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"systems thinking"

Lukas K Schoenenberger, Steffen Bayer, John P Ansah, David B Matchar, Rajagopal L Mohanavalli, Sean Sw Lam, Marcus Eh Ong
OBJECTIVES: Emergency Department crowding is a serious and international health care problem that seems to be resistant to most well intended but often reductionist policy approaches. In this study, we examine Emergency Department crowding in Singapore from a systems thinking perspective using causal loop diagramming to visualize the systemic structure underlying this complex phenomenon. Furthermore, we evaluate the relative impact of three different policies in reducing Emergency Department crowding in Singapore: introduction of geriatric emergency medicine, expansion of emergency medicine training, and implementation of enhanced primary care...
2016: SAGE Open Medicine
Mimi Jenko, Nancy M Short
Bereavement services for families are an established part of hospice and palliative care. However, patients also die in the acute care and long-term care environments. Often, hospice is not involved, creating a potential gap in care. This article recounts a journey to improve care for all families of deceased patients, despite the presence or absence of hospice. A palliative care clinical nurse specialist led a quality improvement team, which used a systems thinking approach to develop and implement a downloadable bereavement booklet for families...
November 2016: Dimensions of Critical Care Nursing: DCCN
Rebekah Frankson, William Hueston, Kira Christian, Debra Olson, Mary Lee, Linda Valeri, Raymond Hyatt, Joseph Annelli, Carol Rubin
The emergence of complex global challenges at the convergence of human, animal, and environmental health has catalyzed a movement supporting "One Health" approaches. Despite recognition of the importance of One Health approaches to address these complex challenges, little effort has been directed at identifying the seminal knowledge, skills, and attitudes necessary for individuals to successfully contribute to One Health efforts. Between 2008 and 2011, three groups independently embarked on separate initiatives to identify core competencies for professionals involved with One Health approaches...
2016: Frontiers in Public Health
Rebecca Patrick, Uta Dietrich
In Oceania, a region challenged by rapid urbanisation and climate change, integrative frameworks are required to enable effective actions on health and sustainability. The Ecohealth approach provides a framework for practice that acknowledges human health is intrinsically linked to ecosystem health. This research communication reports on a study involving interviews with twenty-seven leading health and sustainability thinkers from Oceania and across the globe. In examining their ideas for action, the report presents the study findings in relation to the guiding principles of Ecohealth: systems thinking, transdisciplinarity, participation, sustainability, equity and knowledge-to-action...
September 20, 2016: EcoHealth
Emily F Gates
In the last twenty years, a conversation has emerged in the evaluation field about the potential of systems thinking and complexity science (STCS) to transform the practice of evaluating social interventions. Documenting and interpreting this conversation are necessary to advance our understanding of the significance of using STCS in planning, implementing, and evaluating social interventions. Guided by a generic framework for evaluation practice, this paper reports on an inter-disciplinary literature review and argues that STCS raises some new ways of thinking about and carrying out the following six activities: 1) supporting social problem solving; 2) framing interventions and contexts; 3) selecting and using methods; 4) engaging in valuing; 5) producing and justifying knowledge; and 6) facilitating use...
December 2016: Evaluation and Program Planning
Paul Bowie, Elaine McNaughton, David Bruce, Deirdre Holly, Eleanor Forrest, Marion Macleod, Susan Kennedy, Ailsa Power, Denis Toppin, Irene Black, Janet Pooley, Audrey Taylor, Vivien Swanson, Moya Kelly, Julie Ferguson, Suzanne Stirling, Judy Wakeling, Angela Inglis, John McKay, Joan Sargeant
INTRODUCTION: Significant event analysis (SEA) is well established in many primary care settings but can be poorly implemented. Reasons include the emotional impact on clinicians and limited knowledge of systems thinking in establishing why events happen and formulating improvements. To enhance SEA effectiveness, we developed and tested "guiding tools" based on human factors principles. METHODS: Mixed-methods development of guiding tools (Personal Booklet-to help with emotional demands and apply a human factors analysis at the individual level; Desk Pad-to guide a team-based systems analysis; and a written Report Format) by a multiprofessional "expert" group and testing with Scottish primary care practitioners who submitted completed enhanced SEA reports...
2016: Journal of Continuing Education in the Health Professions
Janet M Phillips, Ann M Stalter
A critical need exists for nursing leadership in current complex health care settings. Systems thinking can be incorporated into nursing education at all levels by using evidence-based principles in education. Teaching tips are provided using a systems awareness model to guide nurse educators in the assessment and integration of systems thinking and engaging learners in interprofessional education and practice. J Contin Educ Nurs. 2016;47(9):395-397.
September 1, 2016: Journal of Continuing Education in Nursing
Julius H Kotir, Carl Smith, Greg Brown, Nadine Marshall, Ron Johnstone
In a rapidly changing water resources system, dynamic models based on the notion of systems thinking can serve as useful analytical tools for scientists and policy-makers to study changes in key system variables over time. In this paper, an integrated system dynamics simulation model was developed using a system dynamics modelling approach to examine the feedback processes and interaction between the population, the water resource, and the agricultural production sub-sectors of the Volta River Basin in West Africa...
August 26, 2016: Science of the Total Environment
Rick Hood, Allie Goldacre, Robert Grant, Ray Jones
This paper presents the results of an exploratory study linking the national data-sets for all children in need and child protection services in England. The study was informed by an emerging literature on systems thinking in public services, and aimed to examine variations and patterns of response in local authorities to demand for child welfare services in their area. One hundred and fifty-two local authority census returns and other statistical indicators covering up to a thirteen-year period were combined into a single data-set...
June 2016: British Journal of Social Work
Laura C Tibor, Stacy R Schultz, Julie L Cravath, Russell R Rein, Karl N Krecke
This initiative utilized a collaborative learning approach to increase knowledge and experience in process improvement and systems thinking while targeting improved patient flow in seven radiology modalities. Teams showed improvements in their project metrics and collectively streamlined the flow for 530 patients per day by improving patient lead time, wait time, and first case on-time start rates. In a post-project survey of 50 project team members, 82% stated they had more effective solutions as a result of the process improvement methodology, 84% stated they will be able to utilize the process improvement tools again in the future, and 98% would recommend participating in another project to a colleague...
May 2016: Radiology Management
Kim Manley, Anne Martin, Carolyn Jackson, Toni Wright
BACKGROUND: Overcrowding in emergency departments is a global issue, which places pressure on the shrinking workforce and threatens the future of high quality, safe and effective care. Healthcare reforms aimed at tackling this crisis have focused primarily on structural changes, which alone do not deliver anticipated improvements in quality and performance. The purpose of this study was to identify workforce enablers for achieving whole systems urgent and emergency care delivery. METHODS: A multiple case study design framed around systems thinking was conducted in South East England across one Trust consisting of five hospitals, one community healthcare trust and one ambulance trust...
2016: BMC Health Services Research
Ashley I Naimi
No abstract text is available yet for this article.
November 2016: Epidemiology
Madhabi Chatterji
This paper explores avenues for navigating evaluation design challenges posed by complex social programs (CSPs) and their environments when conducting studies that call for generalizable, causal inferences on the intervention's effectiveness. A definition is provided of a CSP drawing on examples from different fields, and an evaluation case is analyzed in depth to derive seven (7) major sources of complexity that typify CSPs, threatening assumptions of textbook-recommended experimental designs for performing impact evaluations...
December 2016: Evaluation and Program Planning
Annette June Panzera, Richard Murray, Ruth Stewart, Jane Mills, Neil Beaton, Sarah Larkins
Creating a stable and sustainable health workforce in regional, rural and remote Australia has long been a challenge to health workforce planners, policy makers and researchers alike. Traditional health workforce planning is often reactive and assumes continuation of current patterns of healthcare utilisation. This demonstration project in Far North Queensland exemplifies how participatory regional health workforce planning processes can accurately model current and projected local workforce requirements. The recent establishment of Primary Health Networks (PHNs) with the intent to commission health services tailored to individual healthcare needs underlines the relevance of such an approach...
2016: Australian Journal of Primary Health
Justin Waring, Simon Bishop, Fiona Marshall
BACKGROUND: Hospital discharge is a vulnerable transitional stage in patient care. This qualitative study investigated the views of healthcare professionals and patients about the threats to safe hospital discharge with aim of identifying contributory and latent factors. The study was undertaken in two regional health and social care systems in the English National Health Service, each comprising three acute hospitals, community and primary care providers and municipal social care services...
2016: BMC Health Services Research
N F N Bittencourt, W H Meeuwisse, L D Mendonça, A Nettel-Aguirre, J M Ocarino, S T Fonseca
Injury prediction is one of the most challenging issues in sports and a key component for injury prevention. Sports injuries aetiology investigations have assumed a reductionist view in which a phenomenon has been simplified into units and analysed as the sum of its basic parts and causality has been seen in a linear and unidirectional way. This reductionist approach relies on correlation and regression analyses and, despite the vast effort to predict sports injuries, it has been limited in its ability to successfully identify predictive factors...
July 21, 2016: British Journal of Sports Medicine
Cynthia L Russell, Shirley Moore, Donna Hathaway, An-Lin Cheng, Guoqing Chen, Kathy Goggin
BACKGROUND: Among adult kidney transplant recipients, non-adherence to immunosuppressive medications is the leading predictor of poor outcomes, including rejection, kidney loss, and death. An alarming one-third of kidney transplant patients experience medication non-adherence even though the problem is preventable. Existing adherence interventions have proven marginally effective for those with acute and chronic illnesses and ineffective for adult kidney transplant recipients. Our purpose is to describe the design and methods of the MAGIC (Medication Adherence Given Individual SystemCHANGE™) trial METHODS/DESIGN: We report the design of a randomized controlled trial with an attention-control group to test an innovative 6-month SystemCHANGE™ intervention designed to enhance immunosuppressive medication adherence in adult non-adherent kidney transplant recipients from two transplant centers...
2016: BMC Nephrology
Sonia Wutzke, Emily Morrice, Murray Benton, Andrew Wilson
INTRODUCTION: There is a need and desire to improve chronic disease prevention efforts across Australia. Increasingly, scientists are urging the use of systems thinking and its methods to significantly shift the way we think about, and intervene in, chronic diseases. This research aimed to examine the convergence between the systems science literature and the views of those working in and advocating for prevention, in relation to the value of systems thinking and its methods for the prevention of chronic diseases...
2016: Public Health Research & Practice
Rainer Gaupp, Mirjam Körner, Götz Fabry
BACKGROUND: Patient safety (PS) is influenced by a set of factors on various levels of the healthcare system. Therefore, a systems-level approach and systems thinking is required to understand and improve PS. The use of e-learning may help to develop a systems thinking approach in medical students, as case studies featuring audiovisual media can be used to visualize systemic relationships in organizations. The goal of this quasi-experimental study was to determine if an e-learning can be utilized to improve systems thinking, knowledge, and attitudes towards PS...
2016: BMC Medical Education
Huey T Chen
Theories of program and theories of evaluation form the foundation of program evaluation theories. Theories of program reflect assumptions on how to conceptualize an intervention program for evaluation purposes, while theories of evaluation reflect assumptions on how to design useful evaluation. These two types of theories are related, but often discussed separately. This paper attempts to use three theoretical perspectives (reductionism, systems thinking, and pragmatic synthesis) to interface them and discuss the implications for evaluation practice...
June 7, 2016: Evaluation and Program Planning
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