Augustsson Hanna, Churruca Kate, Braithwaite Jeffrey
Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, North Ryde, Sydney, NSW, 2109, Australia.
Procome research group, Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.
BMC Health Serv Res. 2020 Nov 23;20(1):1063. doi: 10.1186/s12913-020-05929-5.
Improving the quality of healthcare has proven to be a challenging task despite longstanding efforts. Approaches to improvements that consider the strong influence of local context as well as stakeholders' differing views on the situation are warranted. Soft systems methodology (SSM) includes contextual and multi-perspectival features. However, the way SSM has been applied and the outcomes of using SSM to stimulate productive change in healthcare have not been sufficiently investigated.
This scoping review aimed to examine and map the use and outcomes of SSM in healthcare settings.
The review was based on Arksey and O'Malley's framework. We searched six academic databases to January 2019 for peer-reviewed journal articles in English. We also reviewed reference lists of included citations. Articles were included if they were empirical studies focused on the application of SSM in a healthcare setting. Two reviewers conducted the abstract review and one reviewer conducted the full-text review and extracted data on study characteristics, ways of applying SSM and the outcomes of SSM initiatives. Study quality was assessed using Hawker's Quality Assessment Tool.
A total of 49 studies were included in the final review. SSM had been used in a range of healthcare settings and for a variety of problem situations. The results revealed an inconsistent use of SSM including departing from Checkland's original vision, applying different tools and involving stakeholders idiosyncratically. The quality of included studies varied and reporting of how SSM had been applied was sometimes inadequate. SSM had most often been used to understand a problem situation and to suggest potential improvements to the situation but to a lesser extent to implement and evaluate these improvements.
SSM is flexible and applicable to a range of problem situations in healthcare settings. However, better reporting of how SSM has been applied as well as evaluation of different types of outcomes, including implementation and intervention outcomes, is needed in order to appreciate more fully the utility and contribution of SSM in healthcare.
尽管长期以来一直在努力，但提高医疗保健质量已被证明是一项具有挑战性的任务。考虑到当地背景的强大影响以及利益相关者对情况的不同看法的改进方法是必要的。软系统方法论（SSM）具有情境和多视角特征。然而，SSM的应用方式以及使用SSM来促进医疗保健领域产生有效变革的结果尚未得到充分研究。
本范围综述旨在研究和梳理SSM在医疗保健环境中的使用情况及结果。
该综述基于阿克西和奥马利的框架。我们检索了六个学术数据库，截至2019年1月，查找英文的同行评审期刊文章。我们还查阅了纳入文献的参考文献列表。如果文章是专注于SSM在医疗保健环境中应用的实证研究，则予以纳入。两名评审员进行摘要评审，一名评审员进行全文评审，并提取有关研究特征、SSM应用方式以及SSM举措结果的数据。使用霍克质量评估工具评估研究质量。
最终综述共纳入49项研究。SSM已被应用于一系列医疗保健环境以及各种问题情境。结果显示SSM的使用存在不一致性，包括背离切克兰德的原始设想、应用不同工具以及独特地涉及利益相关者。纳入研究的质量各不相同，有时关于SSM应用方式的报告也不充分。SSM最常被用于理解问题情境并提出对该情境的潜在改进建议，但在实施和评估这些改进方面的程度较小。
SSM具有灵活性，适用于医疗保健环境中的一系列问题情境。然而，为了更全面地了解SSM在医疗保健中的效用和贡献，需要更好地报告SSM的应用方式以及对不同类型结果（包括实施和干预结果）的评估。
