What is systems mapping?

System mapping is the process of creating a diagram to represent the elements and relationships of s system

System maps aim to give an overview of a system and how the parts interrelate to form the whole. In short they show the landscape in which actors exist.

Why is systems mapping beneficial?

• Build consensus so we all are working from the same understanding
• Can bring together and communicate complexity to diverse stakeholdes
• Understand interconnectedness
• To be able to see the big picture of the system
• Visual representation of complexity

How to start mapping systems

Define the purpose:

Clearly outline your objectives. Are you designing the map to identify gaps in care, communicate with stakeholders, or plan integrated services? Having a clear purpose will guide your map's development.

Understanding the current system

There are multiple ways to start mapping the system. The first step is to understand the current system as it is. You can start by identifying different services through desk research or speaking to stakeholders. Another way of doing this is to ask stakeholders to draw a map of the current system as they understand it. The stakeholders are the ‘system experts’ as they have insights of the system better than anyone else. The following elements were mapped out by the stakeholders representing the existing mental health and substance use services in one of the NHS health boards in Scotland. Their crude map included a variety of elements such as:

1. Service providers: These are the organisations and facilities that offer mental health and substance use services, hospitals and clinics including specialist units.
2. Key stakeholders: These could be government agencies, third sector, advocacy groups, housing and social support and individuals who play a significant role in either using or shaping the services and policies related to mental health and substance use.
3. Service Parts: These could be different types of services provided, such as therapy, addiction treatment, crisis intervention, harm reduction services.
4. Patient pathways: This shows different entry points to the system and how patients move around different services
5. Policies and regulations: Places where medication assisted treatments (MAT) are delivered, etc.
6. Service interventions: Places where proposed interventions and test of change take place, and where additional capacities are being introduced.
7. Gaps: These could be any gaps that stakeholders have identified but do not know where to fit in.

Clustering and Drawing Connections

System maps can include various elements and components, depending on the specific context and purpose of the map. Once we received the current status map from our stakeholders, we reviewed it using other supporting information including desk research to gain a clear understanding of the current map. The next step was to apply clustering and drawing connections to make sense of the complex system.

Service Clustering and defining boundary:

Group similar services together based on their functions and goals. This arrangement may take several iterations to help you decide the focal point in terms of what to highlight. This process also helps to frame the boundary of the system you want to map out. In our example, we have used all services operating in a geographical location that is covered by one of the Health and Social Care Partnerships in Scotland.

Some examples of clustering include:

a) Group services that are offered at different levels such as primary care, secondary care and third sector providers

b) Identify key stakeholders operating within these service clusters and their roles within the system: Make sure to Identify any missing stakeholders and service providers

Clustering service parts and components can act as fundamental building blocks of the system. They can be represented as nodes or shapes in the map and include things like organisations, individuals, processes, or physical objects. In our map these were the service providers and stakeholders. To help recognise them easily, we have used shapes, colours and labels to differentiate clusters from one another. By doing that we created subsystems within the larger system.

Drawing connections:

Once clustering is done, the next step is to identify relationships to highlight the interconnectedness between clusters and how they are related. We can take different lenses to highlight the dynamics and networks and these may include communication, engagement, influence, causality, etc. When drawing connections we use lines and arrows to show different relationships and this may include input-output relationships. We have used different colour schemes to show entry routes and discharge pathways separately. You can also apply different weighting and different line styles to show various relationships ( e.g. solid lines for direct relationships, dotted lines for potential connections, thicker lines for strong connections and directional arrows). Indicating temporal aspects of the system, such as timeframes, waiting time or duration of care can help in understanding the system's dynamics over time.

Highlight the map focus:

There may be different things you want to highlight in the service map. For instance:

• Service Access Points: Highlight areas where services are accessible and areas with limited access. This shows where bottlenecks in the system are, including which services require more resources, input and capacities to deliver the service better.
• Patient Pathways: Map out the typical pathways patients follow when seeking help, including referrals, intake processes, and ongoing care including timeline. The relationships between different service providers and how patient pathways fit in within the current system is important to represent various types of connections, such as causality, influence, communication, or dependency.

When drawing connections you can also highlight feedback mechanisms that exist within the system. These loops show how changes or actions in one part of the system can loop back and affect other parts, creating dynamic behaviours, often in a cyclical manner.

System mapping tool