Analysis of System Thinking in Emergency Department for Improvement

This report provides a comprehensive analysis of system thinking principles applied to an emergency department setting. It begins with an introduction to system thinking and the identification of system archetypes that may impede performance, such as 'balancing the process with delays,' 'limits to growth,' 'shifting the burden,' 'fixes that fail,' and 'growth and underinvestment.' The report then analyzes the current state value stream map of the emergency department, outlining the steps involved in patient processing and highlighting areas for improvement. The analysis uses system archetypes to diagnose systemic issues. A recommended new state value stream map is proposed, with the goal of reducing patient turnaround time. The report concludes with recommendations for implementing changes, emphasizing the importance of improving patient information tracking and adopting new archetype tools to streamline processes. The report includes references to relevant literature and provides a detailed understanding of applying system thinking to healthcare management.

System Thinking

Table of Contents
Introduction......................................................................................................................................3
Identification and analysis of the System Archetypes that may impede
performance
....................................................................................................................................................3
Analysis of the current State Value Stream Map of the emergency
department based on System Archetypes
.....................................................................................................................................................5
Recommended new State Value Stream Map with desired reduction in
patient turnaround time.
.....................................................................................................................................................7
CONCLUSION ...............................................................................................................................7
RECOMMENDATIONS.................................................................................................................7
REFERENCES................................................................................................................................9

Introduction
System thinking can be termed as the holistic approach that helps in analysing the
functioning of the constituent part of the system and efficiency of all the integrated system to
produce output. This research will based on the Diagnosing systemic issues and designing the
high leverage intervention in order to ensure the efficient working of the system. The study will
help in identifying the system archetypes that restricts the growth and performance of the
system. It will also help in understanding about the current state value stream map of the
emergency department that enable readers in analysing the complete door-to-door facility and
area of improvement in system. This report will also provide new state value stream map in order
to reduce the turnaround time of the patient in operation.
BODY
Identification and analysis of the System Archetypes that may impede
performance
The archetypes can be determined as the patterns which depicts the behaviour of the
system. In order to identify the system archetype that enables the manager to perform efficient
changes in the system. The Archetypes are also used by the managers to test the policies and
structure in order to alter the organisational structure (Banson, Nguyen, & Bosch, 2016). This
can be considered as the highly effective tool of Diagnosing that help in gaining the pattern of
the system behaviour. System Archetypes can be categorised into two ways such as
Diagnostically and prospectively. Various actions which are needed to be taken by the managers
in order to prevent the barriers in the functioning of the system which are described below:
Circle of Casualty
This can be termed as the basic idea which works in system thinking and this idea
basically works on the principle of “every action triggers a reaction”. Circles of casualty helps in
visualising interrelation of different variables in a system which consists of nodes and edges. So
considering this fact in system dynamic which can be called as feedback. So there are two types
of feedbacks which can be described as :
1. Reinforcing feedback:
This helps in accelerating the given trend of the process by provisioning the positive
feedback of the system. This feedback will help in accelerating the growth in case if the trend is

ascending and it will accelerate the decline in case if the trend is descending. For example,
falling of an avalanche.
2. Balancing feedback
This is an stabilizing feedback that enables the working if the goals are already stated.
Balancing feedback mainly helps in reducing the gap between current and new state (Guo, Yiu, ,
& González, 2015). This feedback do not considers ascending or descending trend but it reaches
the present state to a desirable output. For example, at the time of riding a bicycle when the when
an object stays upright on bicycle.
Delays
Delays in the system causes late in perceiving the response of the action. This might
sometimes produce late results that may be incorrect therefore this arises the under or
overestimation of the needed action. It may cause in-stable or breakdown of the desired output
(System thinking, 2018).
Example of System archetypes
There are various system archetypes are present that depicts most generic system
structure. It helps in identifying the best solutions of the problem by properly understanding the
situation. Various sustainable solutions of the problem can be identified systematically in order
to understand the links between different archetypes which are the most popular connection
between different modules.
Balancing the process with delays
In this type of system Archetype ensures the functionalities of the system which avoids
the delayed response of a particular action. Due to delayed responses manager underestimate the
requisite action in order to achieve the stated goals of the organization. For example, supply
chain process of the company.
Limits to growth
Here Reinforcing feedback help in perceiving the unprecedented growth of the system.
This causes the limits to the growth inside or outside of the system. In order to recognise the
limits properly, former method is continuously applied to get the successful operations of the
system. For example, learning foreign languages and dieting that maintains the body weight by
limiting the consumption of eatables and prevents the person from diseases.
Shifting to burden

This problem can be resolved by healing the symptoms where primary problem is overlooked
because of the demanding nature that cannot produce the immediate outcome. It basically helps
in identifying the main emergence of the problem and solving it considering various long term
affects of the system which helps in decreasing the addiction to the symptomatic remedy (Twisk
& et.al., 2015). For example drug addiction, burrowing habits and paying debts.
Fixes the fail
In this type of Archetypes, problem will be solved by fixing some immediate solutions
with positive effects. Examples of the fixes the fail Archetypes can be saving cost on
maintenance paying the interests by other loans etc.
growth the underinvestment
This can helps in determining the current production capacity of the system and this
problem can be resolved by investing in the new capacities (Keynan, Assaraf, and Goldman,
2014). It is basically helps in capacity planning that maximising or declining the quality that
result in decreased demands. Small and fastest growing companies are the best example of the
Growth on underinvestment.
Analysis of the current State Value Stream Map of the emergency
department based on System Archetypes
Value stream map after solution

Value stream map before solution
Current state Value stream map is the team efforts that are applied in the emergency department
of the hospital. It is basically a structure that help in identifying the efforts of those people who
are involved in the process of emergency department. System Archetypes provide various tools
to analyse the performance of the system and also help in growth and sustainability for the longer
duration. Various steps are involved in identifying the current value of the emergency
department of the hospital which are as follows:
Step-1: Selecting the product
Emergency department of the hospital needed the efficient system which helps in
decreasing the formalities and help in reaching the patient at emergency room in order to cure the
disease quickly. The main purpose of improving the system in emergency department which can
determine the product, in this case is reduction of turnaround time of the patient.
Step-2: Value stream mapping symbols
Value stream mapping symbol is the management of team efforts in order to map the
process. VSM can be termed as all those team members which are involved in performing
operation in emergency room. These are Doctor, nurse, patient and physician.
Step-3:Bound the process

Current state value stream mapping consists of the long process that delays the flow of
information to diagnosing the patient. This involves patient history, info, vital statistics, available
room treatment etc.
Step-4: Process the steps
Steps consisted by the current state value stream mapping are the following such as:
 Patient registration
 waiting time to stand in the queue for further processing
 then the patient is taken to ER room(Mjema, 2018).
 nurse examines the patient in order to identify the main cause of disease
 then further doctor examines the patient according to the info passed by the nurse.
 Then nurse will bring the medical suppliers and doctor treats the patient.
 Departing instruction of the customer id again recorded via the same procedure and then
finally patient goes home after a long treatment procedure
Step-5: Information flows
Information flows from various team members which acts as the middle layer which
helps in communicating the information to further step in order to provide the effective treatment
to the person.
Step-6: Calculating the time line
In Current state value stream mapping various communication sources delays the time so
the disease on the customer is not cured on time. So manager have to establish new plan to
develop new diagnostic system to operate the patient efficiently without wasting the time on
different formalities of the hospital.
Step-7: Suppliers and customers involved
Suppliers and customers have to follow the long procedure in order to complete the
whole formality of the hospital before reaching to the emergency room. Lot of information
needed to be transferred to various suppliers such as patient, doctor, nurse, physician etc.
Step-8: Interpreting the data
Current state of the value stream mapping is very lengthy process so various team
members are involved in preparing the data of the patient to treating the customer. Data is passed
to various suppliers

Recommended new State Value Stream Map with desired reduction in
patient turnaround time.
In a emergency department of the hospital manager wish to develop a diagnostic system
that aimed at mapping the New state value stream that helps in maximising the efficient
operations of the patients and also reduction in the turnaround time of the patient. Value stream
mapping is one of the best tool that help in identifying the critical areas which needs the major
improvement in the field of science (Nordby & et.al., 2016). This is the high- level strategic
methodology for developing an improvement plan for product or service line.
In addition, New state value stream Map will help in improving the all the possible
constraints that will improve the overall performance of the company. Managers will establish
the New state value stream map by considering various factors that delays the procedure of
taking patient to emergency room. Information flow of the hospital records to attending the
patient will be confirmed efficiently in order to start curing the disease of the person quickly
without wasting time in formalities of the hospital. This new state value stream map helps in
reducing the turnaround time of the patient.
CONCLUSION
From the above study it has been concluded that System thinking helps in improving the
quality and performance of the system by applying various System Archetype tools in the
business. The report has created a complete understanding regarding the use of Archetype tools
that may prevent the growth and performance of the system. The research has also provided the
various concepts of current state value stream map which needed various improvements in order
to improve the functionality of the system. The report has also helped in creating the new state
value stream map of the emergency department with the modified consequences with reduced
patient turnaround time that is based on the system Archetypes.
RECOMMENDATIONS
Application of modified solution to improve the functionality of the system to deliver quality
based services and efficient operations to patients in the hospital help in satisfying the loyal
customers of the company (Špicar, 2014). Various recommendations are as follows:

 Manager should improve the system by improving the functionality to track the
information of the patient who visits frequently to the hospital in order to take proper
treatment.
 Managers also need to advance various features in current state value stream mapping to
reduce the turnaround time of the patient by establishing new system and adopting new
tools of Archetypes.

REFERENCES
Books and Journals
Banson, K. E., Nguyen, N. C., & Bosch, O. J. (2016). Using system archetypes to identify
drivers and barriers for sustainable agriculture in Africa: A case study in Ghana. Systems
Research and Behavioral Science. 33(1). 79-99.
Guo, B. H., Yiu, T. W., & González, V. A. (2015). Identifying behaviour patterns of
construction safety using system archetypes. Accident Analysis & Prevention. 80. 125-141.
Keynan, A., Assaraf, O.B.Z. and Goldman, D. (2014). The repertory grid as a tool for evaluating
the development of students’ ecological system thinking abilities. Studies in Educational
Evaluation. 41. pp.90-105.
Mjema, E. A. M. (2018). A SYSTEM THINKING APPROACHING MAINTENANCE,
PRODUCTION AND QUALITY. Tanzania Journal of Engineering and Technology,
26(2).
Nordby, A. & et.al. (2016). The art of gamification; teaching sustainability and system thinking
by pervasive game development. Academic Conferences and Publishing International
Limited.
Špicar, R. (2014). System dynamics archetypes in capacity planning. Procedia Engineering. 69.
1350-1355.
Twisk, D. & et.al. (2015). Quantifying the influence of safe road systems and legal licensing age
on road mortality among young adolescents: Steps towards system thinking. Accident
Analysis & Prevention. 74. 306-313.

Appendices
PESTEL
Political – the change in government laws and regulations may impact on operation of hospital. it
may enforce them to follow regulations and provide services accordingly. For example, change
in drug import policies.
Economic- there may be lack of resources through which health care services are provided
accordingly. Also, hospital might not have proper infrastructure.
Social- the change in behaviour of people may impact on health care services of hospital. they
have to ensure that both men and women get proper and equal services.
Technological – any change in technology will force hospital to update their technological
methods. They will have to modify their lab, machines, etc.
Environmental – it is necessary for hospital to maintain standards of health and safety. They
should ensure that inside and outside environment is clean.
Legal- change in laws and regulation will impact on operations of hospital.
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