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01 Cover
02 Contents
03 Find out what's useful for you
04 Foreword
05 Executive summary
06 introduction
07 Section 1 - Healthcare as a ‘system of systems’
08 Section 2 – Approaches to improvement
09 Section 3 – Defining a systems approach
10 Section 4 – A framework for thinking
11 Section 5 – A framework for action
12 Annex 1 – Applications of the approach
13 Annex 1 - study of the Esther Model
14 Annex 1 - study of oral methotrexate
15 Annex 2 – Case studies
16 Annex 2 - explore the case studies
17 Case study 1 – The Esther model
18 Case study 2 – Oral methotrexate
19 Case study 3 – Michigan intensive care unit project
20 Case study 4 – St Aubyn Centre
21 Case study 5 – London Ambulance Service
22 Case study 6 – Arsenal’s Emirates Stadium
23 Case study 7 – Design Bugs Out
24 Case study 8 – Modelling and simulation saves lives
25 Case study 9 – The GlaxoSmithKline Diskus inhaler
26 Case study 10 – Coordinated care at end of life
27 Case study 11 – Daily inpatient schedules in Birmingham
28 Case study 12 – Barts Sustainability Strategy
29 Case study 13 – The Dyson Centre for Neonatal Care
30 Annex 3 – Elements of a systems approach
31 Annex 3 – people perspective
32 Annex 3 – systems perspective
33 Annex 3 – design perspective
34 Annex 3 – risk perspective
35 Annex 3 – Engineering systems
36 Annex 4 – Compilation of approaches
37 Annex 4 – Change model
38 Annex 4 – Model for improvement
39 Annex 4 - Quality improvement journey – NHS Scotland
40 Annex 4 - Leading large-scale change
41 Annex 4 - Human factors in healthcare
42 Annex 4 - Root cause analysis
43 Annex 4 - Systems thinking for health
44 Annex 4 - Experience-based co-design
45 Annex 4 - Lean in healthcare
46 Annex 4 - Risk assessment made easy
47 Annex 4 - Systems engineering
48 Annex 4 - Human-centered design
49 Annex 4 - Six sigma
50 Annex 4 - Inclusive design
51 Annex 4 - Risk management
52 Annex 4 - System safety assessment
53 Bibliography
54 About this project

Foreword

The UK’s health and social care system is, appropriately, one of our most treasured national assets. However, the sheer size and complexity of the system, as well as the pressures it faces from an ageing population and finite resources, mean that making improvements to health and care can be a significant challenge. Successful transformation must take into account the needs of all patients, carers, healthcare professionals and other staff. It requires consistent consideration of every element of the system, the way each element interacts, and the implications of these interactions for the system as a whole – that is, it requires a ‘systems’ approach.

Clinical leaders are increasingly exploring and recognising successes by using a range of evidence based approaches to work on design and improvement, including systems techniques. This work is leading to improved pathways, processes and patient experience. However, such approaches are not yet consistently defined or applied throughout health and care design and improvement.

Engineering is a sector where systems thinking is routinely applied to understand, design, deliver, and sustain systems ranging from the development of worldwide telecommunications networks to the latest Boeing 787 Dreamliner. As a pioneer of minimally invasive surgery, I personally have always been an advocate of an interdisciplinary approach between engineering and healthcare sectors and this project has provided an excellent opportunity for mutual learning. It has led to the development of a rigorous yet workable framework for the application of systems thinking in the unique context of health and care.

I fully endorse the recommendation that healthcare leaders and transformation teams consider the questions and tools laid out here to support a more consistent application of a systems approach to health and care design and improvement. With this work we hope to deliver benefits for patients, carers, and staff, and showcase the value in cross-sectoral working.

Rt Hon Professor Lord Darzi of Denham OM PC KBE HonFREng FRS FMedSci

August 2017

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Foreword

Executive summary

Introduction

Section 1

Healthcare as a ‘system of systems’

Section 2

Approaches to improvement

Section 3

Defining a systems approach

Section 4

A framework for thinking

Section 5

A framework for action

Annex 1

Applications of the approach

Annex 2

Case studies

Annex 3

Elements of a systems approach

Annex 4

Compilation of approaches

Bibliography

About the project