A hospital’s day-to-day operating environment is so dynamic that clinical leaders and frontline staff are forced to make on-the-fly adjustments and reactive decisions because they lack the necessary time and insight to make more intentional, proactive decisions. In this chaotic environment, clinicians can only focus on the patients under their immediate care and make decisions that are optimal for their patients. This localized decision-making becomes problematic because each individual decision has ramifications across the entire system. ‘Systemness’ is the idea that hospitals can broaden clinicians’ awareness to improve decision-making that takes into account the larger hospital ecosystem.
Blending Clinical and Systems Thinking
Nurses, doctors, and other clinicians are trained to provide the best care possible to the patient in front of them. The natural disposition for most clinicians, therefore, is to be fierce advocates for their patients, which may mean moving a patient to an earlier MRI or demanding a procedure they deem necessary. In general, this inclination is one that aligns with most hospital mission statements of providing excellence in care. It also aligns with the patient desire to feel taken care of and advocated for.
However, this well-intentioned behavior is problematic from a system-wide perspective and leads to the opposite of systemness – hoarding. In the clinical realm, hoarding may take the form of putting a hold on an ICU bed for a post-surgical patient whose surgery is still hours away from completion. The instinct to ensure an ICU bed is available is understandable, but if the ICU bed sits empty and can’t be used by another patient with an immediate need, the consequences can be dire. This traditional siloed decision-making is counterproductive and anti-collaborative with clinical peers each pushing to get their patients to the front of the line too.
Systems thinkers, on the other hand, tend to look at populations and how various ecosystems interact. They’re concerned about questions such as, ‘How do we optimize resources to best serve our population?’ ‘If I take action in one silo, how will that affect outcomes in another?’ Ultimately, systems thinkers have a heightened awareness that every action has downstream and upstream ripple effects that may or may not be ideal.
The traditional clinical mindset is understandable given that clinicians are trained and incentivized to advocate for their patients by any means possible. Furthermore, there’s historically been a lack of tools and best practices to show clinicians how their resource requests affect the larger hospital system and could possibly cause bottlenecks and shortages that reduce overall efficiency of resource utilization. Fortunately, systemness enables clinical thinkers to adopt a system-wide mindset while maintaining the core values inherent to their clinical training.
Charting a Path Towards Systemness
Systemness occurs when clinicians gain frictionless awareness of the larger ecosystem in which they operate, leading to decisions that are optimal for the entire organization. The path to systemness starts with the ability to quickly visualize any given patient as a node in a larger environment. This enables clinicians to internalize the relationship between their individual clinical orders, and the impact these orders may have on other patients and clinicians. This journey towards systemness is furthered by the ability to simulate the outcome of various resource decisions such as opening surge units, rearranging surgical schedules, or assigning float pool staff to different units.
In practice, systemness may enable a clinician to realize that pushing to get a CT scan sooner for a less-urgent case means that a more deserving patient may have to wait longer. Given the right tools, this is straightforward to visualize as well as explain to a patient and family who must wait until the end of the day for a non-urgent test.
Another example of systemness in the real world is the growing reluctance to prescribe antibiotics for borderline cases. Most clinicians admit that it’s usually easier to prescribe antibiotics to patients who request them, rather than to explain their illness is more likely viral than bacterial. But the growing awareness of antibiotic resistance makes doctors choose the more difficult path of withholding medication in service of delaying drug resistance. This example shows that clinicians can change their behavior and broaden their awareness with evidence-based tools.
Achieving Systemness Requires a Data-Driven Approach
The emergence of data-driven tools that combine operational intelligence, digital automation, and people has turned systemness from a theoretical concept into a tangible reality. These tools enable systemness by giving clinicians a global view of the hospital so they can develop situational awareness beyond their immediate patients or teams. In turn, staff recognize the interconnected relationship between their decisions and outcomes at an organizational level, which ultimately leads to more streamlined operations, improved staff satisfaction, and enhanced patient care.
A key benefit of using modern data-driven operations software is to nudge clinicians to adopt a degree of systems thinking. This does not mean abandoning the primacy of patient care or compromising the integrity of the patient-provider relationship. Rather, it means that when two choices are clinically equivalent, clinicians choose the one with better operational efficiency.
For example, with data-driven insights, clinicians can view real-time demand for ICU beds and have confidence a bed will be available at the time of patient need. If there isn’t a bed available, clinicians can start making alternative plans such as calling in staff to open capacity or arranging for PACU boarding. Instead of bed hoarding which reduces overall bed utilization, data-driven insights enable bed coordination, which means resources are used at peak efficiency.
Ultimately, systemness allows hospitals to pivot away from exclusive decision-making and towards cooperative care that benefits both the staff and patient population holistically. With the proper tools and best practices, clinicians can amplify their commitment to excellent patient care by gaining system-wide awareness and making decisions that optimize patient outcomes and operational efficiency.
Photo: Feodora Chiosea, Getty Images
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