Abstract
IntroductionImproving the quality of healthcare has proven to be a challenging task despite longstanding efforts. Approaches to improvements that consider the strong influence of local context as well as stakeholders’ differing views on the situation are warranted. Soft systems methodology (SSM) includes contextual and multi-perspectival features. However, the way SSM has been applied and the outcomes of using SSM to stimulate productive change in healthcare have not been sufficiently investigated.AimThis scoping review aimed to examine and map the use and outcomes of SSM in healthcare settings.MethodThe review was based on Arksey and O’Malley’s framework. We searched six academic databases to January 2019 for peer-reviewed journal articles in English. We also reviewed reference lists of included citations. Articles were included if they were empirical studies focused on the application of SSM in a healthcare setting. Two reviewers conducted the abstract review and one reviewer conducted the full-text review and extracted data on study characteristics, ways of applying SSM and the outcomes of SSM initiatives. Study quality was assessed using Hawker’s Quality Assessment Tool.ResultA total of 49 studies were included in the final review. SSM had been used in a range of healthcare settings and for a variety of problem situations. The results revealed an inconsistent use of SSM including departing from Checkland’s original vision, applying different tools and involving stakeholders idiosyncratically. The quality of included studies varied and reporting of how SSM had been applied was sometimes inadequate. SSM had most often been used to understand a problem situation and to suggest potential improvements to the situation but to a lesser extent to implement and evaluate these improvements.ConclusionSSM is flexible and applicable to a range of problem situations in healthcare settings. However, better reporting of how SSM has been applied as well as evaluation of different types of outcomes, including implementation and intervention outcomes, is needed in order to appreciate more fully the utility and contribution of SSM in healthcare.
Highlights
Improving the quality of healthcare has proven to be a challenging task despite longstanding efforts
Despite longstanding efforts to improve the quality of healthcare, increasingly there is a recognition of diminishing returns despite the considerable investments made [1]
It allows for studies using different designs and methods to be included and synthesised, which was considered necessary for this review
Summary
Improving the quality of healthcare has proven to be a challenging task despite longstanding efforts. Despite longstanding efforts to improve the quality of healthcare, increasingly there is a recognition of diminishing returns despite the considerable investments made [1] This is because many of the most pressing issues in healthcare improvement—including integration of services [2, 3], culture change [4], and treating patients with chronic diseases [5]—resist easy solutions. It is not just the problems that are complex; healthcare systems are increasingly understood as complex adaptive systems in that they are comprised of diverse, interconnected agents (e.g., patients, clinicians, hospital managers, government policymakers) whose localised interactions over time give rise to emergent, system-level behaviours [7, 8] Such systems are considered to be more than the sum of their parts; we may be able to discern patterns in the behaviour and performance of the healthcare system as a whole, the agents that comprise it always inevitably act locally, and are interdependent with those around them. Trying to change or improve some aspect of the system, must begin with consideration of this local context [9]
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