created by the BC Patient Safety & Quality Council
Activities for Transforming Teams
and Igniting Change
ATTIC is a collection of tools, games, and activities to inspire innovation, teamwork and engagement in health care settings.

Ripple Effect

This activity demonstrates how you can have a system-wide effect by touching only one element in a system. Sometimes, in isolation, it can be difficult to see that everything we touch has the potential to cause a ripple effect throughout our system. As you embark on your journey of change and transition, what are the implications for the system you work in?

Download Activity Worksheet

  • 10-15 minutes
  • Minimum of 30
  • Space large enough for the group to move around

  • Source: Adapted from Eye Openers; Systems Thinking Playbook

What to do

  1. Have participants stand up.
  2. Have them look around the room and secretly select two people. Tell them not to reveal who they have picked!
  3. Instruct participants that when you say “go” they should try to make an equidistant triangle with those two people. That means they should stand so there is an equal distance between them and each of the two people selected. For example, if I picked you and you, I would stand somewhere around here; if one of you moves, I also have to move with you to keep the equidistant triangle intact
  4. Instruct participants that they are to stick to their original two people throughout this activity. They must keep the triangle intact. No talking. No touching! Okay, get into position.
  5. Once they have had a few minutes to get into place, instruct participants that you are going to touch one of them on the shoulder and move them to a new location.
  6. Instruct everyone that they must all try to maintain their equidistant triangles as this person is moved.
  7. Repeat the exercise 2-3 times staying with the original two people.


What did you observe during this activity?

  • Did anything surprise you?
  • How does this relate to your work?

In his book The Fifth Discipline: The Art & Practice of the Learning Organization, Peter Senge offered this simple, yet profound axiom: “Small changes can produce big results – but the areas of highest leverage are often the least obvious.” Here, he refers to what systems thinkers call “leverage points” – well-timed, well-placed actions that can produce significant, lasting improvements/changes. Most people immediately grasp the concept of leverage points, but to spot them in an actual system is often more difficult. This exercise quickly illustrates the concept of leverage points through concrete changes made to the group’s structure when one person is moved.

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