self-motivated, and capable team members; and the importance of individuals and teams thinking through issues, considerations, and related implications prior to drawing conclusions and making decisions.
A case involving a multifacility medical center that provides “full life cycle” health care services showcases how the effective use of systems thinking might lead to better outcomes. In this scenario, the Emergency Services Department is a well-known and highly recognized trauma center, seeing scores of patients every day who are experiencing some type of physical distress.
The department operates in an environment of continuous improvement, measuring success through a variety of internal and regulatory-driven metrics. The director of the Emergency Services Department conducts quarterly patient satisfaction surveys to gain insight into the overall impact of its policies and procedures, and to measure the effectiveness and efficiency of its operation. A special recognition program includes cards that patients and their families can easily complete and submit to recognize exemplary performance.
The director of the Emergency Services Department, troubled by a decreasing Patient Satisfaction Index, or PSI, decides to take action. The director's strategic intent is to take steps to address concerns raised by patients with the ultimate goal of increasing the department's PSI. Upon analyzing the data revealed through the quarterly patient survey, she realizes that approximately 80 percent of the concerns raised relate to wait time. Patients are spending two to four hours in the waiting room per visit. The director's examination of the data reveals that concerns are being raised by “single appointment” patients and recurring patients who receive extended care.
Further examination reveals that the concerns being raised mostly center on the fact that patients entering the department at certain hours miss meals. Those entering after 3:00 or 4:00 AM miss breakfast, those entering after 9:00 or 10:00 AM miss lunch, and those entering after 2:00 or 3:00 PM miss dinner. The director weighs the options and decides to begin offering breakfast, lunch, and dinner to patients in the waiting room during the appropriate hours.
Time passes, and new patient satisfaction surveys and comments suggest the director's solution is working. Single-appointment and returning patients are pleased with the meals they now receive. The department's PSI is climbing, primarily as a result of increased satisfaction relating to the catered meals. Happy to see this key performance indicator returning to historical levels, the director takes satisfaction in a job well done.
If the director had applied systems thinking concepts and principles, how might have her considerations, conclusions, decision(s), and subsequent actions been different? In terms of her general considerations, the director might have broadened her level of analysis to include local, regional, and national emergency services departments. She might have shifted her focus from attempting to increase patient satisfaction by providing catered meals to attempting to increase patient satisfaction by decreasing wait times. In terms of the questions she asked, the director might have explored how effectively and efficiently the Emergency Services Department operates within the context of other similar emergency services organizations. Perhaps she might have investigated how the department's structure, systems, processes, policies, or staff capabilities affect the department's efficiency and effectiveness. In terms of the conclusions she drew and decisions she made, the director and her colleagues might have attempted to tackle the issue of patients using the Emergency Services Department as their primary health care provider through patient education. Alternately, they might have taken steps to strengthen the integration of systems and processes to enhance efficiency and effectiveness. Perhaps they might have taken steps to bolster controls and incentives to ensure employees at all levels are committed, engaged, and motivated to work together to achieve the Emergency Services Department's goals and objectives.
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