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Whole Systems Thinking

We often need to understand how a whole system works. This can include the whole process of treatment that a patient experiences, from feeling unwell, though to recovery, for instance, and include all the various clinical and organisational processes in between. While whole systems models appear to be descriptive, they are analytical, drawing on research and evidence. Done well, the enable the following benefits, described in a general way:

  • how is clinical decision making done and is it done well; are the right decisions being made at the right times, and do decision-makers have the information they need when they need it;
  • are guidelines and protocols working and do they accurately describe the workflow itself;
  • how does funding flow, where are payment and reimbursement decisions made, and what is the connection between payer priorities and the way the system performs; this helps identify perverse incentives, or where money is wasted;
  • who does what when and are they the right people to do this; and
  • what are the organisational arrangements across the whole system, to determine whether patients are being treated in the right place at the right time or whether there are impediments in referral of patients from one place to another.

Various other analytical tools, such as Triple Aim, are involved in whole systems, which identify where clinical value exists, where problems and opportunities lie, where money is wasted, where patients are least well-cared for.

For companies with products seeking use in healthcare, knowing where the value lies is critically important, as payers are using analytical models, such as health technology assessment, to determine purchasing intensions.

For payers and providers, know where systems are working well, or not, is critical in ensuring the best use of scarce, expensive resources and talented people.

In both cases, systems models are one way of ensuring a focus on solving the right problems. Methods involved can be descriptive (such as Whole System flowcharts, or Logic Maps) or immersive (such as simulations and scenarios).