System Thinking In Healthcare Nursing Essay

brass Thinking In Healthc be Nursing EssayThe health care formation can be defined as a set of interrelated parts or agents, which include caregivers and patients, bound by a common purpose and acting on their acquaintance. This great number of interconnections within and among move ins the healthcare organisation complex (IOM, 2009). Such complexity brings problems and opportunities and requires organisations to adjust to the changes. The ability to go off and respond to both the external and internal environments mogul require a holistic opinion approach of the system (Lebcir, 2006).Systems consist of interrelated, interacting and interdependent parts assemble in a manner that produces a unified whole. System thinking studies these components parts, their interrelationship and the way they function as a whole. According to Senge (1993), system thinking is a conceptual framework, a body of knowledge and tools that has been developed to make the full patterns of systems cl earer, and to help see how they can be changed effectively.There are unlike system thinking approaches and the essay will review some methodologies that were used in managing the case study of Ashford infirmary.1.1 Case Study- Ashford HospitalEarlier in the year, Ashford hospital which serves quite a large population experienced severe pressure on service. The hospital had 67 hold delivers. Patients had to wait for long in chairs or trolleys at accident and emergency unit (A E) before they could be admitted into the wards. This led to overcrowding of AE unit. Patients were asked to stay away from the hospitals AE unless absolutely necessary. The healthcare providers were put under pressure and resulted in trading of blames amongst them. Patients were no longer satisfied with the quality of care. The solicitude of the hospital was disturbed and wanted a way out of the messy situation.2 well-off Systems Methodology (SSM)SSM is an action oriented approach for tackling perceived real world problematic (social) situations ( Checkland and Poulter, 2006). Appendix A shows the SSM process steps that were followed in the course of investigation.2.1 purpose outAn investigation team was invited by Chief Executive (CE) and introduced to some health workers. Using the SSM the first stage was to identify and provide a instruct description of the situation. Due to the workload the clinicians were encountering, getting them round a discussion t fitting wasnt easy. However, the investigation team moved around asking questions and observing proceedings. A rich picture was developed to help capture the main entities, structures and view points in the problem situation of Ashton hospital (Figure1, Appendix B).As part of the finding out, the team had to identify key roles that were affected in this situation (Analysis 1). The team already knew who the client was because it was the CE who requested for intervention. The nurses and reconstructs (some with specialisation) in A E provided handling to patients with various illnesses and injuries.. Where necessary, patients were moved to the ward. The bed manger all(a)ocated beds to patient, while the ward handler supervised the ward. Table1 shows the outcome of Analysis 1 while table 2 shows the worldviews of the have intercourse owners.Having known the key issue owners, the social texture (Analysis 2) of the issue owners in term of their role in the hospital, the norms (expected behavior associated with such role) and the values (standard by which behaviours are judged) were identified. This is illustrated in table 1 of Appendix B.A political analysis (analysis 3) which enriched the cultural appreciation previously obtained through Analyses 1and II was done. The essence was to find out the disposition of power associated with the roles within the hospital thereby buttressing our cultural arrest of the situation. The CE, being the head of the hospital, had positioned power over some other roles w hile the doctors enjoyed able power across the hospital. The details of the analysis 3 are shown in figure 2 of Appendix B. The culture analysis provided a basic for identifying the applicable issues, actors and conflict in the hospital.The Client- person(s) whocaused the intervention tohappenThe Chief Executive of Ashford hospitalThe Practitioner- people performingthe investigationThe Investigation team (Us)The issue owners-people who are come to about oraffected by thesituation.Doctors, put out managers, nurses, patients, ward managers, Chief ExecutiveTable 1 Analysis 1 (the Intervention Itself) in Ashford hospital case studyIssue ownersWorld viewsChief ExecutiveTargets must be met with the availablebudgetDoctorsPatients accept to be given effective interposition before they are dischargedBed managerDoctors do not discharge patients ontime and are always bed blockingPatientsWe need better healthcare service weNeed to get well before we aredischargedWard managersHigh standards must be maintained inthe wardNurseTo many patients to cope withTable 2 Worldviews of the issue owners in Ashford hospital case study.2.2 Making Purposeful act Models.According to Checkland and Poulter (2006), both human situation reveals people trying to act purposefully. The models of purposeful activity system viewed through the world view of the doctors and the bed manager were considered very relevant. This was because the doctors do decisions on patients that needed admission while the bed manager was involved in allocation of beds.In order to model the purposeful activities, root definitions describing the first-string activity processes and functions were developed using a mnemonic CATWOE analysis. Appropriate root definitions for the primary functions performed by doctors and bed manager were formulated as followsA doctor system to provide quality and effective treatment care, through the use of appropriate acquired knowledge and hospital resources in, order to improve p atients condition.A bed manager system that provides timely placement of patients in wards, by optimizing the use of available hospital beds, in order to rear to quality and effective patient care.Tables 3 and 4 show the purposeful activity models for the Bed Manager and Doctor respectively. The conceptual purposeful activity models are illustrated in figure 2 and 3 of Appendix B.Purposeful Activity model 1Root definitionA bed manager system that provides timely placement of patients in wards, by optimizing the use of available hospital beds, in order to contribute to quality and effective of patient care.Activity nameAdmission of patientsTaskPrimary childbedCustomerPatients, doctorsActorsBed managerTransformation processPatients are admitted in hospital ward bedsWorldviewDoctors do not discharge patients on time and they contribute to bed blockingOwnersBed managers, doctors, ward managers, nursesEnvironmentNumber of beds, bed management and ward policiesEfficacyAre beds available for patients? Are beds data counterbalance?EfficiencyHow long do patient wait before being admitted? Do patients over stay on ward bed? Optimal bed usage, waiting timeEffectivenessHave all patients been admitted on time?Table 3 Purposeful Activity model of Bed Manager.Purposeful Activity Model 2Root definitionA doctor system to provide quality and effective treatment care, through the use of appropriate acquired knowledge and hospital resources in order to improve patients condition.Activity nameTreatment and admission of patientsTaskPrimary taskCustomerPatientsActorsDoctorsTransformation processPatients are admitted and treated in the hospitalWorldviewPatients need to be given effective treatment before they are dischargedOwnersNurses, doctors, bed managers, ward managersEnvironmentBed management and ward policies, availability of bedsEfficacyHave patients been treated and admittedEfficiencyAre patients getting better?, cost of drugs, timeEffectivenessHave all patients been treat ed and admitted on time?Table 4 Purposeful Activity model of Doctors2.3 Discussion and Outcomes.Activities in conceptual models developed were used for the discussion. The most meaningful finding that resulted from the investigation was in the area of discharge. The actual problem which was assumed to be limited to the AE was actually as a result of failure to adequately plan discharge in the wards. When the rate of patients needing admission increased, there was a need to change discharge plans.However, it was realised that the doctors did not change discharge behaviour and created waiting lists for patients that needed admission. Facilitated brainstorming sessions resulted in identifying number of contributing causes of delayed discharge. Discharge was done after ward round which took place in dayspring during week days alone. Insignificant numbers of discharge were done over the weekend because there was no major ward round. This meant that most patients needing admission in A E over weekend had to wait till following week before beds could be arranged for them. This also compounded the bed crises.A discharge project team was immediately set up. The main function of the discharge team was to carry out additional ward rounds in the evenings and on weekends so as to discharge patients and free up more beds. They were able to indentify other causes of delayed discharge and resolved them. This ensured timely discharge fashion which then(prenominal)(prenominal) freed up beds for patients in AE.2.4 potence and weakness of SSMThe methodology provided guidelines that were flexible to apply. The use of models provoked debate and learning among the issue owners. Through discussion and debates, the hospital was able to realise that there was a need to amend patient discharge policy.However, this methodology could not satisfy everybody. Some of the discharge decisions were not favourable to the ward patients. Also members of the discharge team had extra work to d o and ways of compensating them were not discussed. This could be seen from Jackson (2000) arguments that SSM tends to favour the more powerful people in the system while genuine participative debate could be severely constrained.3.0 Thinking DifferentlyMost of the inventions in our society today, such as electricity, telephone, automated storyteller machine and many more, are the results of some people who decided to think differently. Thinking differently involves using innovative and creative approaches to transform healthcare legal transfer service (NHS, 2007)The first stage was to stop and think of the whole situation and identify areas where creative thinking could improve matters. It was observed that there was poor co-ordination of patients and beds management while poor communication existed between the bed manager and other clinicians, in the wards and A E, about bed availability.A tool called Others Point of pick up (OPV) was then selected to describe the issue from o thers peoples perspective. The aim was to generate some alternative ways of framing the problem and to think about what other people cogency say about bed management of the hospital.Hotel manager Despite their poor hospitality, they still have moreclients.poor service in hotel industry will make you to beout of businessService Consultant Poor customer service in the hospitalno regards forpatientscustomers are kings ..so are the patientsJournalist Taking the sick to a sick hospital.Patient -This is disgustingwhere else do they want us to goto?The second phase allowed clinicians to brainstorm and come up with imaginations. At this stage no idea was good or bad. It allowed for people to speaking out their imaginations. The Fresh eyes tool was picked to see how similar issues were managed in other industries and the possibility of adopting the solutions into the hospital.Hotels- Hotels manage rooms, checks customers in and out using softwaresystems designed to help administrator to track all rooms availability.University- students can book their accommodation online while a systemassists in organising and allocating rooms to studentsAirline Airline Reservations Systems that manages airline schedules, faretariffs, passenger reservations and ticket records.This gave us insight to how clients and resources were being managed in other industries. The stake holders then agreed to try out a bed management information system.The hospital implemented bed management information system on a small scale and some of the benefits were highlighted (Table 5).Real time online monitoring of bed position, bed manager did not have to go round wards againIt meliorate communication between units for patient admissionsSaved time searching for available beds in the hospitalIt provided an overview of bed occupancy rate in hospitalIt was user friendly and easy to use.Enabled more accurate allocation of beds for emergency patientsTable 5 Realised benefits of Bed management informat ion system after implementation.3.1 Strength and weaknessThe thinking differently methodology was a powerful tool in stimulating thinking and lots of ideas were suggested. However, this took time and caused arguments as feasibility, advantages disadvantages and risk of for each one idea were all argued out. Also, traces of people trying to impose their ideas on others were noticed while others brought up ideas that would satisfy their own interest.4 System dynamicsSystem dynamics is an approach and pretence technique for studying and managing complex feedback systems, that are seen in business and other social systems (SDS, 2009). According to Jun el at (1999), there has been increased use of simulation in healthcare. This could be attributed to numerous success reports of using simulation to address health care system problems and availability of simulation software packages.The methodology was used to estimate and manage the aggregate flow of patient through the hospital and its environment. As the number of people visiting AE increased, it in turn increased the number of people who needed hospital admission. Also, as patients waiting for bed increased, it caused an increase in number of patients that were discharged home early. This is illustrated in Figure 1.There was the need to soften the number of patients coming through A E. The availability and use of other healthcare facilities such as GP practice, community care and nearby hospitals would have a negative feedback on the inflow of patients into aE. This would directly affect the number of patients needing admission. Most of the patients that were discharged home might not have to return to AE as community care could assist carter.This methodology helped the hospital to forecast inflow of patients and ways that could be adopted to control it. Community care services around were informed about the situation of things in the hospital. In addition, ambulance bringing patients were informed ahead to ma ke use of other hospitals or GP practices if condition of patient was not too severe.Figure 1 A model to show the flow of patients through the hospital5. mop upThe complex nature of healthcare system makes system thinking well-suited to tackle problems in this sector. The various methodology approaches used assisted in better understanding of the relationship between the various units in Ashford hospital and its environment. This showed that like any other system, no unit in the hospital is an island. The different methodologies applied in Ashford hospital situation yielded various positive outcomes that helped improved the problematic situation.While some of the methodologies used have their roots in action research, further participatory research will be carried out to investigate occupational work stress among the clinicians. This may help identify majors causes of stress associated with their workflow, how it affects their relationships with others and with the patients in part icular. discourse count -2034