As medical students and in our professional careers we are taught about and teach concepts about the complex interactions within and between systems in the human body. This type of ‘systems thinking’ is a fundamental part of our medical knowledge base.

Undergraduate and post-graduate curricula however pay little attention to ‘other’ systems that play a critical role in healthcare delivery. The systems I am referring to operate at different levels within a health service – so can be viewed as both micro and macro-systems. Public Health and Medical administration curricula do cover these areas, but is there a need for a more general focus on systems and systems thinking in our training?

Our medical training enables us to see that a system is simply a method by which we can view and understand any dynamic process or a series of dynamic processes (i.e. most systems form part of a more complex system). But what does this have to do with quality in healthcare?

We should probably acknowledge that the ‘quality movement’ has been gaining momentum in health as we continually seek to do ‘more’ with fewer resources, tempered by ever improving technologically enabled investigative techniques and interventions. My view of quality is fairly simplistic – it’s giving patients the best possible care and minimising the potential for adverse events, in the most efficient and effective manner, at the same time ensuring you operate within the limits of your available resources. Quality should, in my opinion, be on every health professionals mind.

Let’s take a simple system – transfer of a patient from ED to a ward…. Yes – simple enough system you’d probably say. But take a moment to think about all the actions and processes activated when you make that referral to an inpatient specialty team. Bed managers are alerted, porters are alerted, nursing handover takes place, inpatient specialty review must occur, another patient needs to be discharged from a ward bed, clinical and operational information needs to be processed and passed on… to name but a few – and this must all happen safely and efficiently. We need to stop seeing our actions in isolation, but think about the upstream and downstream effects of our actions and decisions.

Systems thinking, gives us a framework by which we can see how our actions and decisions impact other processes and systems – by creating this transparency, we enable the workforce to drive quality improvement.

So next time you are in hospital or in your practice, think about how the decision you make will impact on a process down the track and then think about how we can create greater visibility of these processes so that we can all contribute to improving quality for the patients we serve.