Journal article
Development and application of ‘systems thinking’ principles for quality improvement
BMJ Open Quality, Vol.9(1), e000714
2020
Abstract
Introduction: 'Systems thinking' is often recommended in healthcare to support quality and safety activities but a shared understanding of this concept and purposeful guidance on its application are limited. Healthcare systems have been described as complex where human adaptation to localised circumstances is often necessary to achieve success. Principles for managing and improving system safety developed by the European Organisation for the Safety of Air Navigation (EUROCONTROL; a European intergovernmental air navigation organisation) incorporate a 'Safety-II systems approach' to promote understanding of how safety may be achieved in complex work systems. We aimed to adapt and contextualise the core principles of this systems approach and demonstrate the application in a healthcare setting. Methods: The original EUROCONTROL principles were adapted using consensus-building methods with front-line staff and national safety leaders. Results: Six interrelated principles for healthcare were agreed. The foundation concept acknowledges that 'most healthcare problems and solutions belong to the system'. Principle 1 outlines the need to seek multiple perspectives to understand system safety. Principle 2 prompts us to consider the influence of prevailing work conditions-demand, capacity, resources and constraints. Principle 3 stresses the importance of analysing interactions and work flow within the system. Principle 4 encourages us to attempt to understand why professional decisions made sense at the time and principle 5 prompts us to explore everyday work including the adjustments made to achieve success in changing system conditions. A case study is used to demonstrate the application in an analysis of a system and in the subsequent improvement intervention design. Conclusions: Application of the adapted principles underpins, and is characteristic of, a holistic systems approach and may aid care team and organisational system understanding and improvement.
Details
- Title
- Development and application of ‘systems thinking’ principles for quality improvement
- Authors
- Duncan McNab (Author) - NHS Education for Scotland, United KingdomJohn McKay (Author) - NHS Education for Scotland, United KingdomSteven T Shorrock (Author) - University of the Sunshine CoastSarah Luty (Author) - NHS Education for Scotland, United KingdomPaul Bowie (Author) - NHS Education for Scotland, United Kingdom
- Publication details
- BMJ Open Quality, Vol.9(1), e000714; 10
- Publisher
- B M J Group
- Date published
- 2020
- DOI
- 10.1136/bmjoq-2019-000714
- ISSN
- 2399-6641
- Copyright note
- Copyright © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/ This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
- Organisation Unit
- Centre for Human Factors and Systems Science; University of the Sunshine Coast, Queensland
- Language
- English
- Record Identifier
- 99450973902621
- Output Type
- Journal article
Metrics
13 File views/ downloads
120 Record Views
InCites Highlights
These are selected metrics from InCites Benchmarking & Analytics tool, related to this output
- Collaboration types
- Domestic collaboration
- International collaboration
- Web Of Science research areas
- Health Care Sciences & Services
UN Sustainable Development Goals (SDGs)
This output has contributed to the advancement of the following goals:
Source: InCites