Ali McGill (BN’02) has returned to UNB as a researcher and assistant professor in the faculty of nursing, and she’s thrilled to be working in a progressive, community-centred environment. Ali is working at the Fredericton Downtown Community Health Centre to study how immigrants are accessing health care in our region and design a system that works.

She uses a systems thinking research methodology to examine, model, and analyze complex health care processes and systems. From this, an enhanced understanding of process/system functionality is gained. She says that practice and policy recommendations that better match the realities of everyday health care delivery can then be developed.

“It’s so important to do system mapping and modelling based on daily work on the front lines. I collect data, do interviews with health care workers and patients, and begin to map the system to identify challenges and gaps. We often look for problems in health care, but this methodology also looks for successes so that we can enhance them. After this system mapping is complete, recommendations can be made — but only after re-consulting with participants in the study to understand if they are accurate and achievable. This kind of research is co-designed with health care staff. It’s directly based on frontline workers and patients to enhance successes and dampen challenges. We want to design a system that actually works.”

Ali has the clinical and research knowledge to ensure the success of her work. After studying for a nursing degree at UNB, she worked as a registered nurse and nurse practitioner in emergency and urgent care for 21 years in her hometown of Saint John, N.B.

“I loved the work and seeing lots of patients. But over time, I became aware of how complex the health care system is for patients. I wanted to do something to create meaningful change to improve how patients can access and experience care. Rose McCloskey (BN’93, MN’00, PhD’09) at UNB Saint John encouraged me to apply for a PhD — she had been conducting an interesting study with engineers at Memorial University in Newfoundland that examined health care from an engineering-systems lens. This was fascinating, so I transferred to interdisciplinary studies at Memorial to combine systems engineering and health. I immediately knew it had the potential to make a practical impact to improve efficiencies and reduce frustrations in everyday processes.”

Ali says that one of the biggest obstacles in the health care system is that everyone works in their professional silos. “When we want to fix a problem, we’re always looking for the simplest solution in our own area, but with complex systems, you need to confront the full complexity of it. There are no simple solutions. We need to look at the system as a whole and understand how it actually functions on an everyday basis to better inform decision making. This is done by involving the people who do the work, as well as those who experience the work.”

“We want to design a system that actually works.”

Although this kind of research may be novel in health care, Ali comes from a lineage of dedicated health care professionals. Her mother, Barbara McGill (BN’74), dedicated her career to health care and served as chief nursing officer for the Saint John health region before retirement. Her grandmother was also a nurse. Ali says that they encouraged her to take nursing as a way to observe all health professions and decide where she could make the biggest impact. “It was good advice. I loved nursing from the first course I took. I came to UNB to play for the basketball team, and it was challenging to excel as a student-athlete, but I knew this was the right path for me.”

“Now, to come full circle back to UNB has been wonderful. It’s a supportive and welcoming faculty, and the downtown community health centre is a living lab to conduct my research. I feel grateful to be able to help make a difference for people — especially vulnerable people — who deserve a good health-care experience. And I’m looking forward to introducing systems thinking into teaching. The Integrated Health Initiative at UNB will provide opportunities to attract more graduate students to this kind of research. It’s exciting to be here right now.”