Systems Thinking in Healthcare Facilities
2020
Virtual
Systems Thinking in Healthcare Facilities - ROJoson
https://www.slideshare.net/rjoson/systems-thinking-in-healthcare-facilities-rojoson
OLETE on Systems Thinking in Healthcare Facilities - UP-CPH-HA 202 (20oct29)
Systems Thinking in Healthcare Facilities - ROJoson
Systems Thinking in Healthcare Facilities - ROJoson
Prescribed Learning Outcomes:
At the end of the session, the student is able to:
•Understand how to run and manage a hospital effectively and efficiently by systematically using the systems approach or perspective and systems thinking.
•Understand the importance of alignment and integration in managing a hospital and its departments.
•Describe a hospital department design and development framework, how to use and apply it and be familiar with the basic requirements in it.
•Discuss common challenges encountered in governance of departments together with their suggested strategic solutions.
Learning Resources
Systems Approach to Hospital Operations: The Unique Framework Applicable To Every Department
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Systems Approach / Systems Thinking Suggested Readings:
System Approach in Healthcare Management
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A systems approach to healthcare: from thinking to practice
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6502599/
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Systems Thinking for Health Systems Strengthening
https://www.who.int/alliance-hpsr/resources/9789241563895/en/
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Five ways to incorporate systems thinking into healthcare organizations
https://pdfs.semanticscholar.org/6599/7e90979d780be5e9e6f5ae8bcb7d5f010c1b.pdf
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Alignment and Integration Suggested Readings:
The ties that bind: an integrative framework of physician-hospital alignment
https://bmchealthservres.biomedcentral.com/articles/10.1186/1472-6963-11-36
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Physician integration: Are your physicians aligned?
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A critical appraisal of physician-hospital integration models
https://www.sciencedirect.com/science/article/pii/S0741521409023088
Answer online ROJ - OLETE on Systems Thinking in Healthcare Facilities and stop only after getting a perfect score
Think of an actual or hypothetical hospital department (any) Make a brief description of the Department and its setting. From experience (hearsay or actual), cite at least one, at most two challenges in alignment, coordination and integration in the following and give recommendations for solutions:
- Within the cited department
- Between the department and the hospital
- Between the department and other department in the hospital
NOTES:
Some notes on slides (see attached ppt with notes).
Systems Thinking in Healthcare Facilities
I was asked to give a lecture with this title: Systems Thinking in Healthcare Facilities for HA 202.
(Organization and Management of the Different Departments and Services of a Hospital)
- with a time limit of 30 to 45 minutes
- With the following prescribed learning outcomes or objectives:
o Understand how to run and manage a hospital effectively and efficiently by systematically using the systems approach or perspective and systems thinking.
o Describe a hospital department design and development framework, how to use and apply it and be familiar with the basic requirements in it.
o Understand the importance of alignment and integration of all the boxes in the above framework.
o Discuss common challenges encountered in governance of departments together with their suggested strategic solutions.
With these prescriptions given to me by the course director, I shall delimit my presentation on “Health Facilities” to the hospitals or hospital setting with focus on governance of a department rather than on the whole hospital. Thus, I will change my title to: Systems Thinking in Hospitals with Focus on Departments, so that I will be aligned with the learning outcomes or objectives.
What is systems thinking?
Let’s start with the structure and basic functioning of the hospitals.
All hospitals are made up of more than one, various, and different departments and services.
We look at the hospitals as a system, that is, a set of interrelated but separate parts working towards a common purpose.
As hospital managers, we must know how to manage the hospital effectively and efficiently by making sure that all the various different departments and services are aligned and integrated in their governance and functioning.
Systems perspective, systems approach, and systems thinking are various terms that one will encounter in management discipline manuals and all are geared towards ensuring alignment, coordination, collaboration and integration of the functioning of interrelated parts of a system.
I will not into detailed discussion of the differences between and among the different terms.
Suffice it to say that systems perspective or approach (to management) views the organization or the hospital and also the department of a hospital as a unified, purposeful system composed of interrelated parts. This perspective or approach gives the manager to see the organization as a whole and as a part of the larger external environment.
Systems thinking on the other hand is a holistic approach to analysis that focuses on the way that a system’s constituent parts interrelate and how systems work over time and within the context of larger systems. Put it another way, systems thinking is basically, a way of helping a manager to view systems from a broad perspective that includes seeing overall structures, patterns and cycles in systems, rather than seeing only specific events in the system. This broad view can help the manager to quickly identify the real causes of issues in organizations and know just where to work to address them.
Systems perspective, approach, and thinking - management discipline that concerns an understanding of a system by examining the linkages and interactions between the components that comprise the entirety of that defined system.
Again, the bottom line of systems perspective, approach and thinking is the recommendation for all managers to view and analyze situations in the hospital and departments holistically and comprehensively and to always look at the interaction of parts to other parts and to the whole and vice versa with alignment and integration as key result areas and key performance indicators.
Alignment
Alignment means a state of consistency among plans, processes, information, resource decisions, workforce capability and capacity, actions, results, and analyses that support key organization-wide goals. Consistency between all hospital plans and hospital goals. Consistency between department plans and hospital goals as well as department goals. Quality of doing things towards the same direction. Thus, all staff should be clear about the hospital’s purpose and policies and procedures as well as those of the department and make decisions in accordance with them.
Integration
Integration means the harmonization of plans, processes, information, resource decisions, workforce capability and capacity, actions, results, and analyses to support key organization-wide goals. Harmonization between and among all parts in the hospital and departments to produce a unified outcome or goal. Effective integration goes beyond alignment and is achieved when the individual components of a system operate as a fully interconnected unit such as the harmonization of music by an orchestra.
In effecting harmonization and integration, coordination (synchronization) and collaboration (cooperation) of parts are important.
Baldrige 2010 Health Care Criteria for Performance Excellence
This slide illustrates the concepts of alignment (in No. 3) and Integration (in No. 4). The ultimate target is an integrated approach or integrated process (in No, 4). No. 1 illustrates the complete absence of uniform or consistent direction of the arrows or processes. No. 2 illustrates some amount of uniform or consistent directions of the arrows or processes.
As mentioned earlier, In effecting harmonization and integration, coordination (synchronization) and collaboration (cooperation) of the aligned parts are important.
Back to Systems Thinking in Hospitals with Focus on Departments.
As mentioned earlier, all hospitals are made up of so many different departments and services.
The number varies from one hospital to another.
The minimum number will be the one imposed by the Department of Health licensing body.
Level 1 – basic departments and services
Level 2 – with medical specialties but without training departments, with more departments and services than Level 1.
Level 3 – with medical specialties and with training departments, with more departments and services than Level 2.
Examples of hospital departments and services
Medical Services Departments such as Department of Emergency Medicine, Outpatient Department and Inpatient Department.
Diagnostic Departments such as Laboratory Medicine, Radiology, and Nuclear Medicine
Treatment Departments such as
Operating Room Complex; OB-GYN Complex; Rehabilitation Medicine Department; Medical Specialty Departments; Nursing Services and Dietary Department
Medical Support Departments such as Facility Management Department, Housekeeping, Security, and Billing and Cashier Departments.
Administrative Support Departments such as
• Quality and Patient Safety Department
• Materials Management Department
• Human Resource Development Department
• Business Development Department
• Finance and Accounting Department
Others that will be created on the basis of needs as deemed by the hospital administration.
Roughly, the minimum could be 25 departments and services and could be up to 50 or more.
This slide illustrates the importance of alignment, coordination, collaboration and integration of all departments and services to effectively and efficiently achieve performance excellence of a hospital.
Just as the hospital is made up of different interrelated parts, in terms of departments and services, to facilitate achievement of its corporate goals, each department and service is also made up of different interrelated parts to facilitate achievement of its authorized functions and services.
Each department and service is also considered as a system as in a hospital.
Each department and service must also utilize systems perspective, approach and thinking in management.
understanding the system by examining the linkages and interactions between the components that comprise the entirety of that defined system.
Viewing and analyzing situations in the department holistically and comprehensively and to always look at the interaction of parts to other parts and to the whole and vice versa with alignment and integration as key result areas and key performance indicators.
Not to say, there must be alignment, coordination, coordination and integration of each department and services with and to the whole hospital and with the other departments and services.
This slide shows the essential and basic components of a department which must be present to facilitate accomplishment of its authorized functions and services and achievement of its goals.
Leadership
Authorized functions
Authorized services
Goals
Architectural design / engineering / construction
Physical structure
DOH licensing and structural requirements
Policies and procedures
Risk management system
Human resource program
Equipment / material program
Data / documents / records program
Business development program
Budget Program
IT-enabled system
Regular performance evaluation and continual improvement program
All of these components must be present, aligned and integrated with and to each other in order to achieve performance excellence for the department.
On the left part of the slides, one sees the need for alignment and integration with the whole hospital as well as the other departments in the hospital.
This slide illustrates the supersystem (which is the hospital), subsystem (which is a particular department), and co-system (which is an interfacing department).
The arrows indicate the need for alignment and integration of all parts of the system (the department) with the supersystem (the hospital) and co-systems (the interfacing departments.
This department design and development framework is applicable to all kinds of department and services in the hospital such as emergency room, surgery department, operating room, housekeeping department, etc.
This Department Design and Development Framework / Administrative Design and Development Program was developed by yours truly in 2010 to facilitate learning, planning, and administration!
There must be a manual that contains description, elements and management system of each box.
Whatever be the department,
the managers should consider, be aligned, coordinate, collaborate and integrate with the whole hospital ‘s concepts and design, governance policies and procedures, operations policies and procedures as well as the interfacing units’ operations policies and procedures!
There must be a SYSTEMS PERSPECTIVE or SYSTEMS THINKING!
Leadership
Whatever be the department,
there must be a competent head with at least the following competencies: unit technical requirements / competency; hospital teamship, managership and leadership.
There must at least be a job description and job specifications and performance evaluation system
Functions
There must be a document stating authorized functions of unit.
It must be complete and clear with general and specific functions and it must be authorized by a higher office.
Services
There must be a document stating authorized SERVICES of unit.
“Services” offered and “functions” authorized must be congruent with each other.
Goals
There must be a document stating the ultimate goals which must be aligned and integrated with the goals of the hospital.
Client engagement
Peformance excellence
Quality and safe health care services
Cost-efficient or value-based services
Maximal utilization of services
All eventually contributing financial viability and sustainability.
This slide shows the basic processes of management in the department design and development framework – the inputs (leadership, functions, and services); the outputs, (goals); and the throughputs (all the boxes in between the inputs and outputs).
DOH LICENSING AND STRUCTURAL REQUIREMENTS means compliance to DOH Guidelines in the Planning and Design of a Hospital and Other Health Facilities; Safe Hospital Initiative – structural, non-structural, and functional indicators; Building Code; Fire Code; local government requirements; etc.
PHYSICAL STRUCTURE refers to a geographical space or area in the hospital to construct the department to receive patient- and physician-clients requesting for services and to house the staff who will perform the functions of the department.
Service requirements as dictated by the authorized functions is the first determinant of the PHYSICAL STRUCTURE of a department.
The other determinants of the PHYSICAL STRUCTURE are the following: 1) statutory and regulatory requirements; 2) DOH Licensing Requirements (DOH Guidelines in the Planning and Design of a Hospital and Other Health Facilities and Safe Hospital Initiative – structural, non-structural, and functional indicators); 3) Building Code; 4) Fire Code; 5) local government requirements; 6) SPECIALTY requirements particularly on training and research; 7) human resource program; 8) equipment and material program; 9) data / documents / records program; 10) budget program; 11) risk management program; 12) business development program; 13) quality standards; 14) community expectations; 15) efficiency; 16) case load; and 17) owners’ wants.
Architectural design will be dictated by the DOH licensing and structural requirements and the physical structure requirements.
Human Resource Program
There must be a document showing job description, job specifications and performance evaluation system of human resource in the department.
There must be documentation of adequacy in number and in competency.
Equipment / Material Program
There must be a document showing adequacy of equipment and materials needed to facilitate an effective and efficient functioning of the unit in consideration of the key functions and services of the unit, statutory and regulatory requirements, and other objectives like business development, risk management, and IT-enabled system.
Data / Documents / Records Program
There must be a document showing adequacy of data, documents and records needed to facilitate an effective and efficient functioning of the unit in consideration of the key functions and services of the unit, statutory and regulatory requirements, and other objectives like business development, risk management, and IT-enabled system.
Business Development Program
There must be a document showing the presence of a structured and comprehensive program that will develop the business of the unit to make it viable and sustainable.
Budget Program
There must be a document showing a budget that project future income and expenses of the unit and the budget is being used as a guide for day-to-day performance and financial evaluation at planned intervals.
Risk Management Program
There must be a document showing a risk management program - which is a planned and systematic process / program to reduce and/or eliminate the probability of a “risk” that usually results in injuries, losses, and legal suits.
(may also include risk with potential positive effect – improving business and client engagement.)
IT-enabled system
• There must be a document showing the use of IT to promote efficiency in performance of functions and accomplishment of services ;
• to manage information of unit – getting, storing, protecting, processing, transmitting as necessary, and later retrieving as necessary;
• to create interconnection with other units in hospital for timely communication, coordination and collaboration in accomplishment of services of unit;
• to communicate with the patient- and physician-clients both in and out of hospital.
Regular Performance Evaluation and Continual Improvement Program
There must be a document that shows a program to appraise extent of accomplishment of the unit in its authorized functions and business plans at planned intervals (quarterly, biannually, and annual) and
To determine areas of improvement and to act on them.
ROJ@20sept18