A healthcare system is a set of activities with a common set of objectives. For each objective it is necessary to choose one, or more, criteria that can be used to measure progress or the lack of it. The dataset of criteria provides another of the essential elements of a system – the feedback loop.
Examples of the uses of the term system relevant to healthcare
editThe concept of a production system as a socio-technical production system emerged as a way of understanding industrial organisations as simultaneously technical and social arrangements. As formulated in classic work from the Tavistock Institute of Human Relations tradition, a production system necessarily combines “a technological organization – equipment and process layout – and a work organization,” with each shaping the other. While technological demands constrain how work can be organised, the work organisation itself has “social and psychological properties… independent of technology.” At the same time, such systems must satisfy economic requirements, possessing “social, technological and economic dimensions, all of which are interdependent but all of which have independent values of their own.”[1]
Building on this foundation, systems thinking developed into a broader analytical perspective. Peter Checkland emphasised that systems thinking is not simply another discipline but a “meta-discipline” capable of reflecting on and being applied across many domains.[2] In this view, the systems paradigm focuses on “wholes and their properties,” paying particular attention to hierarchical organisation rather than merely aggregating parts.[3]
Across disciplines, definitions of a system converge around the idea of interdependence and shared purpose. In healthcare quality literature, a system is described as a “set of interdependent elements interacting to achieve a common aim,” encompassing both human actors and nonhuman components such as technologies and equipment.[4] Similarly, it has been defined as “a network of interdependent components that work together to try to accomplish a specific aim,”[5] or more succinctly, as “an integrated series of parts with a clearly defined goal.”[6]
A comparable definition appears in general scientific writing. James Lovelock, citing Webster’s New Collegiate Dictionary, describes a system as “an assemblage of objects united by some form of regular interaction or interdependence,” invoking examples such as the solar system, the nervous system, or a computer operating system to illustrate the breadth of the concept.[7]
Taken together, these perspectives position systems as structured wholes composed of interdependent elements, embedded in social, technological, and economic contexts, and analysable through a unifying, cross-disciplinary framework.
Setting of Objectives
editThe setting of objectives and the choice of criteria relating to the healthcare provided for a condition such as Parkinson Disease or Renal Failure has a number of benefits, notably:
- It allows a patient to compare the performance of that aspect of healthcare that is of most importance to them.
- It allows those who allocate resources to judge the value that would be added if additional resources were to be invested in that system, at the expense of systems focused on other health problems.
It is necessary to have closed systems like hospitals and primary care services to employ staff and ensure money is administered with probity but they are all parts of an open system of healthcare and changes imposed in any one closed system will have unintended consequences elsewhere through a feedback mechanism that may, or may not, be predictable. Traditional approaches have sought to manage health problems by tighter control of organisations, that cover a wide range of health problems, hospitals and community care, for example, with patients being referred to the former and discharged to the latter. This two-box approach has many weaknesses, implying, for example, that a hospital is not a community service. Another approach is to present different levels of care as a Venn diagram.
For serious, acute problems, a fractured femur, for example, the spectrum of the relative contributions of the different sectors of care is consistent between countries and within a country. Self care is minimal, primary care by an ambulance service brief, and most care is provided in secondary care, with tertiary care being needed for the person who has multiple injuries in addition to the fractured femur and needs the services of a trauma center. For chronic conditions, however, the distribution of care is often suboptimal because the indications for moving from one level of care to another are often unclear and may be influenced by emotional and, apparently, irrational factors.
Even if the number of patients in each part of the spectrum is correct, there will be some
- Receiving care that is more intensive than they need
- Receiving care that is less intensive than they need
Both groups reduce the value derived from the resources invested.
References
edit- ↑ Trist, E. L.; Higgin, G. W.; Murray, H.; Pollock, A. B. (1963). Organizational Choice: Capabilities of Groups at the Coal Face under Changing Technologies. London: Tavistock Publications. p. 6.
- ↑ Checkland, P. (1993). Systems Thinking, Systems Practice. Chichester: John Wiley & Sons. p. 5.
- ↑ Checkland, P. (1993). Systems Thinking, Systems Practice. Chichester: John Wiley & Sons. pp. 13–14.
- ↑ Kohn, L. T.; Corrigan, J. M.; Donaldson, M. S. (2000). To Err Is Human: Building a Safer Health System. Washington, DC: National Academy Press. p. 211.
- ↑ Nelson, E. C.; Batalden, P. B.; Godfrey, M. M. (2007). Quality by Design: A Clinical Microsystems Approach. John Wiley & Sons. p. 230.
- ↑ Dennis, P. (2007). Lean Production Simplified: A Plain-Language Guide to the World’s Most Powerful Production System. New York: Productivity Press. p. 15.
- ↑ Lovelock, J. (2009). The Vanishing Face of Gaia: A Final Warning. London: Allen Lane. p. 168.