Advancing Equitable Nursing Education Through Systems Thinking

As a nurse educator and health care professional, Dr. Ally Brown, PhD, RN, CNE, has built her career at the intersection of curriculum design, academic leadership, and patient-centered care. Based at Western Carolina University, she serves as an Assistant Professor in the Master’s Entry Pre-licensure Program, where she is deeply involved in preparing the next generation of nurses. Her professional journey includes leadership roles in nursing education and recognition as a Harvard Macy Scholar, an experience that sharpened her expertise in health professions education and, critically, in systems thinking.

When Ally enrolled in the Harvard Macy Institute’s Assessment and Evaluation program, she was not simply seeking another continuing education credit. She was looking for a way to fundamentally reframe how assessment is designed and used within complex educational systems.

Looking Beyond Traditional Assessment

Ally came to the program with a clear goal: to better understand how systems thinking could be integrated into assessment strategies in health professions education. As an educator and leader, she had long recognized the limitations of traditional learner assessment methods that focused on isolated skills or single-point measures of performance.

Through the program, she experienced a significant shift in perspective. She began to see assessment not as a discrete act, but as part of an interconnected ecosystem. Curriculum, faculty development, institutional culture, and learner context all interact to shape outcomes. Effective assessment, she realized, must account for—and be intentionally designed around—this complexity.

This lens was especially important for her ongoing project: integrating Social Determinants of Health (SDOH) education across the nursing curriculum. The program reinforced for her that if nurses are to provide equitable, patient-centered care, competencies related to SDOH and health equity cannot be siloed. They must be embedded across didactic courses, simulation experiences, and real-world clinical practice and evaluated in ways that truly capture learners’ readiness to address these competencies in every sphere of care.

The Assessment and Evaluation program also reinforced alignment with national standards, particularly the American Association of Colleges of Nursing (AACN) Essentials. For Brown, this alignment was not a compliance exercise; it was a way to ensure that curriculum, assessment, and outcomes were all oriented toward preparing graduates for the realities of contemporary practice.

A Transformative Learning Experience

Before arriving, Ally expected to deepen her theoretical understanding of systems thinking and its relevance to assessment. The reality surpassed those expectations. Through a dynamic blend of expert instruction, including faculty-led large group sessions and highly interactive small group breakouts, she had structured opportunities to absorb new concepts and apply them to real-world challenges in nursing education, student learning, and patient-centered care.

One of the most memorable and practical concepts she encountered was the “step back” method. Introduced during group discussions, this approach invites leaders and facilitators to pause, observe, and understand the dynamics of a conversation before stepping in. For Brown, this was a powerful tool for facilitating collaborative learning and supporting shared decision-making. It has since become part of her approach to leading teams, classrooms, and curriculum discussions, particularly when navigating complex or emotionally charged topics.

Another standout area was the exploration of triangulating data to assess students’ readiness for practice. Learning how to draw on multiple data sources, rather than relying on a single exam, evaluation, or rubric, gave her concrete strategies to strengthen competency-based assessment. This multidimensional approach has informed both how she assesses learners and how she designs faculty development efforts around assessment literacy.

Collectively, these experiences did more than add tools to her toolkit; they altered how she thinks about her work. The program not only validated her interest in systems thinking; it gave her the confidence and structure to lead with it. 

Community, Faculty, and a Culture of Collaboration

One of the defining features of the Harvard Macy experience for Ally was the truly interdisciplinary and international makeup of the participant group. She credits the diversity of professional backgrounds and global perspectives with expanding her thinking about assessment and evaluation. Conversations with colleagues from different health professions and institutional contexts pushed her to question assumptions, adapt ideas, and appreciate the nuances of implementation in varied settings. The relationships she formed were both personally meaningful and professionally enriching, extending beyond the course in the form of ongoing dialogue, shared strategies, and mutual support.

The faculty’s teaching style was central to the power of this learning experience. Ally describes them as engaging, collaborative, and deeply welcoming. Despite their impressive expertise, they cultivated a space where she felt comfortable asking questions and fully participating. Their approach encouraged open dialogue and affirmed the value of every scholar’s perspective. This atmosphere of psychological safety made it easier to experiment with new ideas, share challenges, and receive constructive feedback.

From Idea to Action: Implementing Change

The impact of the program on Brown’s work was both immediate and tangible. As a direct result of her experience, she assumed the role of Principal Investigator on a research team focused on measuring, integrating, and disseminating education on Social Determinants of Health within health care curricula. The systems-thinking orientation and assessment frameworks she gained at the Harvard Macy Institute (HMI) have been central to how she designs and leads this initiative.

One of the most important lessons she drew from the program was the importance of narrowing focus and building on existing strengths. She initially entered the program with an ambitious goal: to integrate SDOH education across all levels of a Bachelor in Science in Nursing (BSN) curriculum. Through the course, she recognized that attempting to overhaul an entire curriculum at once could be counterproductive. Instead, she shifted toward a more strategic, phased approach of collecting data, identifying gaps, and iterating on what the system was already doing well, while contributing new knowledge to nursing scholarship.

This recalibration extended beyond project design and into her leadership style. She intentionally incorporated the “teach back” method as a core leadership practice. By asking colleagues and learners to reflect back on what they have heard or understood, she is able to listen more deeply, ensure clarity, and help others feel heard and valued. This simple but powerful technique has enhanced her ability to provide feedback, facilitate dialogue, and foster shared understanding. 

A Pathway for Career and Research Growth

For Brown, the HMI Assessment and Evaluation program has been a catalyst for her research trajectory, which is central to her success and advancement in academia. It bolstered her confidence to lead substantive, systems-level projects and reinforced her identity as a scholar committed to improving health equity through education. She sees the program’s influence continuing to shape her career over the coming years: guiding her research questions, informing her approaches to curriculum and assessment reform, and grounding her leadership in a rigorous, systems-based understanding of educational change. 

Advice to Future Participants

Reflecting on her experience, Ally describes the program as genuinely transformative, intellectually and professionally. Her advice to future participants is straightforward: arrive with an open mind and be prepared for meaningful change. She encourages prospective scholars to fully engage with the learning process, embrace the interdisciplinary community, and be willing to reconsider their assumptions about assessment and evaluation. For those who do, she believes the payoff is substantial: new skills, stronger confidence, and a clearer vision of their role in advancing health professions education.

For Dr. Ally Brown, the Harvard Macy Institute's Assessment and Evaluation program did more than refine her understanding of assessment theory. It connected her passion for equity, systems thinking, and nursing education into a coherent, actionable path—one that is already reshaping curricula, informing research, and preparing future nurses to deliver truly equitable, patient-centered care.