MGT603 Systems Thinking (2)

MGT603: Systems Thinking

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Abstract

The activities and operations within the emergency department often have life and death consequence implication. Other than providing needed immediate care, hospital emergency department personnel also play a role in assorting and directing patients to relevant departments where they will be best served. Organizations that operate based on complex and long system archetypes are prone to challenges such as longer patient waiting hours, loss of life due to delayed needed healthcare service delivery e.t.c. Also, the structure of an organizations system archetype is important because it dictates how fast the decision making process will be or not. This report is a case study that explores systems modeling tools including archetypes and how they impede organizational performance, application of value stream mapping analysis for a case study hospital emergency department and to reduce patient waiting times.

Table of Contents

TOC o “1-3” 1. Introduction PAGEREF _Toc450572701 h 3

2. System Archetypes PAGEREF _Toc450572702 h 4

2.1 System archetypes that may impede Performance PAGEREF _Toc450572703 h 4

2.1.2 Systems that fail PAGEREF _Toc450572704 h 5

2.1.2 Drifting goals PAGEREF _Toc450572705 h 5

2.1.3 Shifting the Burden PAGEREF _Toc450572706 h 5

2.1.4 Limits to success PAGEREF _Toc450572707 h 6

2.1.5 Growth and Underinvestment PAGEREF _Toc450572708 h 7

2.1.6 Success to Successful PAGEREF _Toc450572709 h 7

2.1.7 Escalation PAGEREF _Toc450572710 h 8

2.1.8 Tragedy of the outcomes PAGEREF _Toc450572711 h 8

2.2 Current State Value Stream Map Analysis PAGEREF _Toc450572712 h 10

2.3 Recommended new State Value Stream Map PAGEREF _Toc450572713 h 11

2.4 Intended and Unintended Consequences PAGEREF _Toc450572714 h 12

3. Conclusions PAGEREF _Toc450572715 h 13

4. Recommendations PAGEREF _Toc450572716 h 14

5. References PAGEREF _Toc450572717 h 14

MGT603: Systems Thinking

1. IntroductionThe world is presently scrambling with the devastating effects of the global Coronavirus pandemic. Hospitals are at the center of the race to contain the spread while seeking long-term solutions such as vaccines and other viable treatment regimens. So far, Hospital emergency departments have proved vital to the overall success of interventions towards beating COVID19 in any medical institution because it is tasked with the provision of first line medical care assistance to patients coming in need of mediate care. The activities and operations within the emergency department often have life and death consequence implication. Other than providing needed immediate care, hospital emergency department personnel also play a role in assorting and directing patients to relevant departments where they will be best served. According to Sözen et al., (2017), operational efficiency or lack of it within hospital emergency departments is dependent on the existing system archetypes that dictate the flow of service as well as communication and treatment.

Organizations that operate based on complex and long system archetypes are prone to challenges such as longer patient waiting hours, loss of life due to delayed needed healthcare service delivery e.t.c. Also, the structure of an organizations system archetype is important because it dictates how fast the decision making process will be or not. The emergency department operates based on the principle of urgency and therefore quick decision making contributes significantly to the effectiveness of service delivery and the general operational efficiency of the department as well as the entire medical facility. A casing example in this report is the challenges faced by medical facilities in effectively handling the rising cased of corona virus infections across the globe. This paper posits that system archetypes promote organizational learning in a hospital emergency department and that has the potential to significantly improve general service delivery efficiency. Therefore system archetypes must be continuously evaluated and modified to prevent undesirable outcomes such as long hospital queues and delays in service delivery to patients among other unintended and undesirable outcomes.

2. System ArchetypesSystem archetypes are essential and highly effective tools used to study understand organizational behavior patterns; patterns that reflect the underlying gaps and disconnections within the systems being studied. According to Vaillancourt et al., (2014), system archetypes are tools used by managers to identify patterns of behavior in within organizational systems and serve as a medium for gaining deeper understanding of the underlying systems structures and how the observed organizational behaviors originate. Gillies & Maliapen, (2008), in support, explains that system archetypes do not describe one specific problem within a systems but rather a series of problems with causal factors and that is the value they create in terms of offering deep insights into complex and dynamic systems and system behavioral outcomes.

2.1 System archetypes that may impede PerformanceThere are currently 8 common system archetypes. These include systems that fail, drifting goals, shifting the burden, limits to success, growth and underinvestment, success to successful, escalation, and tragedy of the outcomes.

2.1.2 Systems that failThese are often the quick fixes that are passed on disguised as solutions to address symptoms of a seemingly urgent problem. The drawback that arises from such fixes is that they tend to set in motion unintended consequences. These consequences may not always be evident at the onset but will add to the problem in the long-term.

2.1.2 Drifting goalsThis refers to fixes that are applied in the case where there is a significant gap between the system performance and the target goal. The solution is usually to lower the goal or target but in the long run, this fix result in the unintended outcome of lowered organizational performance or productivity. In this case, managers are always faced with the problem of organizational performance that fails to meet the set goals. Rather than finding proper solutions, the managers apply symptomatic solution by finding justifications for lowering the targets to a level that seems easily achievable rather than applying the fundamental solution of finding the performance impediment. In the long run, this archetype becomes a performance impediment because the organization will be forced to adjust its goals downward each time the performance fails to meet targets and this creates a culture of laxity towards goal setting and so the organization will spiral into a downward trend of setting lower and lower targets just to ensure that the goals are achieved regardless.

2.1.3 Shifting the BurdenThis is a situation where managers opt to address symptoms of the problem with both short term and fundamental solutions. Managers often adopt this approach as a way to deflect pressure. When a problem occurs, they seek symptom-based quick fixes that will make the problem go away rather than making a commitment to finding long-term solution. This approach impedes organizational performance because when a quick fix is applied and the problem goes away, the organization’s need to find fundamental solutions also goes away until the same problem reoccur. The outcome behavior overtime is that this pattern will continue until the quick fix applied in one area of the system ends up creating more problems in other system functionality areas thereby creating a performance gridlock.

2.1.4 Limits to successThis is a situation where particular efforts become constrained such that the effort no longer generates positive performance outcomes. Behavior overtime is that the overall organizational performance becomes stagnated no matter how much effort is applied. In this type f archetype, the efforts to sustainably achieve growth will be successful in the early stages but eventually, the system reaches the limits to growth and the efforts applied no longer generate desired outcome in terms of growth. A good example can be drawn from the case study of the hospital emergency department operations. The department manager faces the problem of reduced number of patient attendances because of longer waiting times and long queues at the reception.

To address the problem, the manager decided to eradicate some of the services along the treatment chain that are deemed non-essential. The resultant effect is that the patients are attended to faster and the waiting times are reduced significantly thereby encouraging more people to come to the facility. The long-term behavior is that since the facility is working with limited staff, the huge numbers of patients overwhelm the service providers and therefore the patients will still have to wait longer in queues however fast the providers attend to the patients. The outcome is that overtime, most of the patients will opt to seek help elsewhere.

2.1.5 Growth and UnderinvestmentThis archetype points to the significance of addressing the dynamics in investment balancing loop especially from the managerial decision-making perspective. This is observable in a case where an organizational growth is approaching limit that could easily be avoided by investing in capacity but the managers opt to save on cost instead. The behavior overtime is the resultant performance degradation thereby resulting in low quality product and or service delivery. The decline in product or service quality causes significant decline in demand by targeted consumers of the product or service. The decline in demand consequently leads to decline in revenues, which in turn reduces resources available for investment.

2.1.6 Success to SuccessfulThis archetype is observed in a situation where two or more interventions are competing for the same limited resources, the most successful intervention gets assigned significantly higher amount of resources at the expense of the others. Success to successful archetype therefore creates insights into the trend of rewarding performers while neglecting underperformers. In an organization, the management is likely to fall into the trap of rewarding better performing employees, departments or products by allocating more resources to them at the expense of the underperforming ones without proper understanding of the underlying conditions or factors. Instead, a manager should critically evaluate the circumstances and conditions that contribute to the observed performance gaps and derive a resource allocation strategy that maximizes the potential of all the involved efforts. Otherwise, the rewarded efforts will continue to improve in performance while the unrewarded efforts continue to decline further in performance. This is not a desirable situation for any organization seeking to create and sustain its competitive advantages.

2.1.7 EscalationManagers are expected to create and sustain organizational competitive advantages and superiority over competitors through escalation structures. Managers justify their actions and decisions based on the strong belief that they are acting in the best interest of the company even if the implication of the decision stand to reduce the organization’s value to the customers, and other stakeholders. In the long run, the organization gets caught up in cutthroat action-reaction competition schemes, which in the long run harm the company and its interests, which the managers claimed to be protecting in the first place.

2.1.8 Tragedy of the outcomesThis archetype gives insights into the concept of reductionist thinking and its implication for overall organizational success. A properly functional organization is a collective of resources including people, space, finances, and systems among other resources. These resources are interlinked into a functional system with each aspect significantly dependent on the activities of the other systems. The problem arise when people in an organization for example continue to operate in a manner that does not recognize and appreciate the fact that there are interconnections within the system that contribute to their ability to perform assigned duties and achieve set goals and targets. Eventually, they end up placing too much pressure on such common resources which consequently collapse therefore incapacitating all the other dependent factors from functioning properly as expected including the people. A typical example of common resource is the IT department in a hospital setting. All hospital departments depend on the IT department top function yet when each department asserts increasing pressure on the system without considering the needs of the other departments, the IT department become too constrained for resources and when it eventually collapses, all the other departments cannot continue to function effectively as expected.

-287020115570002.2 Current State Value Stream Map AnalysisThe presented value stream map for the hospital emergency room gives a representative insight into the underlying system structures contributing to the lengthy waiting times. The lengthy waiting times can be traced to existing system archetypes including growth and underinvestment, as well as tragedy of the outcomes. The concept of growth and underinvestment is traceable to the limited space and personnel within the facility. The chine of service delivery is spread across with significant dependency on the attending nurse. The hospital should hire additional staff or capacity build the attnendants at the first level of triage to be able to perform the basic patient examinations. The records station and the ER should be within the same space or proximity to eliminate time wastage in the waiting area. Additionally, the attending doctor and the nurse should work in the same room so that; once the nurse is done examining the patient, the attending doctor takes over. The increased dependency on the attending nurse creates immense pressure on him/her to work faster and see more patients; this may lead to high risks of burnout and collapse, which may then lead to the breakdown of the entire service delivery chain.

2.3 Recommended new State Value Stream Map-57150018478500

Several research studies have been carried tout to determine the effectiveness of value stream mapping as a tool for improving organizational turnaround time in sectors such as healthcare as well as industrial production systems (Satyadi, 2012; Ramaswamy et al., 2017; Aizat Ahmad, 2019). After extensive fact analysis and consideration of existing value stream map, this report recommends adopting the lean approach as proposed by Improta et al., (2018). Their findings on similar problem for the emergency department at AORN Cardarelli hospital proved that lean approach significantly reduces patient waiting time to half the time used in the previous service delivery system. The lean method has proved to be efficient because it is based on simplified and streamlined operational efficiency attributable to task specification, streamlined communication, simple process architecture and results based or evidence based problem solving interventions. The proposed approach is to digitize the health information management system as well as computerization of the major procedures to eliminate time wasted waiting for information and communication transfer between the departments. Additionally, the proposed value stream mapping creates a service delivery system where the medical staff has been reorganized so that those who are interdependent are closely connected to create seamless uninterrupted workflow through out the process.

2.4 Intended and Unintended ConsequencesThe new value stream mapping has significantly reduced the patient waiting time by eliminating process interruptions and fast tracking diagnostic processes through computerization. These interventions will be effective for the long-term but has one major unintended out come. That is the risk of tragedy of outcomes. The system has been highly computerized from records management, communication as well as diagnostic procedures. This creates additional pressure on the existing IT department, which if not properly capacity built, may become overwhelmed, and breakdown resulting in a complete service delivery shutdown. Additionally there is the archetype of growth and underinvestment archetype. The management can opt for the proposed computerization and information system digitization but if they do not invest in capacity building the staff with knowledge and skills for operating and managing the equipment then the waiting time may double since the technology is new to them and they have to take time performing diagnostic procedures with limited knowledge and skills. The healthcare providers are also highly likely to commit errors as a result and this may have significant negative implications for the patients as well as the hospital as a whole in cases of misdiagnosis and wrong treatment related adverse events.

3. ConclusionsSystem archetypes promote organizational learning in a hospital emergency department and that has the potential to significantly improve general service delivery efficiency. They are essential and highly effective tools used to study understand organizational behavior patterns; patterns that reflect the underlying gaps and disconnections within the system being studied. There are 8 major archetypes that can influence or impede organizational performance and must be critically evaluated and understood during decision-processes. Also, value stream mapping is a great tool for visualizing emergency hospital department operational processes for ease of service delivery standardization and problem identification, evaluation and problem solving. Through the lean method, an organization can easily improve its turnaround time, especially in hospitals where timely decisions and interventions mean the difference between life and death for the patients.

4. RecommendationsBased on the findings of this report, the following recommendations are put forward for consideration. Organizations intending to sustain competitive advantage need to critically evaluate its systems to identify existing gaps and formulate long-term solutions rather than symptom based interventions, which are bound to cause additional problems in the long-term. There is need for further studies on value stream mapping approaches to come up with standardized methodologies for addressing related organizational process challenges regardless of the type of industry of business activity in future.

5. ReferencesAizat Ahmad, A. (2019). Process Time improvements through the application of Value Stream Mapping support Lean System. International Journal Of Advanced Trends In Computer Science And Engineering, 8(1.6), 310-317. https://doi.org/10.30534/ijatcse/2019/4681.62019

Gillies, A., & Maliapen, M. (2008). Using healthcare system archetypes to help hospitals become learning organisations. Journal Of Modelling In Management, 3(1), 82-99. https://doi.org/10.1108/17465660810860390

Improta, G., Romano, M., Di Cicco, M., Ferraro, A., Borrelli, A., & Verdoliva, C. et al. (2018). Lean thinking to improve emergency department throughput at AORN Cardarelli hospital. BMC Health Services Research, 18(1). https://doi.org/10.1186/s12913-018-3654-0

Ramaswamy, R., Rothschild, C., Alabi, F., Wachira, E., Muigai, F., & Pearson, N. (2017). Using Value Stream Mapping to improve quality of care in low-resource facility settings. International Journal For Quality In Health Care, 29(7), 961-965. https://doi.org/10.1093/intqhc/mzx142

Satyadi, C. (2012). Practical Application of Value Stream Mapping in Process Improvement of Emergency Department Testing Turnaround Time. American Journal Of Clinical Pathology, 138(suppl 2), A250-A250. https://doi.org/10.1093/ajcp/138.suppl2.201

Sözen, S., Celik, S., Akpinar, C., Güven, F., Yel, C., Kavalci, C., & Salt, Ö. (2017). Analysis of the patients admitted to emergency department due to urogenital trauma and investigation of factors that affect mortality. Journal Of Acute Disease, 6(2), 70-73. https://doi.org/10.12980/jad.6.2017jadweb-2016-0066

Vaillancourt, S., Shahin, I., Aggarwal, P., Pomedli, S., Hayden, L., Pus, L., & Bhattacharyya, O. (2014). Using Archetypes to Design Services for High Users of Healthcare. Healthcarepapers, 14(2), 37-41. https://doi.org/10.12927/hcpap.2015.24107