Health Systems - Abstract of article: Integrating systems engineering practice with health-care delivery
Health-care delivery is a complex and fragmented system with work-around
culture. Improving health-care delivery requires innovating system
interventions that redesign processes for consistent implementation of
evidence-based practices (EBPs). Systems engineering is an approach that
involves anticipating ineffective processes that jeopardize quality,
and designing interventions to overcome such shortcomings. This approach
is based on systems teaching about reflexivity, which when addressed
can support consistent EBP and assesses how the newly designed system
meets this consistency. Integrating a systems engineering approach to
implementing EBP may effectively address complex issues such as
hospital-acquired pressure ulcer prevention, which has an EBP protocol
that is not consistently implemented without system redesign.
Engineering approaches and methods including Plan-Do-Study-Act (PDSA),
Situation-Background-Assessment-Recommendations (SBAR), stochastic
modeling, House of Quality, and statistical process control charts with
lean six sigma provide a structured approach to identifying points of
successful implementation for EBPs that can subvert work-around culture.
This perspective piece reviews successful approaches of systems
engineering to solve the problem of clinical work-arounds and puts
forward the case for its wider application to health-care delivery
systems that could benefit from standardized EBPs.
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