The challenges and pressures facing the health and social care system are considerable and the complexity of the system makes improvement challenging. In recent years there have been numerous calls for the use of a ‘systems’ approach in efforts to transform health and care. [1,2,3] However, there has been a lack of a clear definition of what this might mean in a health context.
The work undertaken through this project aimed to define and describe the engineering systems approach and explore, in partnership with healthcare leaders, whether such an approach could be applied in health and care. While healthcare professionals know intuitively that there is a need to involve stakeholders in decisions and think across pathways, and many people working to improve health and care are aware of and use systems techniques, lessons could be learned from the different perspectives of the engineering sector and the analysis and rigour applied in engineering systems. Our project findings are based on an extended conversation within a unique forum of experts, led by the Royal Academy of Engineering, in collaboration with the Royal College of Physicians and the Academy of Medical Sciences. We brought together systems engineers, health and care professionals, quality improvement experts, and patient representatives (see About the project, page 87 for details) to define a systems approach for health and care, and develop a new and integrated approach to service design and improvement.
Engineers use a systems approach to address challenging problems in complex projects such as the Channel Tunnel
This preliminary report outlines the findings from this work, providing a clear definition of a systems approach, setting out a framework and tools for its implementation in health and care, and presenting case studies exemplifying the importance of such an approach for health and care improvement. It is aimed at stimulating conversations with funders, healthcare provider leaders, teams and individuals delivering quality improvement and service design. Its ideas and tools can be used for improvement by everyone in health and care roles in all professions, clinical and non-clinical, from the smallest local teams to the largest national organisations. This way of thinking is particularly powerful when dealing with complex changes across multiple organisations. Table 1 signposts sections of the report that may be particularly helpful for different readers.
Following our initial exploration, we invite more partners to join us in the next phase to test the contents of this report in the field and to build evidence for and augment what we have proposed. We are continuing discussions with project partners, workshop participants, funders and government on how to best test, and subsequently embed, our ideas into current drives to improve quality and transform health and care. We will seek to publish case studies of this work as it is tested and developed.
 Building a better delivery system: A new engineering/health care partnership, National Academy of Engineering and Institute of Medicine, 2005.
 Learning from Bristol, The Bristol Royal Infirmary Inquiry, Report of the Public Inquiry, 2001.
 Design for patient safety, A system-wide design-led approach to tackling patient safety in the NHS, Department of Health and Design Council, 2003.