Medical errors are the third leading cause of death in the United States (after heart disease and cancer), and patient safety is a top priority for the American healthcare system. Because most of the errors are preventable and due to system failures — not the individuals providing care – any effort to improve patient safety should involve a system-wide view of the delivery of care.
For more than a decade, patient safety advocates such as Dr. Lucien Leape, a physician and professor at the Harvard School of Public Health, have called for systems thinking as a way to improve healthcare outcomes, noting that systems cannot be improved without an understanding of them.
There is also an abundance of evidence that patient safety requires both teamwork and appreciation of the system of care. As a result, medical and nursing schools are now obliged to teach teamwork, appreciation of system and interprofessional collaboration – now formally identified as core competencies by authoritative bodies such as ACGME, AACN and QSEN.
“Building a health care workforce equipped with strong systems thinking skills assists to change the long-held belief that safety is situated within individuals, devices, or single units of an organization to an understanding that safety is found within the system and only when system vulnerabilities are discovered,” explains Jill Sanko of the University of Miami in research she led and published in Nurse Educator. (See A Multisite Study Demonstrates Positive Impacts to Systems Thinking Using a Table-top Simulation Experience.)
Yet health profession educators are often challenged to come up with ways to effectively teach these soft and semi-soft skills. It’s one thing to tell students about the concepts; it’s quite another to show students what they actually have to do to put these ideas and behaviors into routine practice. That’s where experiential learning like Friday Night at the ER is enormously helpful.
Using the game, future (and current) healthcare professionals discover that no one part of the system can achieve quality and safety goals; rather, they learn experientially that it takes serious collaboration and shared responsibility across functional, professional and ideational boundaries to get desired outcomes.
How does this work? In the game, each person plays the role of a hospital department manager, handling patient flow and staffing, dealing with situations that arise, and documenting performance. Yet as players perform distinct functions, they come to realize they also depend on each other. They discover that quality and cost problems can be solved only if they collaborate, are open to new ideas, and use data for decision-making. These are three essential behaviors for putting systems thinking into practice, so the game serves as both a demonstration and a practice field for applying systems thinking.
Of course, the root causes that lead to medical errors and patient deaths are complex and multi-faceted, but applying systems thinking is an important strategy for identifying and solving complex problems, and developing this skillset in our healthcare professionals is a critical first step.
As Sanko concludes in her research, “Individuals with a systems thinking mindset born from systems thinking knowledge and skills are most likely to discover system vulnerabilities and in turn create solutions and work collaboratively to implement them.”