System and Organizational Levels

Today at work, our discussion led to me digging out an old information framework I put together back when I first started with CIHI. The framework consisted of three views: System, Organizational and Technical. Each view consisted of categories, and each category contained information elements. For example, the Structure category was under the System view and contained information elements such as Health System Configuration and Government. Question was raised from my colleagues on the difference between System and Organization Views. It’s been so long since I touched the framework and I didn’t have any good answers to the question. I felt bad for not coming up an answer, so I started to search the literature I reviewed back in 2018 when I worked on the framework. I didn’t come up anything successfully; however, I found an article from Implementation Science on This article talked about the different characteristics from organizational and system levels that influenced implementation of shared decision-making. I thought the content was worthwhile to share.

System and Organizational Characteristics (2018)

According to the authors (Scholl, LaRussa, Hahlweg, Kobrin and Elwyn), organizational-level characteristics influencing the implementation of SDM (shared decision-making) has six main categories: organizational leadership, culture, teamwork, resources, priorities and workflows. Five of the six categories also included some subcategories of characteristics. Besides the six main categories of organizational-level characteristics, there were four system-level characteristics that could influence implementation: incentives, policies and guidelines, culture of health care delivery, and healthcare provider education and licensing.

This information is helpful to shift some of the categories and elements identified in my framework and realign them in both system and organizational views.

Reference: Scholl, LaRussa, Hahlweg, Kobrin and Elwyn (2018). Organizational- and system-level characteristics that influence implementation of shared decision-making and strategies to address them – a scoping review. Accessed from: