7 Healthcare Organizations Demonstrate Power of Systems Approach

A systems approach, which recognizes both the individual and collective effects of processes, has been shown to improve healthcare quality and cost in several organizations, according to a report by participants in the Institute of Medicine Roundtable on Value & Science-Driven Health Care and the IOM/National Academy of Engineering Systems Approaches to Improving Health Innovation Collaborative.

The report, "Bringing a Systems Approach to Health," lists seven types of systems approaches:

• Human factors engineering
• Industrial and systems engineering
• Production system methods
• Modeling and simulation
• Predictive analytics
• Supply chain management
• Operations management and queuing theory

The authors present six examples of healthcare organizations that have used these approaches to improve care:

1. Johns Hopkins University. The Armstrong Institute of Johns Hopkins University in Baltimore and the Gordon and Betty Moore Foundation are taking a systems approach to improve care in the intensive care unit. They plan to reengineer the ICU through an "interdisciplinary, patient-centered approach that integrates clinical information systems and clinical equipment, reengineers the care team workflows and incorporates patient and family goals into routine care," according to the report.

2. Virginia Mason Health System. Seattle-based Virginia Mason Health System has implemented the Virginia Mason Production System, based on the Toyota Production System, to guide its improvement efforts. As one example, leaders mapped processes in its spine center, studied the literature and developed a standard evidence-based process that reduced wait times, improved outcomes and cut costs, according to the report.

3. Vanderbilt University Medical Center. Vanderbilt University Medical Center in Nashville, Tenn., used systems engineering tools to improve compliance with a ventilator-associated pneumonia bundle of interventions. Through visual dashboards that reported the status of VAP bundle implementation for each patient, as well as management reports, average compliance with the bundle increased from 40 percent to 90 percent and VAP rates decreased by more than one-third in one year, the authors reported.

4. Veterans Health Administration. The Veterans Health Administration reengineered its processes with a system-wide electronic health record system, VistA, which improved quality, the use of evidence-based practices and efficiency, according to the report.

5. Cincinnati Children's Hospital and Mayo Clinic. Cincinnati Children's Hospital and Mayo Clinic in Jacksonville, Fla., used mathematical models and data analysis to adjust hospital processes according to patient flow. Cincinnati Children's Hospital increased surgical volume by 7 percent annually for two years without adding staff or increasing the number of hospital beds, according to the report. In addition, Mayo Clinic in Florida increased surgical volume by 4 percent, decreased variability by 20 percent and decreased staff turnover by 40 percent.

6. Centre Hospitalier Universitaire in Lille, France. Centre Hospitalier Universitaire conducted human factors analysis on medication ordering, dispensing and administration processes to identify and remedy problems. This process helped the organization improve the user interface's ability to support care processes, according to the report.

More Articles on a Systems Approach to Healthcare:

4 Stages of a System Approach to Drive Value in Healthcare
7 Guiding Themes to Advance Safety of Medical Device Interoperability
Why Hospital Quality Improvement Should Depend on Systems More Than People

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