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Grasp of systems puts change in perspective The Mind Your Health educational series for August is “Making Changes: Moving Beyond the Status Quo.” This free seminar, presented by Dean Schuyler, M.D., is Aug. 15 from 6 to 7:30 p.m. in the auditorium of the Institute of Psychiatry.  by Penelope Chase Psychiatric Consultation Liaison Because the Medical University Hospital Authority and MUSC system are part of the U.S. health care system as well as the university-hospital system, we thought a brief review of systems theories might be helpful to put the changes we are currently enduring into a larger perspective. The following very brief overview is meant to show that our human reactions to change in a system are rather predictable. It also demonstrates why communication (feedback) is so crucial in times of system dys-equilibrium to help reestablish a dynamic and vital balance in the reconfigured system. Definitions: System n. 1. A group of interacting, interrelated or interdependent elements forming a complex whole.(American Heritage Dictionary, 1991) System: A set of objects together with relationships between the objects and between their attributes. (Broderick & Smith, 1979.  The General Systems Approach to the Family) Human Organization: A natural social system which responds automatically to forces which threaten its survival or well-being or those of its members. (Comella, The Emotional Side of Re-engineered and Re-invented Workplaces: in The Emotional Side of Organizations: Applications of Bowen Theory—a paper presented at the Georgetown Family Center’s Conference on Organizations, April 22-23, 1995) Systems can be open or closed.  Closed systems, deprived of the stimuli of  input and output, eventually end in entropy (death).  Open systems with permeable boundaries are more apt to stay dynamic and flourish, or at least continue to function. In general systems theory a change in one part of the system affects all other parts, due to relationships and interdependence of the parts. Input generates energy for the open system. Output is the product of the processing of the energy (throughput) within the system.  Think of an oil-fueled furnace (a simple open system). Oil is put in. It is processed/burned. Heat is put out. If we have a thermostat hooked up to the furnace to measure the air temperature in a room, it will tell the furnace when to stop putting out heat and when to re-start oil going in to produce more warmth. Hence output becomes part of feedback. In a system that is selectively open,  matter, energy, and  information can be filtered in and out of the system in a manner healthy to the system (Clements, 1983. Elements of a Living System). The elements in a system are in “constant and meaningful interaction.”...  “Control within the system keeps them within acceptable limits and also permits adaption to occur.  This controlled adaption is critical to the living (open) system and leads to growth and development. The selectively open system with its permeable boundary maintains a steady state or homeostasis” (Clements, p. 64).  This might be equated with a “status quo.” When protective filters fail, the dynamics of the steady state are interrupted. A healthy system is able to adjust and adapt, using the feedback/input functions of the system. Comella states in her paper that “Bowen’s family systems theory may inform the workplace about how the organization may be conceptualized as an emotional system and about what is to be expected when an organization embarks on a process of continuing change to survive and compete in the marketplace” (p. 46). Describing a natural social system’s reciprocal relationships between a system and its members, Comella writes:  “...relationships have an emotional component.  Through their membership, individuals derive benefits not otherwise realizable either fully or in part and automatically accept constraints on choice and functioning as a condition of membership. The system itself extracts contributions from its members but, since it cannot survive without members, automatically limits what it demands of its members.  “When the survival or well-being of the system is threatened or the conditions for survival are harsh, members of the system tend to accept greater constraints on functioning to enhance survival or ensure the continuation of benefits.” (p. 39) She continues: “From a natural systems perspective, ...chronic anxiety is a product” or characteristic of a restructured workplace (p. 40). This anxiety is a predictable response to the stress of uncertainty and reflects the diminished flexibility to adapt to the perceived threats that imposed change implies to members of the system. If, at some point, “the constraints on functioning of the organization ...exceed the limits of the system or its members to adapt... instabilities or symptoms may develop, including movement of members from one social group to another or the formation of new groups” (Comella, p.39).  The local newspapers have reported recently some incidences or predictions of this phenomena occurring in vulnerable South Carolina hospitals.  Members of an organization need to be responsive to the needs of the marketplace in a cost-effective, efficient manner “so that the organization may survive or enjoy continued well-being” (Comella, p. 40). There is more to be said of systems, of course, and how organizations and their members may respond to stress and threats, both internal and external. This is merely a brief overview of some basics to remind us that we indeed are living in a manmade open social and organizational system which is changing and adjusting as both invited and uninvited input.