Improvement of Existing Healthcare Systems

Open Versus Closed Systems Perspectives: Healthcare Processes
According to Zakus & Bhattacharyya (2007), one of the great paradoxes of modern healthcare is despite the “availability of many cures, treatments, and preventive measures” for both severe and mild ailments, there remains a failure to engage in effective delivery of treatment to patients (p. 278). One possible explanation to this conundrum is that while the actual technology and medical care may be of high quality, the systems which deliver such care are faulty. Systems theory suggests that many of these issues lie in the fact that healthcare organizations are closed rather than open systems. Closed systems are by their very nature impervious to outside influences and determined to maintain standard operating procedures. Although this can ensure consistency, given that healthcare is a field constantly in flux, it is not an effective approach for the long term (Zakus & Bhattacharyya 2007).
In contrast, open systems are receptive to input from the external environment. They are constantly “exchanging materials, energies, or information, and are influenced by or can influence this environment; they must adjust to the environment to survive over time” (Zakus & Bhattacharyya 2007, p.279). A good example of an inefficient closed system approach was manifest at my healthcare institution was in regards to its attitude towards medical errors. Medical errors are a serious problem for all healthcare institutions to varying degrees. But because my institution’s rate of errors is not significantly worse than the national average, there is not as much as pressure to go above and beyond to identify what processes could be improved to achieve a preferable rate of zero errors.
One reason to make improving medical errors that are the result of inefficient processes an important goal is that such a goal is a measurable target, and what is not measurable cannot be improved. Numerous systematic research studies have confirmed that the most common errors to result in serious harm to patients include: “drug to wrong patient, wrong dose of medication, drug overdose, omitted drug, wrong drug and wrong administration time” (Carayon, & Wood, 2010, par. 3). The causes of these errors are also well known, including “failure to follow checking procedures, written miscommunication, transcription errors, prescriptions misfiled and calculation errors” (Carayon, & Wood, 2010, par. 3).
A closed system approach usually involves simply inflicting disciplinary action towards such violators. An open systems approach, however, would attempt to discern why the breakdown was occurring. For example, overtired and overstressed medical staff may be apt to commit more errors, and more efficient scheduling can reduce errors. Not having appropriate checklists for personnel can also result in errors. A good electronic medical records system can eliminate failures in communication, such as inaccurate prescriptions or failures to keep track of patients’ allergies and medical histories. It has also been shown that having more educated staff in general results in lower rates of errors (Carayon, & Wood 2010).
Determining the points during processes when errors occurs is also important, such as during patient transitions. “In today’s healthcare system, patients are experiencing an increasing number of transitions of care…when patients are transferred from one care setting to another, from one level or department to another within a care setting, or from one care provider to another” (Carayon, & Wood, 2010, par. 12). At many institutions, these are when errors are most likely to occur. Regardless, a full audit is necessary of the experience and willingness to adhere to treatment of medical personnel at our institution, as well as regular observations to determine how to improve holistically, versus simply focusing on individual errors.
Open systems theory is thus a “focus on the forest, not the trees” approach. It entails a willingness to admit what is currently being done may not work for providers and patients. And even if what is occurring is working, it means a willingness to strive for error-free procedures, not simply the status quo.


References
Carayon, P., & Wood, K. E. (2010). Patient safety: The role of human factors and systems
engineering. Studies in Health Technology and Informatics, 153, 23–46.
Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3057365/
Zakus, D. & Bhattacharyya, O. (2007). Health systems, management, and organization in low-
and middle-income countries, 278-291. Retrieved from: https://cdn1.sph.harvard.edu/wp- content/uploads/sites/114/2012/10/RP248.pdfHealth