Development and application of 'systems thinking' principles for quality improvement

McNab, D., McKay, J., Shorrock, S., Luty, S. and Bowie, P. (2020) Development and application of 'systems thinking' principles for quality improvement. BMJ Open Quality, 9(1), e000714. (doi: 10.1136/bmjoq-2019-000714) (PMID:32209593) (PMCID:PMC7103793)

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.

• Item Type: Articles
• Keywords: Complexity, human factors, quality improvement.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Bowie, Dr Paul and McNab, Duncan
• Authors: McNab, D., McKay, J., Shorrock, S., Luty, S., and Bowie, P.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > General Practice and Primary Care
• Journal Name: BMJ Open Quality
• Publisher: BMJ Publishing Group
• ISSN: 2399-6641
• ISSN (Online): 2399-6641
• Published Online: 24 March 2020
• Copyright Holders: Copyright © 2020 The Authors
• First Published: First published in BMJ Open Quality 9(1): e000714
• Publisher Policy: Reproduced under a Creative Commons License