Session: Healthcare as a Complex System
Last modified: June 20, 2006
Patient Safety has risen to the top of the “worries about healthcare”. We have to worry about access to care and then worry about the possibility of it killing us when we do get it. The Institute of Medicine has produced three major works on this concern – “Too Err is Human” (1999), “Crossing the Quality Chasm” (2001) and “Hospital Emergency Rooms: At the Breaking Point” released in June 2006. Because these publications have attracted the nation’s attention there have been valiant efforts to address medical errors. The Institute for Health Care Improvement launched the 100,000 lives campaign and patient safety legislation was passed into law last year. These and many other efforts to reduce medical errors have approached the problem condition by condition, compensating for failing processes and gathering data.
However, the delivery of care to the sick is a messy business. The opportunities to fail are legion. The number of errors, despite the dogged determination of researchers, is likely far higher than estimates. Happily, most errors do no harm. Many are not even noticed. There may be more realistic ways to improve the systems and reduce the errors than mechanistic step by step approaches.
Healthcare is the poster child for complex adaptive systems. It is nonlinear work trapped in a rigidly linear management structure. How much that structure contributes to failures at all scales of the system is anyone’s guess.
This presentation discusses a few specific dimensions of complex systems: purpose/intent, relationship/connectivity, information, rules, boundaries, predictability, control and patterns and their relationship in reducing mistakes in health care settings – in inpatient and ambulatory care. Examples of a complex systems method of reducing errors in practice are provided.
This is a recommendation to approach diagnosis, treatment and nursing care as a complex adaptive system rather than a series of linear tasks within disciplines. This requires new structures, new measurements, new questions and a very destabilizing new way of thinking.
Helen Harte RN, MPH, MPA is the Director of Patient Safety at the Puget Sound VA Health Care System. She has been active in healthcare quality improvement for seventeen years. Helen has consulted with rural and urban hospitals and clinics in the evaluation of work systems and the application of Dr. W. E. Deming’s work and complex systems thinking to improve health care processes and outcomes. She is an associate of the New England Complex Systems Institute.