthcare Quality, and Heidi Gortakowski, Director of Performance Management.
  • The second Systems Thinking live training, held on June 5, 2018, in Hartford, CT, ws attended by the state health department and six local health departments from Connecticut with the help of the Connecticut Department of Public Health and the Connecticut Association of Directors of Health.  Kristin Sullivan, Manager of Public Health Systems Improvement at CT DPH is on NEPHTC’s Advisory Committee.
  • The third Systems Thinking live training will be held on July 17 in Nashua, New Hampshire.  Attendees will drawn from a variety of public health working groups with the help of Bobbie Bagley, Director, Division of Public Health and Community Services, Nashua, NH .
  • A Systems Thinking live training to be held August 17 in Rhode Island.  We are being assisted by the Rhode Island Department of Health.

NEPHTC thanks our health department colleagues for their assistance implementing Systems Thinking training!

Heidi Klein
Heidi Klein
Heidi Gortakowski
Heidi Gortakowski
kristin sullivan
Kristin Sullivan
Bobbie Bagley



What is Systems Thinking?

It is an approach that helps you better understand why you are getting the outcomes you are getting.

It is a perspective and point of view that allows you to step back to see the “bigger picture.”

It is a problem solving methodology that enables you to understand and resolve complex problems.

Iceberg illustration in vector
The iceberg is commonly associated with Systems Thinking because it shows how we commonly respond to “events” at the tip of the iceberg, rather than “patterns” and “structures” that contribute to the problem. (Learn more through an NEPHTC training!)

NEPHTC has been working with Julia Ross of Ross and Company, to develop a training program that consists of:

  • One live day of training for a large health department or a group of health departments
  • An online self-paced training module (due for release June 30, 2018)
  • Three months of follow up coaching for teams who volunteer to work on a problem using a Systems Thinking Approach

Julia Ross

Training participants from Health Departments and community organizations are able to use insights from taking a Systems Thinking approach to identify high-impact interventions.  The live session is highly interactive session allowing participants to learn to how to apply easy-to-use system thinking tools to practical issues faced by their program or organization.


Excerpts from our initial evaluation report in Vermont:

Level One (Satisfaction, Perceived Relevance) Findings:

“The level one evaluation findings indicate that trainees were satisfied with and engaged in the training and found it relevant to their roles.”


Figure 1. Trainee agreement (agree/strongly agree) with level one statements about the training (n=24)

Satisfaction ratings: # %
The information was presented in ways I could clearly understand. (n=23) 21 91.3%
I was satisfied with this training/course overall. (n=24) 21 87.5%
I found the content of this workshop to be relevant and useful for my role. (n=24) 24 100.0%
The objectives of the training were clearly defined. (n=24) 23 95.8%
The training objectives were met. (n=24) 22 91.7%
The training was appropriate for my skill level. (n=24) 23 96.0%
The facilitator was knowledgeable about the subject matter. (n=24) 24 100.0%
The facilitator was responsive to participants’ questions and needs. (n=24) 24 100.0%
The facilitator provided information in an interesting manner that facilitated my learning. (n=24) 22 91.7%
The amount of time allotted for the training was sufficient. (n=24) 20 83.3%
The training materials were helpful. (n=24) 23 95.8%



Level Two (Knowledge Gain and Confidence) Findings:

Trainee Knowledge Gain

Results of the 10-item pre/post-test also suggest that the training improved trainees knowledge of the subject matter.  A paired-samples t-test comparing pre- and post-test[1] scores revealed a significant difference in scores at pre- (M=22.92; SD=21.964) and post-test (M=70.42; SD=17.565); t(23)=110.617, p<.001.”

Trainee Confidence

On the six-week follow-up survey, 81% of the 21 respondents indicated that, as a result of the Systems Thinking Training, they feel more confident about their ability to address complex problems with others in the workplace.

Figure 2.  Trainee agreement (agree/strongly agree) with level two statements about the training (n=24)

Satisfaction ratings: # %
My understanding of the subject matter has improved as a result of having participated in this training. (n=23) 19 82.6%
I have identified actions I will take to apply information I learned from this training in my work. (n=24) 22 91.7%


Level Three (Application on the Job) Findings:

Of the 21 respondents who completed the six-week follow-up survey, over three-quarters offered agreement (somewhat or strongly agree) that the training enhanced their ability to do their job better by preparing them to address problems effectively with others in the workplace. Over half (52.4%) had already found the training materials helpful in performing their job and most (81%) believe the materials will be useful to their work moving forward.

Figure 3. Assessed change in job performance related to participating in Systems Thinking Training

No Change (i.e., I do this about the same as before the training) Minimal change (i.e., I do this a little bit more than I did before the training) Moderate Change (i.e., I do this quite a bit more than I did before the training) Major change (i.e., I do this a lot more than I did before the training
Statements: # % # % # % # %
I consider unintended consequences of proposed solutions prior to taking action on them. (n=19) 2 10.5% 11 57.9% 5 26.3% 1 5.3%
When problems arise, I first seek to understand why they happened. (n=18) 4 22.2% 7 38.9% 5 27.8% 2 11.1%
When I disagree with others, I actively seek to understand their reasoning. (n=19) 2 10.5% 8 42.1% 8 42.1% 1 5.3%
I understand how my work affects others and find ways to make the “whole” work better. (n=20) 2 10.0% 6 30.0% 11 55.0% 1 5.0%
When something goes wrong, I attempt to look at the “big picture” rather than solving the immediate problem with a quick fix. (n=19) 2 10.5% 8 42.1% 9 47.4% 0 0%



[1] A paired samples t-test was performed on the 24 available pairs of pre and post quizzes. A quiz (either pre or post) was missing for four individuals and thus, excluded from analyses. The internal VTDOH course organizer was asked to view the quiz prior to taking the training, thus her results were omitted from analysis.