A system’s complexity can be defined by the number of interactions between the separate parts of the system. The more interactions between the parts, the more complex the system becomes (Naaldenberg, et al, 2009). Within the complex system, many process problems arise that require an assortment of interventions. Consequently, problems are often poorly defined. The co-operation and communication of many different people and departments is key to uncovering viable solutions. These types of systems require an approach with a more holistic nature. The systems thinking approach highlights that there is a larger system with many interacting components that need to be taken into account when addressing problems and implementing change. In a hard …show more content…
system approach, such as many of the quality improvement methodologies, the focus is on defining a main problem to provide the best solution (Naaldenberg, et al, 2009). With a focus on the system as whole rather than specific parts, long-term and sustainable changes can be implemented. Therefore, systems thinking should be applied to improve the delivery of healthcare in a complex system. Cardiac surgery patients are amongst a group with complex care needs, where a variety of factors and people influence the management of care and recovery. An increase in technology for providers, patient acuity, and heavy patient caseloads can cause variation in patient management and errors in processes (Trbovich, 2014). Based on my personal experience, on average postoperative care required in the hospital setting is between five to seven days. However, for several patients, other comorbidities exist, and prolonged hospitalizations resulting in deconditioning is common. In many instances, it is recommended by the physical therapist that a patient be discharged to a rehabilitation facility after deemed medically appropriate by the surgeon. Making arrangements for rehabilitation requires a variety of time-consuming steps that involve many players. Additionally, there does not seem to be a standardized method for triggering the processes. Therefore, when a patient is medically stable and ready for discharge, there have been prolonged hospital stays. Prolonged hospitalization for medically stable patients is costly, increases the risk for hospital acquired infection, and unnecessary use of hospital resources. Applying a systems thinking approach to the problem will be beneficial toward reducing practice variations with the achievable goal of streamlining discharge planning and the implementation of a maintainable process. Systems Thinking Systems thinking focuses on concepts such as system structure and system behavior influenced by the environment, dependencies, and feedback loops.
“Systems thinking centers on the dynamic interaction, synchronization, and integration of people, processes, and technology. 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” (Trbovich, 2014).
Trbovich (2014) provides five ways in which systems thinking can be incorporated into healthcare organizations. First, a holistic approach to problem solving should be applied. Instead of studying each patient’s discharge plan individually the process should be reviewed in its entirety. Reviewing the process structure also helps to recognize task dependencies and outlines the sequence of events as well as the types of coordination that are required for the discharge process (Trbovich, 2014). Also, all stakeholders’ needs should be taken into account when examining a problem. The requirements of the patient, the physician, physical therapist, rehabilitation facility, and care manager should all be taken into account to avoid solving one problem while creating another. For example, if every post-operative patient has a physical therapy order on post-op day one, this may improve the timing of physical therapy recommendations, and in turn improve
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the lag time between hospital and discharge. However, not every patient may need physical therapy, which can create a problem of abusing the physical therapy teams intentions and develop staffing problems. Secondly, approaches to evaluating and understanding system-wide effects should be defined. In order to determine accurate conclusions, interventions effects should be studied over time. Interdependence among variables is often distantly related to the initial intervention and the effects of the intervention may not be linear over time (Trbovich, 2014). The cause and effect relationship in the complex system is circular and includes balancing feedback when trying to attain the goal. The end result of discharge will feedback to the patient in an attempt to further develop the process. Third, the system needs to identify and nurture great systems thinkers. Implementing a process for improving discharge planning should include team members with strong leadership skills who are constantly questioning system processes in order to promote system wide improvement (Trbovich, 2014). “The Five Whys” is the practice used to apply systems thinking. “Current policy, practice, or circumstances are analyzed by asking the question “why?” five times” (Palm & Nelson, 2000, p. 165). Each question layers upon the last and reveals more levels of connectedness and the root cause becomes apparent rather than just the symptoms of the problem. A team including members of the surgical team, nurses, physical therapists, and care managers should be assembled and communicate regularly with suggestions for progressive change. Next, apply a proactive approach to identify leverage points or places that are most effective in resolving problems (Trbovich, 2014). Leverage is identifying changes in structure that can lead to improvements. Making a small structure change, such as ordering physical therapy on postoperative day two on all patients who had decreased mobility preoperatively will help to identify patients who need rehabilitation, likely a few days prior to discharge date. The nurses caring for the patients can also take a proactive approach in the discharge planning process. They can encourage activity and set activity goals for the patient. Then, a nursing judgment regarding a patient’s deconditioning can be concluded. The final recommendation is to create a culture of systems thinking. “Willingness to learn and shift mental models within an organization is essential to this approach” (Trbovich, 2014). Mental models are assumptions or beliefs that people hold, which shapes how the person perceives what is happening. The provider may assume that when a patient is ready to discharge medically, they should be able to leave the hospital. However, this is not viewing the situation as a whole and hinders efforts for improving the discharge system process. The nurse can aid in anticipating a patient’s discharge needs and can alert the provider of any concerns. Overall, the post-op cardiothoracic patient discharge process is part of a complex system.
Many aspects of a systems thinking approach can be applied to the process to evoke change. The most important part of systems thinking approach is viewing the system as a whole and not each part of the process individually in order to be successful. The results should be measured over time so that dependencies can be discovered, and feedback loops should constantly be addressed. The system thinking process can be visualized by a model (Figure 1), with the hopes to simplify and restructure the process in the most efficient
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Determined healthcare systems routinely examine their environments internally and externally to locate significant trends and forces in the present and for the future which will have an effect on their performance goals and mission efforts. These healthcare systems understand who their stakeholders are, their needs and how best to meet those expectations and needs. These systems give attention to specific efforts on accomplishing goals that acquire opportunities in the whole environment while they continue to adjust their internal structures and functions. Precise aims are dealt with by uninterrupted sequences for performance improvements. Strategic directions for systems originate from the mission and directives. Strategic directions are identified by observing key stakeholders, addressing their interests and being proactive about responding to current, as well as, future shifts and trends in the systems’ entire environment (Skinner, 2001).
Due to WellStar being a multi facility health system, its organizational design is constantly being reviewed for simpler and more efficient processes. WellStar’s two smallest hospitals, WellStar Paulding and WellStar Douglas, previously under went reconstruction with regards to their hierarchical structure in Patient Access Services (PAS). WellStar Paulding, the smallest facility of the five hospitals, renovated their managerial chain of command in PAS. WellStar Paulding’s patient volume is less than half in comparison to the 4 additional hospitals. As a result, their staff is smaller and only requires minimal supervision. In the past WellStar Administrators requested supervisors for every department, a manager of the entire department, and a director that managed PAS’ management directly and PAS staff indirectly. Recent cuts ...
“When technology is seen as a combination of devices, skills, and organizational structures, it becomes natural to think of it as a system.”
Health care systems rely heavily on good business principles to be successful. Business principles outlines the structure of how a business will be managed and operated. More importantly, it sets standards and establishes core values for consumers. In a health care system, business is sought from patients. This discussion board will discuss three business principles that are necessary to uphold safe, quality, patient-centered care that is financially sound, if the principles are exercised at my current facility, the reasons why the principles are pertinent in health care, and an explanation of why the principles are of significance.
Hall, G. E., & Hord, S. M. (2011). Implementing change: Patterns, principles, and potholes (3rd ed.). Pearson.
For example, if an organization wants to build a Shared Vision for a project, it cannot be done without Team learning (conversations). This will begin by incorporating Systems Thinking to understand issues within the team. To top everything off, the team will need to understand assumptions and analyze whether the project is going to be worth it (Mental Models).
Royal Dutch Shell (RDS) is the sixth largest company on the planet. It is made up of 1700 smaller companies and employs 101,000 people throughout the world. This is not a nimble start-up company that is attempting to create a brand new culture; this is a behemoth of a company, with over 100 years of history and a workforce that is literally global. The business in which RDS operates is primarily oil and natural gas, commodities that can fluctuate dramatically in market value by the minute. Systems thinkers in the 1970’s at Royal Dutch began to plan for many future scenarios, including a future where a barrel of oil would cost $15 (this, at a time when the value of a barrel of oil was $30 a barrel). This was a move in a positive direction. However, if RDS was to survive for another 100 years, then a new culture had to be born out of the old to enable it to adjust to these possible scenarios. In the 1990’s, Royal Dutch Shell began its transformation into a learning organization. There is now an emphasis on self-direction for every employee and a true commitment at all levels of viewing mistakes as learning models. Management has to allow the organizational systems and structures to be re-made, and then commit to the belief that everything is subject to re-examination.
The complexity of the health care system provides a unique dilemma for leaders. Health care systems are multi-dimensional; composed of numerous specialties, professional areas, and multidisciplinary interests who often have conflicting goals. Great leadership needs to capitalize on the diversity within health care organizations, efficiently utilize resources when designing management processes, and encourage personnel in diverse health areas to work towards common goals (AL-Sawai, 2013). A number of leadership approaches can be adapted to the healthcare setting to optimize management in this unique and complex environment.
For today’s managers, there is a need to learn and to understand the complex nature of complex problems, but not from the simple version, we know and learned from an early age. J. Atwater and Paul Pittman (2006) clarify that as children we learn in a simple linear view. For example, if someone cries, there will be someone there to comfort. A simple action and result, but in reality it is more dynamically complex, not simply a cause-and-effect, or cause and reaction. According to Jay Forrester (1995) , it is hard for a company and senior leadership to evaluate behavior in a complex environment without tools and technology. People do not naturally think systemically or strategically, therefore, managers must be trained in systemic thinking tools and concepts to learn strategic thinking (Forrester, 1995). From the perspective of the structure of an organization, it is important in how the organization structure influences behavior and decision making by placing constraints on what the company has historically known from its experiences, which influence decision-making process within the business. According to excerpt articles from Bob De Wit and Ron Meyer, strategic thinking is not simply framed in the manner in which we have learned in our prior class. In the prior class, we framed our understanding according to Hamel and Prahalad (1996), the rational reasoning approach. To expand on strategic thinking, creative approach must be added to gain additional understanding of De Wit and Meyer’s intent, in addition to a rational systems thinking approach.
In order to develop a way for the Forestry to prioritize who makes what kind of input to their direction, it will be important to understand how different stakeholder groups communicate with one another and with local Forestry offices. Applying systems thinking to support decision makers and capture best practices born at the local Forestry offices with the goal of transferring learning to the organization at the institutional level, while maintaining the capacity for innovation and imagination across the Forest Service will provide a process for continuous improvement. I recommend the Forest Service implement Bryson’s ten-step Strategy Change Cycle in order to identify and implement feasible change and evaluate outcomes toward that continuous improvement. Bryson offers that the Strategy Change Cycle may be viewed in several ways. I propose we apply a “processual model for decision making” in order to implement change by baking the model in to the processes used by decision makers and learners across the agency.
Three waves of systems theory were developed (Healy, 2005). The first wave, being General systems theory. General systems theory is about focussing on a more effective social order for the client,...
After the systems planning is complete, the next course of action is the systems analysis phase. This phase includes defining the requirements of the system. This means that the team must conclude what the system needs to do in order to satisfy the users. This is done by forming a requirements...
There are positives and negative feedback loops in life (Meadows, 1999). The positive serves as an uncontrollable source of growth if not managed; the negative loop serves as an intervention that reduces the self-multiplying power (Meadows, 1999). Like with medical graduates, there are countless positive feedback loops in society reward the winners with the resources for bigger winning next time (Meadows, 1999). However, the opportunity for change exists when understanding the archetypes and relaying the message of thinking as a system. Communication is primordial when individuals, teams, departments, and organizations increase communication capabilities that promote systems perspectives. Systems archetypes provide the language to explain habitual patterns of behavior (Senge, 2006). Mastering systems archetypes promotes the practice of systems perspectives (Senge, 2006). The purpose of systems archetypes is to recondition perceptions, to be abler to observe structures at play and to distinguish the leverage in those structures (Senge,
middle of paper ... ... A system of creative suggestions not only stresses on continuous improvement but it also emphasizes importance in identifying problem sources and eliminating waste so that organizational performance can be improved. viii) Vision towards quality achievement.
It took 12 years to perfect his system. His system was based on tasks and that each worker’s assignments should be pre-planned by management. Each job shoul...