How does a system work?

Work Redesign

Knowing how a system "works" is necessary in order to change it.

So here goes.

The "state" of the system is whatever amount of stock exists in the system right now. The break room sink is half full of water. All of the exam rooms are occupied. My energy level is low. Water, patients, and energy are all stocks.

Inflows increase the stock. Turning on the faucet. A patient arrives to the appointment. A phone call with a friend, a piece of chocolate, and a vacation give me energy. Outflows decrease the stock. Water down the drain. An exam is completed. Meetings and responding to email in the evenings decrease my energy.

Stocks and flows.

It takes time for an inflow to accumulate in a stock—the drain must be stopped in order for a sink to fill. If the inflow rate is higher than the outflow rate (patients arriving first thing when the clinic opens), the stock will rise (patients in exam rooms). If the outflow rate (lots of meetings, all the energy sapping realities of a pandemic) is higher than the inflow rate ... the stock decreases ( ... burnout).

Information causes flows to change, which then causes a stock to change. If you're about to wash the stack of your co-workers' dishes sitting next to the sink, you have a desired water level in mind (your goal; well there are actually two goals in this example, but for the time being, let's focus on the sink). You stop the drain, turn on the faucet, add a little dish soap, and wait as the water fills the sink ... "until the discrepancy between the goal and the perceived state of the system is zero."

If you start to wash a dish and the water is splashing all around the break room because the sink is too full, you can open the drain until the water drains to your (new) desired level.

Turning on the faucet to add water (inflow) and opening the drain to reduce water (outflow) are two negative, or correcting, feedback loops—both of which you can use to bring the water level to your desired goal and in this case, the connection between the goal and feedback are invisible.

Pretty straightforward.

Now add another faucet to the sink, you have one hot and one cold, and the need to adjust for another system state: temperature. Suppose the hot inflow is fickle—it has been since you started working here—and while you're adjusting the hot inflow to find the right temperature, a co-worker comes into the break room and shares the latest office gossip ... you're not paying attention to the sink's water level ... "The system begins to get complex, and realistic, and interesting."

Now turn the sink into your organization's cash on hand—accounts receivable collects payments (many little inflow faucets), accounts payable makes payments (lots of large outflow faucets); add a pandemic and the inflow faucets are reduced, while the outflow faucets are significantly increased; now the CFO is doing some maneuvering with banks and investment firms to ensure the organization has enough cash on hand to make payroll and pay suppliers. Extrapolate that out to every healthcare organization in the country, combined with the effects of a pandemic on other capital-intensive businesses, and it's enough to cause the federal government to draft emergency legislation in an attempt to make sure organizations can keep operating.

Hopefully it all works—and hopefully you can begin to imagine how simple stocks and flows, connected to other simple stocks and flows, make up systems "too complex to figure out."

(Thanks to this intro from Donella Meadows which I leaned on heavily in writing this introduction.)

Through The Work is a talent development studio for healthcare leadership embracing The Transforming—the always-happening, always-unfolding state of change in your job ... and using it to make more of the change you know should be happening, happen.

The Transforming is the most important professional opportunity of our careers—one that will lead to new job opportunities, real change, and a transformed industry for all of us and everyone else.

My name is Drew Weilage and I work in healthcare, too. At Through The Work, I assist people like you with the skills, attitudes, and points-of-view to propel your professional success. It's personal training for a transforming world of work.

Oh, and pep talks! Get a pep talk when you need one: big day, bad day, or any day at all. Text me at 646-450-2465 or send me a note.

Through The Work Writing

Working Out Loud Blog

Ideas and inspiration on The Now of Work to fuel your thinking, learning, and creating. Get inspired.



Navigating The Transforming—the always-happening, always-unfolding state of change in your job—is the path to personal satisfaction, professional success, and real progress. Here's how to do it.

Get Organized To Get creative

Being organized is the foundation of a creative practice and creativity. Here are a series of guides to help you get organized at work. Get organized.

Learning From The (Work) Experts

Talented people have worked on similar problems to the problems we're now solving. Thankfully for us they've shared what they've learned. So let's learn from them.

(Personal) Professional Development

Your current role can be viewed as a platform to get better at the work you do and how you do the work. Your professional development is a you activity. Make it work for you.


Why we work the way we work is important to understand ... so we can create something better. Here's what's happening.