Abstract
This article presents the application of the systemic problem structuring approach Viable System Diagnosis (VSD) within the Department of Orthopedic Surgery in a large hospital in Norway. It explains why systemic thinking is relevant to this uniquely complex form of human organization. The department was coping with systemic dysfunction and VSD was chosen because previous applications demonstrated VSD excels at diagnosis of what is causing dysfunction. VSD was employed through a participatory framework that included in the process, among other stakeholders, medics, technologists, managers, administrators and, as far as possible given the sensitive nature of patient information, the patient. VSD guided thinking about what the organization is set up to do and the existing organizational arrangements to achieve that. The outcome was an agenda for debate that guided stakeholder discussions toward ways and means of improving organizational arrangements. The article briefly reviews previous applications of VSD in the hospital sector and other large complex organisations.
Highlights
Hospitals in advanced economies face a substantial increase in chronic health problems and number of patients; the result of lifestyle-induced diseases and an overall longer life expectancy
We report an application of the systemic problem structuring approach Viable System Diagnosis (VSD) to the care of orthopedic patients in a hospital in Norway
We proposed to the hospital’s Projects Management Team (Clinic Manager, Head of Nurses, and occasional co-opted personnel) the systemic process of learning and problem structuring known as Viable System Diagnosis and our proposal was well received
Summary
Hospitals in advanced economies face a substantial increase in chronic health problems and number of patients; the result of lifestyle-induced diseases and an overall longer life expectancy. Advances in medical knowledge and technology facilitate diagnosis and treatment of a wider range of illnesses and create even more demand on physical and human resources. In many cases the increase in demand outstrips the increase in resources so that delivering effective hospital care has become ever-more challenging and stressful for hospital staff. There is a growing need in hospitals for problem structuring approaches that help hospital staff to gain a better understanding of the complex systemic nature of their work environment, thereby leading to systemic improvement and more effective and enjoyable work practices. We report an application of the systemic problem structuring approach Viable System Diagnosis (VSD) to the care of orthopedic patients in a hospital in Norway. Our approach to VSD emphasises a participatory approach that engages involved and affected parties in a meaningful and fair process of identifying weaknesses and ways of tackling them
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