Systems Based Practice

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Systems Based Practice

Business of Medicine
Author Credentials 

Lawrence M. Simon, MD
Assistant Clinical Professor
Department of Otolaryngology-Head & Neck Surgery
LSU Health Sciences Center 
New Orleans, LA

I would like to thank Dr. Brian McKinnon, Associate Professor and Vice-Chairman of Otolaryngology at Drexel University College of Medicine, and Dr. David Roberson, Associate Professor of Otology and Laryngology and Harvard Medical School, for their assistance in preparing this module.

Module Summary

Understanding Health Care Systems and the systems that we used to run them is a complex field of study.  Understanding how these concepts relate to each other and are interwoven into the practice of medicine is critical to becoming a leader and ensuring that your patients receive the highest quality of care.  After completing this module, the physician will be able to:

  • Demonstrate an awareness of and responsiveness to the larger context and system of healthcare.
  • Demonstrate the ability to effectively call on system resources to provide care that is of optimal value.
Module Learning Objectives 
  1. Define a Health Care System 
    • List key attributes of a medical system.
    • Describe what makes a system successful
    • Distinguish a Health Care System from Systems within Health Care (both relate to Systems-Based Practice)
  2. Explain why a surgeon should care about systems.
  3. Describe various types of health care delivery systems.  
    • Know the various elements of these systems, including their pros and cons
    • Know how these elements of the system affect a physician’s own practice.
  4. Recognize how types of medical practice and delivery systems differ from one another, including methods of controlling healthcare costs and allocating resources.
  5. Review how to partner with healthcare managers and healthcare providers to assess, coordinate, and improve healthcare, and know how these activities can affect system performance.
  6. Cite what, if any, is the benefit of physicians studying systems literature that is derived from studies of other areas (e.g., industry, the military, airline industry- safety is equally important for them as it is to us).
  7. Explain system process improvement
    • Identify metrics for measuring success
    • Methods of identifying problems and producing solutions
      • Checklists
      • Sentinnel event analysis
      • Communication trees
      • Uniformity
    • Importance of feedback
    • Importance of standardization

Review

References 

American Medical Association:
Teaching New Content in Health Systems Science

Literature

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  3. Clemmer TP, Spuhler VJ, Berwick DM, et al. Cooperation: the foundation of improvement. Ann Intern Med. 1998;128:1004-1009.
  4. Collins SJ, Newhouse R, Porter J, Talsma A. Effectiveness of the surgical safety checklist in correcting errors: a literature review applying Reason's Swiss cheese model. AORN journal. 2014 Jul;100(1):65-79.e5.
  5. Dingley, C, Daugherty, K, Derieg, MK, Persing, R. Improving patient safety through provider communication strategy enhancements. In: Henriksen, K, Battles, JB, Keyes, MA, Grady, ML, eds. Advances in Patient Safety: New Directions and Alternative Approaches (Vol. 3: Performance and Tools). Rockville, MD: Agency for Healthcare Research and Quality; 2008.
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  10. Helmreich RL. On error management: lessons from aviation.  BMJ. 2000 Mar 18;320(7237):781–785.
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  14. Martinez J, Phillips E, and Harris C. Where do we go from here? Moving from systems-based practice process measure to true competency via developmental milestones.  Med Educ Online. 2014; 19: 10.3402/meo.v19.24441.
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  19. Shah RK, Stey AM, Jatana KR, Rangel SJ, Boss EF. Identification of opportunities for quality improvement and outcome measurement in pediatric otolaryngology.  JAMA Otolaryngol Head Neck Surg. 2014 Nov;140(11):1019-26.
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  21. US Department of Defense. Human Factors Analysis and Classification System: A Mishap Investigation and Data Analysis Tool.  2015 Jan.
     
Resources 

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  1. Annual Meeting Webcast (AMW):