[MUSIC] Hi, I'm Shirley Moore a professor of nursing at Case Western Reserve University in Cleveland, Ohio. I've been teaching quality improvement to health profession students for the past 20 years, and was part of a team here at Case Western Reserve, who developed the first course in the United States on quality improvement for health profession students. I've been asked to discuss a key concept in process improvement: the concept of systems thinking. Our lives are full of systems, personal systems, such as the systems we use to buy and prepare our food, get ready for bed, or study for this course. We are also often part of work place systems. In the delivery of healthcare, we have systems for admitting and discharging patients, for administering medications, assessing patient needs, or just getting someone to and from X-ray. We're also surrounded by systems of our family, our community, and the systems in our larger society and environment. Some are micro systems and some are macro systems. What do we mean when we refer to systems? Systems are comprised of a set of individual components that are designed for a specific purpose or an aim. In fact, every system is perfectly designed to produce exactly the outcome it achieves, a good outcome or a bad one, but perfectly designed to achieve that outcome. One of the great things about systems is that they can be changed. We can improve a system by understanding its individual components, how those components interact within that system or with other systems, and we can then redesign the components of the system. We can add components, remove components, reorder them, merge them. When you think about it, it's a very powerful idea to think that you can have the skills and tools to change systems, and thus, change outcomes. So what is systems thinking? Systems thinking is ability to recognize and understand the interactions and interdependencies in a set of components that comprise a system. This includes the ability to recognize patterns and repetitions in these interactions, and an understanding of how those actions and components can reinforce or counter act each other. These relationships and patterns occur at different dimensions. Temporal, spacial, social, technical, or cultural. The ability to engage in systems thinking is a key component in a successful delivery of safe and high quality healthcare. In fact, systems thinking may be as important as critical thinking. How healthcare professionals experience themselves in their work, is shaped by the structure and processes of the systems in which they work. Most professionals provide care in healthcare organizations that are complex, multi-level, and multi-functional. In your day-to-day work, your ability to engage in better problem solving, priority setting, interactions and collaborations and decision making, is greatly influenced by your ability to understand how any one component of your work system is related to the whole of that system. This is particularly true for yourselves who aim to improve health care systems. But how well do you see and understand the systems around you? There are a set of skills to learn about, understand, and improve systems. You'll have the opportunity in this course to learn about and use some of these skills. Specifically the use of flow charts and fish bone diagrams. These tools, and others that you'll be introduced to, can be applied to any system. A personal one, or the ones in your workplace. You may want to try these tools first, to change a personal system in your life. Such as getting more sleep, eating healthier foods at lunch, or having some more time for leisure type reading. I teach systems thinking in the use of these tools to school age children to change the habits in their daily lives to be more healthy. Habits are systems, and our daily routines are often some of the systems that we least recognize, understand, or go about changing in a deliberate way. I've found that children as young as ten years old are able to learn about and use flow charting of their daily routines, in order to understand them better. And that children also use fish bone diagrams to consider possible influences on their routines, and discover changes in them that could be healthier, such as eating, sleeping, and getting exercise. These children, and their families, have been quite successful at using the process improvement techniques to improve their healthy living habits. But, getting back to health care organizations, some questions associated with systems thinking that you might consider are... How do systems drive behavior? How do daily work routines, and momentary behavior relate to the big picture? How and why do responses to simple work problems sometimes escalate to big irritations? What are the unintended consequences of shortcuts and workarounds? Examples of skills you can learn to have better systems thinking are: The use of feedback in individual and group interactions; seeking, and incorporating the views of others to promote understanding and change; and the use of tools to examine the process in greater detail. Other skills include how to look beyond a specific event to determine the underlying cause, or recognize recurring patterns. Or how to analyze a problem from a system perspective. I'm happy to report that those of you who may be interested in measuring your level of systems thinking, or that of your students or colleagues, we now have a valid and reliable measure of systems thinking. With the help of an expert panel, our team here at Case Western Reserve University has designed the systems thinking scale. This measurement scale consists of a 20 item questionnaire, to which individuals, such as healthcare professionals, indicate the extent to which they engage in systems thinking regarding the quality and safety in their daily work. If you're interested in obtaining this measure of systems thinking, you can contact Dr. Mary Dolansky or myself at Case Western Reserve University. So think about the systems around you that you would like to improve. Personal systems, such as getting more exercise or getting more sleep. Our work system, such as how to better engage families and patients in their care, or the safer administration of medications. Be more alert to the components of those systems and how they might be changed in order to improve the system, and thus improve the outcome of that system. I'd suggest that you'd start with a small system. Engage a team of others to help you. Use some of the new tools that you've been introduced to in this course on quality improvement. Seeing systems and engaging in systems thinking is a powerful way to learn about and improve the quality and safety of healthcare. I hope you enjoy changing systems as much as I do. [MUSIC]
