Using systems thinking to extend continuous quality improvement.

Traditional CQI tools have proven effective in improving discrete processes, but the strengths of these tools often render them inappropriate to improve complex systems made up of multiple processes. After finding that CQI tools failed to reduce emergency department waiting times, a QI team applied systems thinking tools and learned that the cause of delays was rooted in interrelationships among processes, such as the impact on laboratory testing when emergent and routine patients arrived back to back. Computer modeling allowed the team to reject some quick fixes--such as adding ED beds--that simulations showed would be ineffective. By reorganizing patient flow and automating hospitalwide bed control, the team so far has reduced waiting times 19 percent and increased patient satisfaction despite an increase in census.