A systems approach to healthcare: from thinking to -practice

Abstract

Medicine is increasingly complex, involving a highly connected system of people, resources, processes, and institutions. Attempts to improve care involve disruptions to this system, with the potential for wide-ranging consequences, both positive and negative. Despite this, many improvement methodologies are poorly equipped to manage either complexity or risk - instead focusing on discrete interventions whose effects are narrowly monitored. Engineers have long understood that complex problems require a systems view, and that attempts to make things better can themselves introduce new risk into a system. Given this, an engineering systems approach may be of significant value to those trying to improve healthcare. Two fundamental questions emerge from such an approach: what can we do better, and what could possibly go wrong? This paper describes the evolution of a systems approach to healthcare, and explores a recently co-developed framework outlining a systems approach based upon a synergy between healthcare and engineering.

Keywords: Systems approach; healthcare improvement; healthcare systems; quality improvement; systems engineering.

Fig 1.

The INCOSE (2009) V-model.

Fig 2.

A spiral model of the questions that define an iterative approach to health and care improvement.

Fig 3.

A linear improvement process transforming current performance into a measurably better state.

Fig 4.

A systems-spiral improvement process. An ordered and iterative set of activities drawn from people, systems, design and risk perspectives and linked to the spiral questions, applied at each stage of the improvement process.

Fig 5.

An Engineering Better Care toolkit, facilitating a systems approach to health and care improvement.