Healthcare Quality at the Organization and Microsystem Level
Systems Thinking
“…A view of reality that emphasizes the relationships and interactions of each part of the system to all the other parts” (McLaughlin & Olson 2012, 23).
–
McLaughlin, D.B., & J.R. Olson. 2012. Healthcare Operations Management, 2nd ed. Chicago, Health Administration Press.
A systems thinking approach to quality management
The interconnected system model
The three core process model
The Baldrige performance excellence program framework
Socioecological framework
Interconnected system level
Divided into four levels:
Environment level
Organization level: is a critical level of change in the health care system because it can provide an overall climate and culture for change.
Microsystem level
Patient level
Three core process model
Clinical, Medical, and Technical process: are critical process because they are the main reason why clients seek health care assistance.
Operational or patient flow process (registering patient, scheduling): enable clients to gain access.
Administrative process (decision making, communication, resource allocation, and performance evaluation)
The improvement in any one of these process has the potential to increase the value of the service provided.
Three Core Process Model
Outcomes
Clinical outcomes
Cost
Satisfaction
Functional status
Clinical/Medical/Technical Processes
Operational/Patient & Client Flow Processes
Administrative Decision-Making Processes
Administrative Decision-Making Processes
Source: Kelly, D. L. 2017. Applying Quality Management in Healthcare, 4th Edition. Chicago: Health Administration Press.
Baldrige Performance Excellence Program Framework (BPEP)
The model describes essential elements of organizational effectiveness
The model shows the importance of alignment in the organization
www.nist.gov/baldrige
Source: www.baldrige.gov.
Socioecological Framework
A transdisciplinary systems perspective on promoting health and wellness that uses and reflects theory from multiple fields; medicine, public health, behavior and social science.
Emphasis on multilevel and recognition of the complexity of human environment
Provide a more expansive view of the nature of health and wellness
Help to understand interventions designed to improve the quality and safety of services.
Maybe used to better understand smoking behavior and drinking
Socioecological Framework: Determinants, Interventions, Evaluation
https://www.cdc.gov/cancer/crccp/sem.htm
Systems Models: Lessons for Managers