Five Ways to Incorporate Systems Thinking into Healthcare Organizations

Abstract

Healthcare is a complex system that involves high risk to patients, clinicians, manufacturers, and other stakeholders. Clinicians process inordinate amounts of data and synthesize these inputs to make critical decisions that affect patient health and safety. The unprecedented advancement in medical technology during the past half-century has contributed substantially to healthcare’s expanding complexity.1 Consequently, clinicians have more knowledge to synthesize, tasks to perform, and processes to manage than ever before.1 The delivery of care often is overly complex and unstandardized, thereby reducing rather than increasing safety. For example, new devices are being implemented in medical practice at an astounding pace, requiring clinicians to continuously expand their breadth of knowledge and expertise. Consequently, a main cause of adverse events is misuse of medical devices. Variation in medical devices among hospitals (and within a given hospital) is a key cause of these adverse events. Design improvements and standardization of equipment have been suggested as ways to reduce errors. Although new technologies usually are advantageous for the patient, health professionals often encounter difficulties in using devices. Furthermore, current healthcare systems are not designed to support the care of complex patients, such as populations with chronic conditions requiring care management across multiple providers and services. In 2005, a joint report from the National Academy of Engineering and Institute of Medicine advocated the extensive application of systems thinking to improve the delivery of healthcare.2 Systems thinking centers on the dynamic interaction, synchronization, and integration of people, processes, and technology.3 By gaining an understanding of the dynamics among people, processes, and technology, systems thinking aids in recognizing how to intervene (e.g., focusing on changes to device design, clinician training, and/or clinical practice) in the system successfully. Moreover, systems thinking helps identify the critical relationships and connections often missed or undervalued that are pivotal to a successful implementation effort. If the high-risk healthcare industry focuses on an enhanced application of systems-thinking approaches, it will benefit from opportunities to reform the care delivery system by reducing unnecessary complexities and unexplained practice variations. This article describes five ways in which systems thinking can be incorporated into healthcare organizations. Rather than providing an exhaustive list of information, this report is meant to serve as a starting point for exploring how to integrate systems thinking.