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Systems Thinking

Systems Thinking. The Quality Academy Tutorial 18. Learning Objectives: You Will Learn About…. • •. What a system is Importance of system change in HIV care Transforming systems with the help of quality improvement tools. •. 2. Learning Objectives.

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Systems Thinking

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  1. Systems Thinking The Quality Academy Tutorial 18

  2. Learning Objectives: You Will Learn About… • • What a system is Importance of system change in HIV care Transforming systems with the help of quality improvement tools • 2 Learning Objectives

  3. Tips for Viewing This Presentation Read along with the narrator Search for keywords in the presentation Skip to other slides in the presentation Review current slide Play, rewind and fast forward View full screen Tips for Viewing 3

  4. Key Question How do I account for the complexity of my organization in my program’s quality improvement work? 4 Key question

  5. A System is…. “…an interdependent group of items, people or processes with a common purpose.” Langley et. al., The Improvement Guide 5 System Definition

  6. Lack of a System Can Show Up As… • Lost lab results • Delays in specialty appointments • More cases of HIV infection 6 Why Systems Matter for HIV Care

  7. A Few Important Principles for Improving Systems • A system needs a purpose to aid people in managing their interdependencies • The structure of a system significantly determines the performance of the system Thomas W. Nolan, Ph.D. 7 Why Systems Matter for HIV Care

  8. Test Question To function, a system must: A) Have a common purpose B) Make a profit C) Meet regulatory requirements D) Keep patients happy E) Employ lots of staff F) All of the above G) None of the above 8 Why Systems Matter for HIV Care

  9. Organization Viewed As a System Community Need Plan to Improve Vision Design/ Redesign Key Performance Characteristics Suppliers and Inputs Customers Product/Output Key Processes Support Processes Adapted from T he New Economics by W. Edwards Deming and "Organizing Hospital Care as a System: An Annotated Guide" by HCA Resource Group 9 System Diagram Tool

  10. Questions to Understand Your System • What product(s) do we make? What service(s) do we provide? • Who uses or receives these products or services? • What is the underlying, core need that those customers have for what you make? • What measures or characteristics do customers use when they assess and judge the goodness or quality of what you make? 10 System Diagram Tool

  11. What Products and Services? • Primary health care services for people with HIV and AIDS • A physical environment in which care can take place • Information about HIV and its effective treatment • Referrals to other providers, social services 11 System Diagram Tool

  12. Who Uses or Receives Them? • People with HIV and AIDS • Their families, partners and friends • Employees • Provider staff-in-training (e.g., medical residents, students in other disciplines) • Governmental funding agencies • Advocacy groups • Specialty care services and social services 12 System Diagram Tool

  13. The Underlying, Core Need Is? “Reduction of the impact of HIV and AIDS on the lives of individuals with the diagnoses and on society as a whole” 13 System Diagram Tool

  14. Characteristics to Assess the Goodness or Quality? People with HIV and AIDS: • Effectiveness of care • Respect and compassion from caregivers • Clarity and relevance of information given • Ease of use of facility (friendliness of support staff, waiting time, cleanliness of facility, etc.) • Confidentiality Families, partners and friends • Confidence that loved one is satisfied with care • Information targeted to specific needs of this group 14 System Diagram Tool

  15. Characteristics to Assess the Goodness or Quality? Employees • Adequate resources to provide effective, respectful, compassionate care • Safe environment • Respect for their contribution • Opportunities to grow and advance Provider staff-in-training • Accurate information • Good teaching • Opportunity to practice skills • State-of-the-art models to follow 15 System Diagram Tool

  16. Characteristics to Assess the Goodness or Quality? Governmental funding agencies • Health care services that meet governmental standards • Non-wasteful use of government funds Advocacy groups • Confidence that patients are satisfied with their care • Responsiveness to their requests for information and action Specialty care services and social services • Complete information on any patients referred 16 System Diagram Tool

  17. What Do I Have Now? • Right-hand section of the system diagram • Clarity of purpose • Understanding of complex needs 17 System Diagram Tool

  18. Test Question Which of these is an example of a product or service a health care organization could provide? A) Drawing blood for testing purposes B) Individualized "When to Take Your Medications" calendars C) Neither D) Both 18 System Diagram Tool

  19. What Can I Do Next? • Turn your quality characteristics into measures • Clarify key and support processes 19 System Diagram Tool

  20. We’ve Only Scratched the Surface • Changes in the structure of a system have the potential for generating unintended consequences • Another reason for PDSA • Systems must be managed • An effective quality program helps in this 20 Topics for Future Study

  21. Key Points • A system is a an interdependent group of items, people or processes with a common purpose • Your long-term goal is to improve the operations of your system, because system changes have the greatest impact • Understanding how the parts of your system support its purpose strengthens your ability to improve your system 21 Key Points

  22. Resources • For more information on principles for improving systems in health care, see: Nolan, Thomas W., “Understanding Medical Systems,” Ann Intern Med 1998;128:293-298. For more information on how to change systems by identifying key leverage points, see Senge, Peter, The Fifth Discipline. New York: Doubleday, 1990. The Deming System Diagram and an exercise to support its use in your HIV program is available in the HIVQUAL Group Learning Guide, which can be downloaded by going to: http://www.nationalqualitycenter.org/index.cfm/5659 • • 22 Resources

  23. Related Tutorials To learn more about leadership, study Tutorial 17 23 Related Tutorials

  24. The Quality Academy For further information, contact: National Quality Center New York State Dept. of Health 90 Church Street, 13thfloor New York, NY 10007-2919 Work: 212.417.4730 Fax: 212.417.4684 Email: Info@NationalQualityCenter.org Or visit us online at NationalQualityCenter.org 24 In Closing

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