McNab Duncan, McKay John, Shorrock Steven, Luty Sarah, Bowie Paul
Medical Directorate, NHS Education for Scotland, Glasgow, UK.
Institute of Health and Wellbeing, University of Glasgow, United Kingdom.
BMJ Open Qual. 2020 Mar;9(1). doi: 10.1136/bmjoq-2019-000714.
'Systems thinking' is often recommended in healthcare to support quality and safety activities but a shared understanding of this concept and purposeful guidance on its application are limited. Healthcare systems have been described as complex where human adaptation to localised circumstances is often necessary to achieve success. Principles for managing and improving system safety developed by the European Organisation for the Safety of Air Navigation (EUROCONTROL; a European intergovernmental air navigation organisation) incorporate a 'Safety-II systems approach' to promote understanding of how safety may be achieved in complex work systems. We aimed to adapt and contextualise the core principles of this systems approach and demonstrate the application in a healthcare setting.
The original EUROCONTROL principles were adapted using consensus-building methods with front-line staff and national safety leaders.
Six interrelated principles for healthcare were agreed. The foundation concept acknowledges that 'most healthcare problems and solutions belong to the system'. Principle 1 outlines the need to seek multiple perspectives to understand system safety. Principle 2 prompts us to consider the influence of prevailing work conditions-demand, capacity, resources and constraints. Principle 3 stresses the importance of analysing interactions and work flow within the system. Principle 4 encourages us to attempt to understand why professional decisions made sense at the time and principle 5 prompts us to explore everyday work including the adjustments made to achieve success in changing system conditions.A case study is used to demonstrate the application in an analysis of a system and in the subsequent improvement intervention design.
Application of the adapted principles underpins, and is characteristic of, a holistic systems approach and may aid care team and organisational system understanding and improvement.
医疗保健领域常推荐采用“系统思维”来支持质量与安全活动，但对这一概念的共同理解以及关于其应用的针对性指导却很有限。医疗系统被描述为复杂系统，在其中，人们往往需要根据当地情况进行调整才能取得成功。欧洲航空安全组织（EUROCONTROL；一个欧洲政府间航空导航组织）制定的管理和改进系统安全的原则纳入了“安全-II系统方法”，以促进对如何在复杂工作系统中实现安全的理解。我们旨在调整并结合该系统方法的核心原则，并展示其在医疗环境中的应用。
采用与一线工作人员和国家安全领导人达成共识的方法，对EUROCONTROL的原始原则进行了调整。
就医疗保健的六项相互关联的原则达成了一致。基础概念承认“大多数医疗问题和解决方案都属于系统”。原则1概述了需要从多个角度来理解系统安全。原则2促使我们考虑当前工作条件——需求、能力、资源和限制因素的影响。原则3强调分析系统内相互作用和工作流程的重要性。原则4鼓励我们尝试理解为什么当时做出的专业决策是合理的，原则5促使我们探索日常工作，包括为在不断变化的系统条件下取得成功而做出的调整。一个案例研究用于展示其在系统分析和后续改进干预设计中的应用。
应用经过调整的原则是整体系统方法的基础和特点，可能有助于护理团队和组织系统的理解与改进。
