What is common between these two very different settings: sitting in a moving aeroplane and having a surgery done in an operation theatre? Well, both are highly complex, man-made environments that their end-users are hardly aware of. These environments are operated by highly skilled technical teams that carefully monitor several parameters on a real-time basis and do the needful to give a good experience to its users.

These complex environments don’t exist in isolation. There is a full ecosystem around these controlled settings that prepare patients or passengers for it. For instance, if you are catching a flight, you need to follow a well-laid down procedure of collecting/printing your boarding pass, handling check-in baggage, undergoing security checks, boarding an aircraft and so forth.

Similarly, for a patient who is to undergo surgery, his body vitals such as blood pressure and sugar levels are brought under control, all the necessary documents — be it diagnostic reports or consent forms — are put in order before rolling a patient in an operation theatre.

How is this all created? Well, systems thinking is applied to design these complex environments as well as to form an ecosystem around it. A design team is typically a multidisciplinary team consisting of engineers, architects, behavioral scientists, management experts and so forth, who co-created the environment while evaluating it from different perspectives. The entire ecosystem is designed from the users’ perspective.

System Design

Systems design thinking is needed not only for the aviation and healthcare sectors. It’s necessary for solving almost every development challenge — be it in infrastructure, education, transportation, energy, water supply, and sanitation and so forth — in any country. Systems thinking is quite conventional in developed countries, but not so in developing countries. When systems reasoning isn’t applied, we end up either solving only a part of the problem or solving it superficially, or creating new challenges elsewhere.

A large part of NDA government’s response to India’s broken healthcare system is a programme called Ayushman Bharat (AB) that consists of two pillars: the primary care pillar is about converting 150,000 health sub-centers that provide selective care into health and wellness centers.

It would provide comprehensive primary healthcare; the hospital care pillar consists of hospital insurance programme, Pradhan Mantri Jan Arogya Yojana, aimed at giving financial protection of Rs 500,000 per household to almost 100 million poor households against hospitalization costs. Undoubtedly, AB is a big and bold initiative.


In this context, Niti Aayog’s initiation of a development dialogue — a series of multi-sectoral conversations on India’s development issues — is very welcome. The first of this conversation, which was focused on the health system for a new India, seeks to bring systems design thinking into healthcare.

Healthcare is one of the most complex development challenges. Solving this challenge with a systems design thinking needs a longer-term horizon than what is covered in the National Health Policy 2017. Systems thinking doesn’t come naturally to public administrators. So, getting a group of experts in a room to deliberate and develop a blueprint is a progressive step. But the real test of it will depend on achieving necessary coordination between the Centre and states.