Annex 3: elements of a systems approach
A people perspective — identify, locate and situate
A people perspective uses knowledge of stakeholders’ abilities, experience, competence and culture to enable the design of systems that are fit for their intended purpose.
The contribution of treatments, equipment, systems, processes and protocols are undeniably critical to health and care provision; however, it is people who ultimately affect the quality of that delivery. An appropriate awareness of people applies not only to the recipients of care, but also to the providers of care. It is important to acknowledge the diversity of the population and that health and care services should be accessible to, and usable by, as many people as reasonably possible, regardless of age or health condition (Figure 12). Equally, a chief executive and other senior people can have a significant impact on an organisation, through their actions and behaviour, creating a culture that values the importance of the quality of relationships between employees and, most critically, the people in their care.
People are diverse in their size and capability, whether they are members of the public, patients or providers of care. Systems should be designed to be accessible to, and usable by, as many people as reasonably possible.
The success and effectiveness of a system are dependent on consideration of the people within the system, its context or place and the policy defining its operation. This can be represented as a series of iterative identify, locate and situate cycles where it is crucial to pay attention to provider/patient relationships as well as the relationships between health professionals, and how these can be enhanced by providing appropriate technologies, systems and policies to deliver a quality of care judged by the degree of warmth and reassurance shown to both colleagues and the people receiving care.
The people perspective can be thought of as the iterative sum of the identify, locate and situate phases
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Population diversity — a need for inclusive systems
People are at the heart of an effective systems approach,  permeate all stages of the development and delivery of a system, and are rightfully central to the systems, design and risk perspectives.
A people perspective serves to involve patients, practitioners and the public to ensure that the systems created are truly fit for their intended purpose and reflect a deep understanding of how knowledge, competence and culture enables people, individually and corporately, to deliver and receive health and care within a complex socio-technical environment. 
The identify phase asks the question ‘Who will use the system?’ and leads to an understanding of the full range of people involved and their needs and capabilities. It is likely to include a variety of activities to develop this understanding, for example:
- identify all the people who will use the system
- co-create the system with system users
- ensure accessibility for all systems users
- maintain communication between all system users.
The locate phase asks the question ‘Where is the system?’ and leads to an understanding of the context within which the system is situated, including reference to organisation and culture, as well as the demographics and needs of the local population. It is likely to include a variety of activities to develop this understanding, for example
- capture needs of the local population
- identify related or adjacent systems of care
- define structures that will contribute to success
- establish culture to maximise quality of care.
The situate phase asks the question ‘What affects the system?’ and leads to an understanding of the wider context within which the system is situated, including reference to policy opportunities and constraints, and the political landscape. It is likely to include a variety of activities to develop this understanding, for example:
- understand the political landscape
- identify opportunities for improvement
- encourage a systems approach to care
- identify policies that put patients first.
Explore the other perspectives
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 New care models: empowering patients and communities, a call to action for a directory of support. NHS England, Redditch, UK, 2005. www.england.nhs.uk/wp-content/uploads/ 2015/12/vanguards-support-directory.pdf
 Implementing human factors in healthcare, ‘taking further steps’. Clinical Human Factors Group, 2013. chfg.org/best-practice/how-to-guide-to-human-factors-volume-2/