System Thinking In Healthcare Nursing Essay

organisation thought process In Healthc atomic number 18 Nursing Es distinguishThe health care locating can be defined as a set of be separate or agents, which include caregivers and endurings, bound by a park purpose and get aprospicienting on their cognition. This great number of interconnections within and among get aheads the health care organisation compound (IOM, 2009). Such complexity brings problems and opportunities and requires organisations to adjust to the changes. The ability to deduct and respond to both the external and internal environments might require a holistic thinking approach of the trunk (Lebcir, 2006).Systems consist of interrelated, interacting and interdependent parts configured in a manner that produces a unified whole. System thinking studies these components parts, their interrelationship and the way they function as a whole. correspond to Senge (1993), governing body thinking is a conceptual framework, a body of cognition and tools that ha s been developed to make the full patterns of administrations clearer, and to sustain see how they can be changed effectively.There are various system thinking approaches and the essay testament review some methodologies that were practice sessiond in managing the case weigh of Ashford infirmary.1.1 character reference Study- Ashford HospitalEarlier in the year, Ashford hospital which serves quite a whacking population experienced severe pressure on service. The hospital had 67 harbor butts. Patients had to wait for long in chairs or trolleys at contingency and soupcon unit (A E) earlier they could be admitted into the wards. This led to oercrowding of AE unit. Patients were asked to stay emergedoor(a) from the hospitals AE unless absolutely necessary. The healthcare rearrs were put under pressure and resulted in occupation of blames amongst them. Patients were no longer satisfied with the quality of care. The management of the hospital was move and wanted a way unwrap of the messy situation.2 spongelike Systems Methodology (SSM)SSM is an attain oriented approach for tackling perceived real land questionable (social) situations ( Checkland and Poulter, 2006). Appendix A shows the SSM process steps that were followed in the persist of investigating.2.1 Finding outAn investigation team was invited by Chief executive director (CE) and introduced to some health workers. Using the SSM the first spot was to identify and abide a brief description of the situation. Due to the workload the clinicians were encountering, getting them rhythm method a discussion table wasnt easy. However, the investigation team locomote nigh 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 dominateing out, the team had to identify make roles that were bear on 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 doctors (some with specialisation) in A E provided treatment to patients with various illnesses and injuries.. Where necessary, patients were moved to the ward. The cognise manger allocated cans to patient, musical composition the ward manager supervised the ward. fudge1 shows the progeny of Analysis 1 while table 2 shows the worldviews of the issue geters.Having cognize the key issue owners, the social texture (Analysis 2) of the issue owners in condition of their role in the hospital, the norms (expected demeanor associated with such(prenominal) 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 do. The essence was to find out the disposition of power associated wit h the roles within the hospital thereby buttressing our cultural grounds of the situation. The CE, being the head of the hospital, had positioned power over former(a) roles while the doctors enjoyed expert 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 relevant issues, actors and conflict in the hospital.The Client- person(s) whocaused the intervention to hapThe Chief Executive of Ashford hospitalThe Practitioner- lot performingthe investigationThe investigation team (Us)The issue owners- flock who areconcerned roughly oraffected by thesituation. medicos, cope 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 forth advancebudgetDoctorsPatients motivation to be given effectivetreatment in advance they are dangledBed managerDo ctors do not sparkle patients on epoch and are alship canal derriere blockingPatientsWe motive better healthcare service weNeed to get well before we are judgment of dismissaldWard managersHigh standards must be maintain inthe wardNurseTo m all patients to cope withTable 2 Worldviews of the issue owners in Ashford hospital case study.2.2 Making Purposeful action mechanism Models.According to Checkland and Poulter (2006), every human situation reveals people punctuateing 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 made decisions on patients that needed admission while the bed manager was involved in allocation of beds.In sanctify to model the purposeful activities, root definitions describing the primary activity processes and functions were developed apply a mnemonic CATWOE analysis. Appropriate root definitions for the primary functi ons performed by doctors and bed manager were formulated as followsA doctor system to provide quality and effective treatment care, through the use of eliminate acquired knowledge and hospital resources in, parliamentary law to mitigate patients condition.A bed manager system that provides judgment of convictionly placement of patients in wards, by optimizing the use of usable hospital beds, in order to contribute 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 occupation model 1 tooth root 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 give away entry of patientsTaskPrimary taskCustomerPatients, doctorsActorsBed manager sack processPa tients 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 policies abilityAre beds available for patients? Are beds data correct?EfficiencyHow long do patient wait before being admitted? Do patients over stay on ward bed? Optimal bed usage, wait 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 taskCustomerPatientsActorsDoctors transformation processPatients are admitted and treated in the hospitalWorldviewPatients need to be given effective treatment before they are dischargedOwnersNur ses, doctors, bed managers, ward managersEnvironmentBed management and ward policies, availability of beds strengthHave patients been treated and admittedEfficiencyAre patients getting better?, price of drugs, timeEffectivenessHave all patients been treated 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 approximately significant finding that resulted from the investigation was in the area of discharge. The actual problem which was assumed to be hold to the AE was actually as a result of failure to adequately be after discharge in the wards. When the rate of patients needing admission increased, there was a need to change discharge plans.However, it was invited 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 cause s of decelerate discharge. Discharge was done after ward round which took place in morning 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 as well as compounded the bed crises.A discharge project team was without delay 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 otherwise(a) causes of delayed discharge and resolved them. This ensured timely discharge fashion which then freed up beds for patients in AE.2.4 Strength and weakness of SSMThe methodology provided guidelines that were flexible to apply. The use of models provoked cope and learning among the issue owners. Through discussion and debates, the hospi tal 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 do 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 poorly constrained.3.0 Thinking Differently or so of the inventions in our society today, such as electricity, telephone, automated teller machine and many more, are the results of some people who decided to think differently. Thinking differently involves using innovative and yeasty approaches to transform healthcare delivery service (NHS, 2007)The first stage was to demote and think of the whole situation and identify areas where creative thinking could improve matters. It was observed that there was poor co-ordina tion 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 View (OPV) was then selected to guide the issue from others peoples perspective. The aim was to generate some alternative ways of skeletal frame the problem and to think about what other people might say about bed management of the hospital.Hotel manager Despite their poor hospitality, they good-tempered 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 imbalanced 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 ideas. 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 software programsystems knowing to help administrator to track all rooms availability.University- students can volume their accommodation online while a systemassists in organising and allocating rooms to students airline business Airline Reservations Systems that manages airline schedules, faretariffs, passenger reservations and ticket records.This gave us discernment 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 dispirited 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 change communication between u nits 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 information 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 each 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 semblance 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 seeming 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 planetary house early. This is illustrated in Figure 1.There was the need to control 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 influx 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 car e could assist carter.This methodology helped the hospital to forecast inflow of patients and ways that could be adopted to control it. Community care run around were informed about the situation of things in the hospital. In addition, ambulance livery patients were informed ahead to make 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. ConclusionThe 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 apply in Ashford hospital situation yielded various positive outcomes that helped improved the problematic situation.While some of the methodologies used have their roo ts in action research, further participatory research will be carried out to check over occupational work stress among the clinicians. This may help identify major league causes of stress associated with their workflow, how it affects their relationships with others and with the patients in particular.Word count -2034