First Order and Second Order Problem Solving

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From the course by Johns Hopkins University

Patient Safety and Quality Improvement: Developing a Systems View (Patient Safety I)

217 ratings

Johns Hopkins University

Patient Safety and Quality Improvement: Developing a Systems View (Patient Safety I)

217 ratings

Course 1 of 7 in the Specialization Patient Safety

In this course, you will be able develop a systems view for patient safety and quality improvement in healthcare. By then end of this course, you will be able to: 1) Describe a minimum of four key events in the history of patient safety and quality improvement, 2) define the key characteristics of high reliability organizations, and 3) explain the benefits of having strategies for both proactive and reactive systems thinking.

From the lesson

Applying a Systems Lens to Healthcare

In this module, you will learn the basics of systems thinking and then apply these to a healthcare setting. At the end of this module, you will be able to 1) explain the basic components of a system, 2) differentiate first order problem solving and second order problem solving, 3) explain the benefits of having strategies for both proactive and reactive systems thinking.

Definition of a System2:19

Definition of Systems Thinking3:16

Reductionistic Thinking vs. Holistic Thinking6:17

Swiss Cheese Model6:59

First Order and Second Order Problem Solving2:33

Whose Problem Is It?1:55

Oncology Infusion Clinic: Case Study4:30

Proactive and Reactive Systems Thinking Strategies8:18

Conclusions1:50

Meet the Instructors

Melinda Sawyer
Director, Patient Safety
Armstrong Institute for Patient Safety

This next topic addresses a concept called first order and second order problem solving.

This concept is a very important one and

was described very well by Anita Tucker and colleague.

And in the reference that's on your screen,

I encourage you to pull that reference and take a close look at it.

It's Why Hospitals Don't Learn From Failures is the title,

and I think you'll find it very interesting.

So, here's the idea.

Let's consider the following problem.

A nurse doesn't have the medication when needed for administration.

Using first order problem solving,

and that's similar to reductionistic thinking.

What we do is say, "Okay,

I don't have the medicine that I need right now,

so I'm just going to borrow the medicine from another patient."

Now, that solution solves the problem at

hand without decreasing the chance of error recurrence.

It's pro is that it's very fast.

It's con is it does not address why the error occurred

and doesn't create a fix that's really gonna prevent recurrence.

In second order problem solving,

we're using holistic thinking.

What we should do is to consider upstream process steps to

identify root causes of the error that we're having.

So, let's look at this example again.

The nurse doesn't have the medicine at the time they need it.

So, what we may do is identify and resolve

the many upstream processes that lead to missing doses.

The pro is that it may decrease error recurrence.

The con is that it's very time consuming.

As an aside, one of the things you might try is this.

If you have a staff,

what you might do is ask them to carry around a card,

and when they encounter a problem like a missing dose, write it down.

And while they may not be able to apply second order problem

solving right there on the spot because they're taking care of patients,

they might just have to solve the problem as best they can on the fly,

but then, when you have a staff meeting,

everybody can pull out their cards,

look to see what those problems are and as a team,

try to address the issues that come up in a second order holistic way of thinking.

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