Iceberg model

Many factors contributing to healthcare issues are not immediately apparent, like an iceberg, only a small portion is visible above the waterline. The Iceberg model is a powerful tool that helps visualise a holistic view of the system leading to more effective and sustainable improvements.

To make the most of the tool, you must be willing to:

  • seek diverse perspectives

  • challenge assumptions

  • approach with curiosity and humility, and

  • engage with uncertainty.

Download the Iceberg model template.

The iceberg model involves exploring 4 stages that represent a different ‘depth’ of the problem in the system starting with the immediately visible surface layer through to the deeper systemic influences that contribute to systemic problems.

1. Events

The tip of the iceberg represents the most visible occurrences or issues that we notice and react to, including:

  • actions

  • outcomes

  • events.

2. Patterns and trends

If we string events together, we start to see patterns and trends that emerge from within the system.

  • Studying patterns and trends enables us to see beyond individual incidents and understand deeper dynamics within the system.

  • To make change at this level we need to anticipate the patterns that occur and make plans to intervene.

  • By identifying and analysing patterns, we can move beyond treating symptoms of recurring issues.

3. Underlying structures

Patterns are maintained by the underlying systems, rules and norms within the system.

  • At this level we start to expose higher leverage opportunities for sustainable change. By changing structures we can have greater influence over patterns and events.

  • Take the time to understand how various structures interact and influence each other as this provides further opportunities for intervention.

  • By redesigning structures, we can help support desirable patterns or reduce undesirable patterns.

4. Mental models

Mental models are deeply held beliefs, assumptions and values that shape individual and organisational world views.

  • These ultimately guide decision making that influence the structures, patterns and events above.

  • Understanding and addressing mental models is key to driving meaningful change. By challenging and reshaping these beliefs, health systems can create environments that support more effective, patient-centered, and sustainable practices.

  • While changing mental models can be very difficult, doing so offers the power to make transformative change.