The design of systems determines the results they produce. Most problems are caused by the system itself, rather than the people involved. Recognising that healthcare organisations consist of complex systems and processes is crucial for improving the quality of care we provide. “Systems thinking” draws upon various disciplines and helps us understand that improvements are achieved through systematic approaches to change that consider this complexity.
“Every system is perfectly designed to get the results it gets. If we want better outcomes, we must change something in the system. To do this we need to understand our systems”
Don Berwick, President and CEO, Institute for Healthcare Improvement (IHI) USA
Understanding your local context, systems and culture
Improvement occurs within a complex system, context, and culture. There are elements within your system, context, or culture that can either support or hinder your improvement work. Consider the following:
- What does your benchmarking information reveal about your local context?
- What patterns can be observed from your service data?
Take a closer look at your team. Do you have a clear aim that everyone is working towards? What are your working patterns? How do you communicate effectively with each other and with service users? Do people feel safe and listened to? Are they empowered to make changes? Is it a conducive work environment? Does the building and technology support or hinder your work? Is there good accessibility?
A helpful starting point in understanding your local system is conducting a 5Ps assessment, which is a key tool derived from microsystem theory at the Dartmouth Institute. This assessment examines your system in terms of the following:
- What is the purpose of our system?
- Who do we care for? Are there any sub-populations that we could care for differently?
- What support do we need?
- How satisfied are our patients and caregivers?
- Who provides care and support?
- What skills and talents are required?
- What is the role of IT?
- How is staff morale?
- How is care delivered? (core/supporting processes)
- Do our operating hours align with our customers’ needs?
- How does technology support us?
- How do we learn from our mistakes?
- Health outcomes
- Cost of care
- Interaction with other systems
- Common work activities
- What is it like to work in the team?
- How often is quality and safety discussed?
- Team traditions and rituals