SlideShare a Scribd company logo
Systems theory and quality patient care
Understanding Quality through Systems Thinking Basis of this presentation: Paper by Dr Peter Cusins entitled: Understanding Quality through Systems Thinking Published in The TQM Magazine, 1994
What is a system? A way of thinking about any dynamic process. Five key statements about systems: Arbitrary boundary Inputs cross boundary from environment Within system inputs interact in transformation process Transformed inputs leave system as outputs Direction of flow indicates flow of energy, materials, information, etc.
What is systems theory and how is it relevant to the health sector? – a simple model
The “natural law” of systems “If the outputs of a system do not satisfy the environment, the inputs will cease” Decisions around satisfactoriness governed by the environment The environment is everything not within the artificial boundary of the system
Complexity of Systems ,[object Object]
Environment is complex collection of other systems
“Focus” system is that part on which we are focussing
All inputs to any system are outputs from some other system, all outputs are inputs to another system,[object Object]
Systems in health care Human body is a set of systems: ,[object Object]
Endocrine system
Muscular system
Nervous system
Bronchial system
Alveolar system
Blood systemWhich all work together to maintain bodily health So what are the systems in the health care “body”?
Third principle of systems thinking Whether we zoom in or out, we always find more systems
The concepts of product and waste Product = satisfactory output (the user system is able to use it) Waste = unsatisfactory output (the user system is unable to use it) Because it is an output, “waste” will always enter another system (nature, very often) Waste which is damaging the system it enters is “toxic” waste Applicable to service systems also
The concepts “output” and “outcome” Output produced within focus system – cross boundary into environment Outcome/s the effect of outputs on the environment
Four more principles of systems thinking Outputs can be seen from within the system while outcomes can only be seen outside the system Beneficial or adverse outcomes might only be observable at some remove from focus system Might take some time to manifest External feedback loops impact on effectiveness; internal ones on efficiency
Feedback and open systems Closed system has no feedback loops Open system has effective feedback loops Hard system – purpose of internal feedback loops is to maintain consistency Soft system – effective external feedback loops allow flexible outputs in response to changing needs of users
The relevance of the concept of quality to patient care – a systems view. What is quality? A judgement made at the boundary between producer and user systems Judgement made against referent/s Especially standards agreed between producer and user systems Quality can only start when the supplier knows exactly what the user wants
Quality judgements involve: Observing actual output Comparing output with standards Judging whether or not actual outcomes fulfil expectations of user As Covey said – “is the ladder against the right wall?”
What constitutes quality in terms of patient care? While actual outputs might be defined in terms of agreed standards judgement of outcomes introduces a value question Values are core beliefs about what is good or bad, right or wrong. To judge quality in terms of patient care we have to go outside the system to see the effect of the system on the environment

More Related Content

Similar to Systems Theory And Quality Patient Care

Rules for Healthcare Transformation Frameworks and Tools v1
Rules for Healthcare Transformation Frameworks and Tools v1Rules for Healthcare Transformation Frameworks and Tools v1
Rules for Healthcare Transformation Frameworks and Tools v1
Imad Hassan
 
Walden UniversityMaster of Science in NursingWeek 2 Journa.docx
Walden UniversityMaster of Science in NursingWeek 2 Journa.docxWalden UniversityMaster of Science in NursingWeek 2 Journa.docx
Walden UniversityMaster of Science in NursingWeek 2 Journa.docx
celenarouzie
 
LESSON-1-CONCEPTS-PRINCIPLES-AND-THEORIES-IN-NURSING-INFORMATICS.pptx
LESSON-1-CONCEPTS-PRINCIPLES-AND-THEORIES-IN-NURSING-INFORMATICS.pptxLESSON-1-CONCEPTS-PRINCIPLES-AND-THEORIES-IN-NURSING-INFORMATICS.pptx
LESSON-1-CONCEPTS-PRINCIPLES-AND-THEORIES-IN-NURSING-INFORMATICS.pptx
kayemapa
 
1The Nature of SuccessClass SeventeenREVIEW!!!!.docx
1The Nature of SuccessClass SeventeenREVIEW!!!!.docx1The Nature of SuccessClass SeventeenREVIEW!!!!.docx
1The Nature of SuccessClass SeventeenREVIEW!!!!.docx
vickeryr87
 
Jeanette Kinahan and Dr Sallie Strickland
Jeanette Kinahan and Dr Sallie StricklandJeanette Kinahan and Dr Sallie Strickland
Jeanette Kinahan and Dr Sallie Strickland
Resolution Institute
 
Nursing and Area of Specialty Discussion HW.pdf
Nursing and Area of Specialty Discussion HW.pdfNursing and Area of Specialty Discussion HW.pdf
Nursing and Area of Specialty Discussion HW.pdf
bkbk37
 
Commissioning And Procurement
Commissioning And ProcurementCommissioning And Procurement
Commissioning And Procurement
alecfraher
 
Commissioning And Procurement
Commissioning And ProcurementCommissioning And Procurement
Commissioning And Procurement
alecfraher
 
Mustafa Degerli - 2016 - Systems Ideas
Mustafa Degerli - 2016 - Systems IdeasMustafa Degerli - 2016 - Systems Ideas
Mustafa Degerli - 2016 - Systems Ideas
Dr. Mustafa Değerli
 
Strategic Partnership of Healthcare and SE v.2.5.1
Strategic Partnership of Healthcare and SE v.2.5.1Strategic Partnership of Healthcare and SE v.2.5.1
Strategic Partnership of Healthcare and SE v.2.5.1
Gary Smith
 
شناسایی ائتلاف استراتژیک بهینه با در نظر گرفتن نقش نوآوری باز در طنجیره تامین...
شناسایی ائتلاف استراتژیک بهینه با در نظر گرفتن نقش نوآوری باز در طنجیره تامین...شناسایی ائتلاف استراتژیک بهینه با در نظر گرفتن نقش نوآوری باز در طنجیره تامین...
شناسایی ائتلاف استراتژیک بهینه با در نظر گرفتن نقش نوآوری باز در طنجیره تامین...
PouyaMahdiani1
 
Dr Brent James: quality improvement techniques at the frontline
Dr Brent James: quality improvement techniques at the frontlineDr Brent James: quality improvement techniques at the frontline
Dr Brent James: quality improvement techniques at the frontline
Nuffield Trust
 
325ch04(system theory).ppt
325ch04(system theory).ppt325ch04(system theory).ppt
325ch04(system theory).ppt
JoshuaLau29
 
System Approach in Healthcare Management
System Approach in Healthcare ManagementSystem Approach in Healthcare Management
System Approach in Healthcare Management
Zulfiquer Ahmed Amin
 
System Analysis and Design 1.pptx
System Analysis and Design 1.pptxSystem Analysis and Design 1.pptx
System Analysis and Design 1.pptx
PoonamMalik26
 
Team 7 Group Project: Evaluation of CIS
Team 7 Group Project: Evaluation of CISTeam 7 Group Project: Evaluation of CIS
Team 7 Group Project: Evaluation of CIS
chelc_331
 
SYSTEM THINKING IN PUBLIC HEALTH
SYSTEM THINKING IN PUBLIC HEALTHSYSTEM THINKING IN PUBLIC HEALTH
SYSTEM THINKING IN PUBLIC HEALTH
Aneesa K Ayoob
 
Edgar huse systems and the change process
Edgar huse   systems and the change processEdgar huse   systems and the change process
Edgar huse systems and the change process
Jofel Delicana
 
Recommending an Evidence-Based Practice ChangeSilifat Jones-.docx
Recommending an Evidence-Based Practice ChangeSilifat Jones-.docxRecommending an Evidence-Based Practice ChangeSilifat Jones-.docx
Recommending an Evidence-Based Practice ChangeSilifat Jones-.docx
audeleypearl
 
Diagnosing Healthcare
Diagnosing HealthcareDiagnosing Healthcare
Diagnosing Healthcare
Martin Hedley
 

Similar to Systems Theory And Quality Patient Care (20)

Rules for Healthcare Transformation Frameworks and Tools v1
Rules for Healthcare Transformation Frameworks and Tools v1Rules for Healthcare Transformation Frameworks and Tools v1
Rules for Healthcare Transformation Frameworks and Tools v1
 
Walden UniversityMaster of Science in NursingWeek 2 Journa.docx
Walden UniversityMaster of Science in NursingWeek 2 Journa.docxWalden UniversityMaster of Science in NursingWeek 2 Journa.docx
Walden UniversityMaster of Science in NursingWeek 2 Journa.docx
 
LESSON-1-CONCEPTS-PRINCIPLES-AND-THEORIES-IN-NURSING-INFORMATICS.pptx
LESSON-1-CONCEPTS-PRINCIPLES-AND-THEORIES-IN-NURSING-INFORMATICS.pptxLESSON-1-CONCEPTS-PRINCIPLES-AND-THEORIES-IN-NURSING-INFORMATICS.pptx
LESSON-1-CONCEPTS-PRINCIPLES-AND-THEORIES-IN-NURSING-INFORMATICS.pptx
 
1The Nature of SuccessClass SeventeenREVIEW!!!!.docx
1The Nature of SuccessClass SeventeenREVIEW!!!!.docx1The Nature of SuccessClass SeventeenREVIEW!!!!.docx
1The Nature of SuccessClass SeventeenREVIEW!!!!.docx
 
Jeanette Kinahan and Dr Sallie Strickland
Jeanette Kinahan and Dr Sallie StricklandJeanette Kinahan and Dr Sallie Strickland
Jeanette Kinahan and Dr Sallie Strickland
 
Nursing and Area of Specialty Discussion HW.pdf
Nursing and Area of Specialty Discussion HW.pdfNursing and Area of Specialty Discussion HW.pdf
Nursing and Area of Specialty Discussion HW.pdf
 
Commissioning And Procurement
Commissioning And ProcurementCommissioning And Procurement
Commissioning And Procurement
 
Commissioning And Procurement
Commissioning And ProcurementCommissioning And Procurement
Commissioning And Procurement
 
Mustafa Degerli - 2016 - Systems Ideas
Mustafa Degerli - 2016 - Systems IdeasMustafa Degerli - 2016 - Systems Ideas
Mustafa Degerli - 2016 - Systems Ideas
 
Strategic Partnership of Healthcare and SE v.2.5.1
Strategic Partnership of Healthcare and SE v.2.5.1Strategic Partnership of Healthcare and SE v.2.5.1
Strategic Partnership of Healthcare and SE v.2.5.1
 
شناسایی ائتلاف استراتژیک بهینه با در نظر گرفتن نقش نوآوری باز در طنجیره تامین...
شناسایی ائتلاف استراتژیک بهینه با در نظر گرفتن نقش نوآوری باز در طنجیره تامین...شناسایی ائتلاف استراتژیک بهینه با در نظر گرفتن نقش نوآوری باز در طنجیره تامین...
شناسایی ائتلاف استراتژیک بهینه با در نظر گرفتن نقش نوآوری باز در طنجیره تامین...
 
Dr Brent James: quality improvement techniques at the frontline
Dr Brent James: quality improvement techniques at the frontlineDr Brent James: quality improvement techniques at the frontline
Dr Brent James: quality improvement techniques at the frontline
 
325ch04(system theory).ppt
325ch04(system theory).ppt325ch04(system theory).ppt
325ch04(system theory).ppt
 
System Approach in Healthcare Management
System Approach in Healthcare ManagementSystem Approach in Healthcare Management
System Approach in Healthcare Management
 
System Analysis and Design 1.pptx
System Analysis and Design 1.pptxSystem Analysis and Design 1.pptx
System Analysis and Design 1.pptx
 
Team 7 Group Project: Evaluation of CIS
Team 7 Group Project: Evaluation of CISTeam 7 Group Project: Evaluation of CIS
Team 7 Group Project: Evaluation of CIS
 
SYSTEM THINKING IN PUBLIC HEALTH
SYSTEM THINKING IN PUBLIC HEALTHSYSTEM THINKING IN PUBLIC HEALTH
SYSTEM THINKING IN PUBLIC HEALTH
 
Edgar huse systems and the change process
Edgar huse   systems and the change processEdgar huse   systems and the change process
Edgar huse systems and the change process
 
Recommending an Evidence-Based Practice ChangeSilifat Jones-.docx
Recommending an Evidence-Based Practice ChangeSilifat Jones-.docxRecommending an Evidence-Based Practice ChangeSilifat Jones-.docx
Recommending an Evidence-Based Practice ChangeSilifat Jones-.docx
 
Diagnosing Healthcare
Diagnosing HealthcareDiagnosing Healthcare
Diagnosing Healthcare
 

Systems Theory And Quality Patient Care

  • 1. Systems theory and quality patient care
  • 2. Understanding Quality through Systems Thinking Basis of this presentation: Paper by Dr Peter Cusins entitled: Understanding Quality through Systems Thinking Published in The TQM Magazine, 1994
  • 3. What is a system? A way of thinking about any dynamic process. Five key statements about systems: Arbitrary boundary Inputs cross boundary from environment Within system inputs interact in transformation process Transformed inputs leave system as outputs Direction of flow indicates flow of energy, materials, information, etc.
  • 4. What is systems theory and how is it relevant to the health sector? – a simple model
  • 5. The “natural law” of systems “If the outputs of a system do not satisfy the environment, the inputs will cease” Decisions around satisfactoriness governed by the environment The environment is everything not within the artificial boundary of the system
  • 6.
  • 7. Environment is complex collection of other systems
  • 8. “Focus” system is that part on which we are focussing
  • 9.
  • 10.
  • 16. Blood systemWhich all work together to maintain bodily health So what are the systems in the health care “body”?
  • 17. Third principle of systems thinking Whether we zoom in or out, we always find more systems
  • 18. The concepts of product and waste Product = satisfactory output (the user system is able to use it) Waste = unsatisfactory output (the user system is unable to use it) Because it is an output, “waste” will always enter another system (nature, very often) Waste which is damaging the system it enters is “toxic” waste Applicable to service systems also
  • 19. The concepts “output” and “outcome” Output produced within focus system – cross boundary into environment Outcome/s the effect of outputs on the environment
  • 20. Four more principles of systems thinking Outputs can be seen from within the system while outcomes can only be seen outside the system Beneficial or adverse outcomes might only be observable at some remove from focus system Might take some time to manifest External feedback loops impact on effectiveness; internal ones on efficiency
  • 21. Feedback and open systems Closed system has no feedback loops Open system has effective feedback loops Hard system – purpose of internal feedback loops is to maintain consistency Soft system – effective external feedback loops allow flexible outputs in response to changing needs of users
  • 22. The relevance of the concept of quality to patient care – a systems view. What is quality? A judgement made at the boundary between producer and user systems Judgement made against referent/s Especially standards agreed between producer and user systems Quality can only start when the supplier knows exactly what the user wants
  • 23. Quality judgements involve: Observing actual output Comparing output with standards Judging whether or not actual outcomes fulfil expectations of user As Covey said – “is the ladder against the right wall?”
  • 24. What constitutes quality in terms of patient care? While actual outputs might be defined in terms of agreed standards judgement of outcomes introduces a value question Values are core beliefs about what is good or bad, right or wrong. To judge quality in terms of patient care we have to go outside the system to see the effect of the system on the environment
  • 25. Quality patient care Patient system (and its sub-systems) is the user system – efficiency will be judged at boundary between patient system and health care provider Primarily – are the sub-systems of the patient improved? Effectiveness will be judged outside of the user and provider systems Is the environment improved?
  • 28. Who cares? – some implications for management All systems are operated by people Managing quality or systems is a myth Management is about people Most important principle in managing people – always treat your people exactly as you would want them to treat your most valued customer (Covey)
  • 29. Who is the “most valued” customer of the health care system? Essentially it is the person most directly affected by any sub-system within the environment The patient who enters the system with the expectation of getting “better”, whatever that might mean to her or him Without a patient there is no purpose for the health care system
  • 31. References Cusins, Peter J.: Understanding Quality through Systems Thinking. The TQM Magazine, Volume 6 Number 5, pp 19 – 27 Covey, Stephen R: The Seven Habits of Highly Effective People. Simon & Schuster, 1992.
  • 32. My contact details Tony McGregor Email: tony.mac@iburst.co.za Cellphone: 072 163 2463