ArticleJournal of general internal medicine2020
Development and Validation of the Systems Thinking Scale.
Article in Journal of general internal medicine, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04356274 (Participatory System Dynamics vs Audit and Feedback), which is not on this map. Cited by 22 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Participatory System Dynamics vs Audit and Feedback: A Cluster Randomized Trial of Mechanisms of Implementation Change to Expand Reach of Evidence-based Addiction and Mental Health Care
Who cites it
22 citing papers in PubMed, 71 citations in OpenAlex.
- Integrating Systems and Critical Thinking, Clinical Reasoning, Decision-Making, and Judgement in Dietetic Education: Development of a Conceptual Pilot Model.Journal of human nutrition and dietetics : the official journal of the British Dietetic Association · 2026Article
- Patient Safety Competency Among Operating Room Nurses: Associations With Safety Attitudes, Systems Thinking and Burnout in a Multicentre Cross-Sectional Study.Nursing open · 2026Observational
- Strengthening patient safety competencies among physician interns through a structured quality and safety course.BMC medical education · 2026Article
- Evaluating the use of participatory system dynamics group model building for expanding systems thinking capacity among community-based stakeholders.Journal of prevention & intervention in the community · 2026Article
- A Qualitative Content Analysis Exploring Systems-Based Practice Across Health Professional Competency Standards.Journal of human nutrition and dietetics : the official journal of the British Dietetic Association · 2026Article
- Understanding health systems thinking in medical education: qualitative interviews with expert clinicians.BMC medical education · 2026Article
- The impact of nurses' perceptions of systems thinking on patient safety competencies: a cross-sectional study.BMC health services research · 2025Article
- Investigation of the psychometric properties of the German System Thinking Scale in an interprofessional learning setting using the game "Friday Night at the Emergency RoomBMC medical education · 2025Article
- Integrating Systems Thinking in Nutrition and Dietetics Education.Journal of human nutrition and dietetics : the official journal of the British Dietetic Association · 2025Article
- Exploring the hidden synergy between system thinking and patient safety competencies among critical care nurses: a cross-sectional study.BMC nursing · 2025Article
- Using gaming to prepare health professional students to practice systems thinking.Learning health systems · 2025Article
- An interprofessional postgraduate quality improvement curriculum: results and lessons learned over a 5-year implementation.Medical education online · 2024Article
- Systems thinking in, and for, public health: a call for a broader path.Health promotion international · 2024Article
- Teaching Systems-Thinking Concepts with Hypothetical Case Scenarios: An Exploration in Food-Systems Science Education.Foods (Basel, Switzerland) · 2023Article
- Individual sustainability competence development in engineering education: Community interaction open-source learning.PloS one · 2023Article
- Systems thinking in practice when implementing a national policy program for the improvement of women's healthcare.Frontiers in public health · 2023Article
- Assessing System Thinking in Senior Pharmacy Students Using the Innovative "Horror Room" Simulation Setting: A Cross-Sectional Survey of a Non-Technical Skill.Healthcare (Basel, Switzerland) · 2022Article
- Systems-Based Practice: Time to Finally Adopt the Orphan Competency.Journal of graduate medical education · 2021Article
- Quality improvement education innovation: evaluation of Coursera MOOC 'Take the Lead on Healthcare Quality Improvement'.Journal of research in nursing : JRN · 2021Article
- Safety culture and systems thinking for predicting safety competence and safety performance among registered nurses in Saudi Arabia: a cross-sectional study.Journal of research in nursing : JRN · 2021Article
Corrections and comments
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Authors and funding
4 authors at 2 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeSystems thinking is the ability to recognize and synthesize patterns, interactions, and interdependencies in a set of activities and is a key component in quality and safety. A measure of systems thinking is needed to advance our understanding of the mechanisms that contribute to improvement efforts. The purpose of this study was to develop and conduct psychometric testing of a systems thinking scale (STS).
methodsThe development of the STS included obtaining national quality and safety experts' conceptual domains of systems thinking and the generation of a provisional set of items. Further psychometric analyses were conducted with interprofessional healthcare faculty (N = 342) and students (N = 224) engaged in quality improvement initiatives and education.
resultsOf the 26 items identified in the development phase, factor analyses indicated three factors: (1) system thinking (20 items), (2) personal effort (2 items), and (3) reliance on authority (4 items). The six items from factors 2 and 3 were omitted due to low factor loadings. Test-retest reliability of the 20-item STS was performed on 36 healthcare professionals and a correlation of 0.74 was found. Internal consistency testing on a sample of 342 healthcare professionals using Cronbach's alpha showed a coefficient of 0.89. Discriminant validity was confirmed with three groups of healthcare professions students (N = 102) who received high, low, or no dose levels of systems thinking education in the context of process improvement.
conclusionsThe 20-item STS is a valid and reliable instrument that is easy to administer and takes less than 10 min to complete. Further research using the STS has the potential to advance the science and education of quality improvement in two main ways: (1) increase understanding of a critical mechanism by which quality improvement processes achieve results, and (2) evaluate the effectiveness of our education to improve systems thinking.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.