Healthcare in the United States consists of a tangled web of complex interconnected drivers, including payment models, regulations, processes, and facilities. However, the lack of a cohesive system design has resulted in less than optimal care industry for the US population and highlighted the need for a more comprehensive approach.
Year over year, data from the Commonwealth Fund demonstrates that despite high costs for healthcare, the patients in United States experience worse outcomes with lower life expectancy and higher rates of preventable and treatable deaths than other developed nations.
The impact of healthcare’s non-linear structure frequently results in unintended consequences when linear changes are applied, and as such, traditional quality or process improvement initiatives often fail to lead to sustainable and scalable change. Traditional point-by-point approaches are insufficient for tackling systemic problems like chronic disease and healthcare disparities. Instead, a systems thinking approach, which involves understanding the interconnections and interdependencies within the myriad drivers influencing healthcare systems, is necessary to predict behaviors and adjust outcomes effectively.
Systems thinking ultimately is a goal-oriented system in which the system is specifically designed to achieve the desired outcomes, which in healthcare means improved patient outcomes at lower cost. Systems thinking acknowledges the roots of complex elements and interdependencies to better predict system behavior and adjust outcomes.
Systems thinking involves several key principles:
- Seeking Multiple Perspectives: Engaging all stakeholders, including administration, physicians, nursing, and support staff, to understand the elements and functions of the system.
- Assessing Current State Conditions: Considering the influence of prevailing work conditions, including demand, capacity, resources, and constraints.
- Analyzing Interconnections: Understanding how elements relate to and influence each other within the system.
- Understanding the Current State: Identifying why and how the current state exists and what conditions reinforce it.
- Designing Changes: Implementing workflow adjustments and other changes to improve system performance.
The high rates of hospitalization for patients with heart failure serve as a good example of implementing systems thinking approaches. Despite a focus on chronic disease, the prevalence of heart failure has increased over the last 20 years, and heart failure represents one of the most common causes of hospitalization. Clear evidence-based studies that demonstrate reduced readmissions and improved patient outcomes address the following systems-level components of care:
- Identifying and treating patients with heart failure
- Addressing psychosocial care and social determinants of health
- Coordinating care across multiple providers
- Managing medications and device therapies
- Providing comprehensive patient education
- Offering palliative care when indicated
Studies show that more effective models to reduce hospitalizations and mortality involve comprehensive, multidisciplinary, in-person interventions such as multidisciplinary heart failure clinics or nurse-led case management programs that help to address cardiovascular health from an enterprise perspective. Systems thinking helps design these comprehensive care models by evaluating current state conditions, analyzing interconnections, and designing workflow adjustments.
Too often, healthcare improvement has focused on fixing healthcare workers so that they adopt new behaviors and mindsets. However, that approach fails if the system in which they work is not designed to achieve the desired outcomes. Instead, healthcare organizations should focus on fixing systems by designing systems that facilitate high quality care deliveryAchieving systematic, meaningful change in healthcare requires a systems thinking approach. Systems thinking provides a way to understand the roots of complex elements and interdependencies, predict system behavior, and adjust outcomes. By planning, designing, and building systems that support continuous improvement and equity, healthcare organizations can improve patient outcomes, reduce costs, and address disparities. By understanding and addressing the interconnections and interdependencies within healthcare systems, organizations can create more effective, equitable, and sustainable solutions to complex healthcare challenges. This systems thinking approach is essential for improving patient outcomes, reducing costs, and addressing healthcare disparities in a meaningful and lasting way.
About Holly Urban, MD, MBA
Holly Urban, MD, MBA has extensive experience in healthcare technology and believes in the power of evidence-based content to transform EHRs beyond transactional systems into tools that allow clinicians to provide improved patient outcomes. In her role, she supports the clinical editorial teams that are the foundations of the UpToDate® and Medi-Span® information solutions.
After practicing as a primary care pediatrician, Dr. Urban worked for several EHR technology and evidence-based content companies, and has served in healthcare IT leadership roles for over fifteen years. With this experience, she brings unique insight into how evidence and workflow can optimally merge to benefit clinical users and healthcare teams. Her experience with both provider and payer customers allows her to holistically understand the healthcare ecosystem with all the complicated drivers that influence how care is provided.