System theory provides a framework for quality improvement (QI) in healthcare systems due to its significance in system thinking (Clancy, Efken, & Pesut, 2008). System thinking can be defined as a process that allows individuals to apply the whole system, as well as, the relationships of the sections instead of applying the sections in isolation. One health problem that requires being addressed is the aspect of quality care. According to Reid et al. (2005), quality care is essential as it increases patient satisfaction. Clancy, Efken, and Pesut (2008) argue that high-quality care results in systems that value relationships and interrelationships.
Although relationships are significant, more emphasis is placed on education, process management, behavioral competencies and skill competencies, conflict management, team building, and effective communication (Meyer & O’Brien-Pallas, 2010). One of the problems I have identified is the delivery of quality care. Some of the core components of quality care include specific mission-driven behaviors like organizational commitment to safety, patient involvement in the plan of care through effective communication, interdisciplinary evidence-based disease management processes, safe healthcare environments, well-constructed policies and procedures that guide practice, and competent staff. Although each component is essential in the delivery of care, I have witnessed that some components receive too little if any attention.
The input of a system theory in the health facility includes patients desiring the best of care. Thus, providing quality patient centered care results to patient satisfaction. Another aspect of input is health personnel desiring to provide the best patient oriented care that is valuable among the patients. The health administration and the legal fraternity expect the health facility to provide valuable and quality care to the clients.
The desired output for this component is satisfied patients who have received valuable care, and health personnel feedback, which reinforces the desire to provide care and stimulate interdisciplinary collaboration.
The transformation energy (throughputs) is present in the production subsystems and is effectively attained through the labor division. Katz and Kahn (1978) explain that the effectiveness of subsystems is through technical proficiency, which is attained through the transformation of energy. In the production system, the division of labor is the determiner of workflow and structure. In this case, subdividing the work among the interdisciplinary will form breaks in the workflow. The health facility can attain this component by integrating work processes across roles and subunits using coordination devices.
Quality improvement in the health facility can be attained through the application of system theory in stuff involvement in decision-making, the creation of supportive environments of care, and ensuring professional autonomy. Reid et al. (2005) argue that use of system theory in quality improvement is beneficial; as it improves collaboration among all disciplines, reduce turnover rates in the health facility, and result in best-practice quality outcomes. Therefore, encouraging a generative relationship in the health system will reduce tensions in relation to practice boundaries and improve interdisciplinary collaborative practice. The nurse-physician conflict is disadvantageous as the health personnel will be averse to conflict and instead of resolving the conflicts, they will identify new ways to avoid conflict.
One of the strategies to resolve the issue is providing more education, as well as, greater conflict tolerance. The healthcare management in the facility has a critical role to play where they encourage diverse viewpoints, as well as, conflicting viewpoints. However, this is unattainable without an atmosphere that is open to cooperation, flexibility, and patience. The reason for including education is because the system is a cycle of events. A system as a cycle of events is defined as the process by which a health facility exchanges and transforms energy and requires renewal to ensure it is cyclic (Pertula, 2013). In this case, education is a continual process where health personnel is impacted with knowledge and skills to ensure the delivery of quality of care. Although it is challenging for the health facility to educate personnel, it may offer attractive packages that prompt health personnel to advance their education.
Another critical component is negative feedback. One of the aspects that the facility should adopt is organizational performance indicators. Through this, the administration is in a better position to evaluate how each person performs within a given time. For example, the use of Key performance indicators would be essential in identifying the effectiveness of strategies employed in the health system. Lastly, the health facility can embed project management techniques that will provide a planning and organizing framework for interdisciplinary patient-focused quality improvement team.
According to Meyer and O’Brien-Pallas (2010), some components of quality care may greatly affect the social process in the delivery of care. Based on the social system perspective, parallel functions and boundaries among health personnel in a health facility may result in challenges in the generation of collaborative and generative relationships, healthy work environment, and effective communication. Pertula (2013) explains that the application of collaborative interdisciplinary relationships is beneficial in improving outcomes, as well as, reducing mortality and morbidity.
Using system theory, quality improvement can be attained by underpinning system processes in the health facility by recognizing that they are equally important as the component parts. For example, many healthcare systems neglect the interdisciplinary relationships. In particular, I have observed that in my area of work, there lacks an interdisciplinary relationship between administration, social work, medicine, and nursing. One of the major issues is nurse-physician conflict, an aspect that is greatly significant to social processes in a healthcare system. The said facility pays little to no attention to the inter-relationship between these disciplines. One of the core reasons for its failure is the emergence of unanticipated behaviors from the unanticipated interaction of these components.
Nonetheless, the failure of the system can be prevented through system thinking by supporting quality improvement. One of the strategies the health facility can apply includes putting more emphasis in both competency and skill competency. The aspect of nurse-physician conflict is greatly prompted by hierarchical power, but this can be solved by a reduction of power differentiation between the subsystems or departments. In addition, management should promote ongoing training and education. The more health personnel are educated, the higher the likelihood of understanding each component of the health facility. Another strategy is encouraging communication between the subsystems in the health facility.
There is a dynamic relationship between the healthcare delivery system, the quality of care, and health promotion. The dynamism of healthcare delivery system causes complexities, which can undermine the attempts to deliver quality healthcare. However, the complexities can be solved with the adoption of system theory in care delivery. Through this system, health providers can collaboratively work as a team to ensure all the components of system theory are attained. Hence, the components of system theory are effective in formulating standards that will ensure quality care and patient satisfaction.
Clancy, T. R., Effken, J. A., & Pesut, D. (2008). Applications of complex systems theory in nursing education, research, and practice. Nursing Outlook, 56(5), 248-256.
Katz, D., & Kahn, R. L. (1978). The social psychology of organizations (Vol. 2, p. 528). New York: Wiley.
Meyer, R. M., & O’Brien‐Pallas, L. L. (2010). Nursing services delivery theory: an open system approach. Journal of Advanced Nursing, 66(12), 2828-2838.
Pertula, S. (2013). Can applying systems theory improve quality in healthcare systems? Journal for Healthcare Quality, 27(6), W6-2.
Reid, P. P., Compton, W. D., Grossman, J. H., & Fanjiang, G. (2005). Building a better delivery system: a new engineering/health care partnership (Vol. 15). Washington, DC: National Academies Press.
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