Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.
School of Psychology and Vision Sciences, College of Life Sciences, University of Leicester, Leicester, UK.
Age Ageing. 2024 Oct 1;53(10). doi: 10.1093/ageing/afae238.
Existing models for the safe, timely and effective delivery of health and social care are challenged by an ageing population. Services and care pathways are often optimised for single-disease management, while many older people are presenting with multiple long-term conditions and frailty. Systems engineering describes a holistic, interdisciplinary approach to change that is focused on people, system understanding, design and risk management. These principles are the basis of many established quality improvement (QI) tools in health and social care, but implementation has often been limited to single services or condition areas. Newer engineering techniques may help reshape more complex systems. Systems thinking is an essential component of this mindset to understand the underlying relationships and characteristics of a working system. It promotes the use of tools that map, measure and interrogate the dynamics of complex systems. In this New Horizons piece, we describe the evolution of systems approaches while noting the challenges of small-scale QI efforts that fail to address whole-system problems. The opportunities for novel soft-systems approaches are described, along with a recent update to the Systems Engineering Initiative for Patient Safety model, which includes human-centred design. Systems modelling and simulation techniques harness routine data to understand the functioning of complex health and social care systems. These tools could support better-informed system change by allowing comparison of simulated approaches before implementation, but better effectiveness evidence is required. Modern systems engineering and systems thinking techniques have potential to inform the redesign of services appropriate for the complex needs of older people.
现有的医疗保健安全、及时和有效的交付模式受到人口老龄化的挑战。服务和护理途径通常针对单一疾病管理进行优化，而许多老年人同时存在多种长期疾病和虚弱。系统工程描述了一种整体的、跨学科的变革方法，其重点是以人为本、理解系统、设计和风险管理。这些原则是许多既定的医疗保健和社会护理质量改进（QI）工具的基础，但实施通常仅限于单一服务或疾病领域。新的工程技术可能有助于重塑更复杂的系统。系统思维是这种思维模式的重要组成部分，用于理解工作系统的基本关系和特征。它促进使用工具来映射、测量和质疑复杂系统的动态。在这篇新视野文章中，我们描述了系统方法的演变，同时注意到小范围 QI 努力未能解决整个系统问题所带来的挑战。描述了新颖的软系统方法的机会，以及最近更新的包括以人为中心的设计在内的患者安全系统工程倡议模型。系统建模和仿真技术利用常规数据来了解复杂的医疗保健和社会护理系统的运作。这些工具可以通过在实施之前比较模拟方法来支持更明智的系统变革，但需要更好的有效性证据。现代系统工程和系统思维技术有可能为满足老年人的复杂需求重新设计服务提供信息。
