System Thinking in Hospitals: Challenges and Solutions

This assignment discusses the challenges faced by hospitals in providing specialized care to patients in a timely manner. It explores the impact of system archetypes on performance and recommends strategies to reduce patient turnaround time. The assignment also highlights the unintended consequences of crowded emergency departments and provides recommendations for improvement.

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SYSTEM THINKING

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Executive summary
Hospitals have to face many issues that are all related to the emergency cases and to give an
extreme specialization of care to their patients on time. This assignment typically gives light on
the impact of challenges that a hospital faces and can work to stimulate their work to give better-
operating results to the patients.

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Contents
Introduction......................................................................................................................................3
Identification and analysis of the System Archetypes that may impede performance....................4
Understand the problem:..............................................................................................................5
The root cause of the problems....................................................................................................5
Analysis of the current State Value Stream Map of the emergency department based on System
Archetypes.......................................................................................................................................6
Recommended new State Value Stream Map with the desired reduction in patient turnaround
time..................................................................................................................................................7
Recommendations to problem.....................................................................................................8
Discussions on intended and unintended consequences of the modified system............................9
The unintended consequence: Delayed treatment and assessment..............................................9
Intended consequences: Exposure to error.................................................................................10
Conclusion.....................................................................................................................................11
Recommendations..........................................................................................................................11
Implement the best customer experience with interactions.......................................................11
To win hearts and minds by giving the best approach...............................................................12
Referencing....................................................................................................................................12
Appendices....................................................................................................................................15

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Introduction
According to the report, the emergency departments in Austria are overcrowded during the
nights and in Sunday’s. In emergency department of Australia, it is also seen that the patients had
to wait for a minimum of 4-5 hours to get special care service. It is all due to the lack of
systematic approach, that range from the capacity of care service, lack of investments, high
ageing population, less nursing homes and low social services.
The consequences are typically related to the overcrowded emergency departments, cancelled
elective operations, ambulance shortages, financial penalties and low staff morale. As, there are
ever increasing number of patients in Australia, the delay in admission in hospital is also one of
the major issue. The hospitals must turn on their process into simulation and modeling so that
they can increase their ability to deal up with different variations.
The assignment also presents the challenges the Australia hospitals are facing in managing the
demand of their patients and how they can resolve their flexibility issues to meeting the wants of
their patients in ties of bed pressures.
Identification and analysis of the System Archetypes that may impede
performance
In recent years, many hospitals in Australia are experiencing the unprecedented emergency
department waiting times and patients attending pressures. The use of system archetypes that
may impede performance in hospital is taken to assist and to solve that is increasing in the
organization. This tool has also been implied to identify the informal policies and consequences
that are leading in declination of patient care and to elicit the proposals to improve the patents
experiences (Yang 2018).

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Several students have aimed to highlight the scenario that can be helpful for public hospital
which are there to reduce delays that patients are generally gaining the experience in the
emergency departments and also for improving the patient’s turnaround time inside the hospital
throughout.
Understand the problem:
The particular part of this conceptual model is implemented to gain a clear understanding of
emergency departments delayed problems. According to the research, there is an increase of
number in problems related to ED that is all due to the external factors which are out of the
control of public hospitals in Australia. This included the patient's population that has more
patients in ageing who required the more frequent need of emergency departments (Høgmo
2018). Most of the hospitals have the capacity to accommodate a minimum of patients and can
give minimum care needs. As ageing patient’s remains in beds even if they no longer require
acute care from the hospital, this effectively decreases the working capacity of hospital wards
that eventually creates a backlog for other patients in emergency departments (Wang et al. 2019).
The root cause of the problems
According to the research, the below categories were found as the main contributors in extending
the time of patients in emergency departments. The categories are:
1. Resources:
The shortage of beds in emergency departments leads to a direct impact of negative
performance in emergency departments. As the admitted patients have to wait for a longer
time so that they can be transferred into their wards is not only one major blockage in ED but
is also one of the most over-utilized resources in public hospitals (Mjema 2018).

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In public hospitals, there are lacks of ED doctors that can access the chronic patients which are
also one of the major things that impact as a negative thing in giving care facilities to the
patients.
2. Information Technology (IT)
According to the research, there was no IT system found in public hospital based in Australia
where there were sufficient ED staff members that are ready to collect the X-ray or blood
samples. The long wait time for diagnostic results is reviewing one of the major problems
that patients face.
3. Manpower
In the research, it was found that there was no dedicated nursing care in the emergency
departments. This causes a long waiting time for the patients who were attending the minor
or major injury areas. In few cases, when the nurses were not skilled enough to do their
duties, the ED doctors had to do it by themselves which also made another let back for the
patients care (Rehman et al 2018).
4. Investigation
The public hospitals in Australia also face limited access on the diagnostic tests at midnights
or night such as the ct scans, and X-rays which can gradually increases the length of stay of
patients in emergency wards.
Analysis of the current State Value Stream Map of the emergency department
based on System Archetypes
The emergency departments and hospital background in Australia are noted with more than
1.5million patients attending the emergency wards every year. The overcrowding and delay of

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patients care have been declared as one of the national emergency in Australia. The shortage of
beds, shortage of staff, high patient demand has affected the performance of emergency
departments to provide safe care to the patients. The prolonged waiting of patients in emergency
departments has been reported more than 40 % that is between 11-24 hours (Mupepi et al. 2019).
It is also reported that the overall emergency department's infrastructure and space for the
patients are quite insufficient. According to the analysis the patients flow in the emergency
departments is there to optimize the ED capacity to minimize the length of patients stays has
become as one of the most crucial requirement.
The public hospital studies have noted that almost there is an average of 463 beds that can handle
around 230,000 patients annually. But, the ED logs over 45000 patients every year. The ED has
around 4 minor injury beds, 4 resuscitation beds, 1 triage room, 9 major beds and 2 x-ray rooms.
However, there are uncertain complexities in the ED process that requires techniques and
strategies to render the system to validating variations and improvements before it can be
implemented (Sedarati et al. 2019).
A proper technique is required to manage variations of the system as well as to validate the steps
required for improvement prior to implementation.
The proposed framework is used to identify VA and NVA activities and model the complexity of
the ED to explore potential solutions to meet the national metrics.
Stream map
The stream map can be used within the healthcare line to that can be used to map the patients path to
give them ultimate treatments that can improve their services and can help them to minimize their
delays.

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Recommended new State Value Stream Map with the desired reduction in
patient turnaround time
The emergency departments in Australia have reflected the poor planning to not delivering the
patient demands in several cases. There is no coincidence that an emergency department presents
delays to give the best patient care on weekends and on the nights. Well, according to the
research, most of the patient’s demands for emergency departments in nights and during. The
recommend new state value stream map to reduce the patient turnaround time has been given
below.
As typically patients have to spend more time in the waiting area, it has resulted according to the
research that an average patient spends typically three hours in the emergency room (Zang 018).
Recommendations to the problem

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Contrary to the above-presented model, the emergency departments can be appropriately staffed
and predicted on most days and even during the busiest times of the day, the three changes that
can be proved as most effective in the emergency departments of public based hospitals are as
follows
 Staffing upon the demand: According to the research, most of the patients tends to come
in the emergency centres in nights and also during the weekends. The patients come often
due to the reasons when a doctor clinic is off or there is no local alternative clinic in their
area. Although the data of patient's volumes have been seen to be higher during the nights
and weekdays, the demand cannot be predictable. The problem of delayed care of the
patient is seen due to the inadequate staff during nights and weekends. However, the
problem can be eliminated successfully if the hospital studies their volume of patients,
and according to that, they can staff appropriately and accurately (Aven 2019).
 Redeploying the nursing staff: In emergency departments, there must be adequate nursing
staff where they can identify the real emergency of a patient. The process helps in giving
the defined medical care in due time (Turnheim et al. 2018). The approach can also be
utilized to maintain the care of patients when there is a delay in the presence of a doctor
in emergency time. Redeploying skilled nurses can also eliminate the problem of high
turn over time of patients as skilled nurses can even treat the most serious patients.
 Modifying the physician staffing: In some cases, the emergency departments have only
one or two doctors on duty at the time of high patient volumes. In large volume cases, the
emergency doctors can appoint or pair with emergency physicians, internists or medicine
practitioners by training them adequately to further prepare them to give the definite
treatment to the patients on life-threatening illness in emergencies.

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 This approach has also helped to increase the staffing in hospitals within their budget and
it also makes the availability of more physicians when there is a high volume of patients
in the hospitals.
Discussions on intended and unintended consequences of the modified system
The unintended consequence: Delayed treatment and assessment
The delay of time in inflation for patients experience has been said to be the major unintended
consequence during the times of crowded emergency departments. The researches have also seen
that significant delay during the surgery of patients that also presents to the crowded Ed's. A
number of researches have investigated the effects of crowing in ED's as one of the major
unintended consequences that have late negative impacts of timely care of patients. The study
has also reported that there was a significant delay in times where many patients have faced life-
threatening scores in times of crowding (Perkins et al. 2019).
The modified systems should be implemented in a way where there can be a strong team
dedicated in hospitals where quick actions could be taken to eliminate the risk factors a patient
may get due to not getting up timely care on time.
Intended consequences: Exposure to error
According to the Australian perspective of observational study, there has been seen an increased
frequency of medication errors in emergency departments where the doctor implemented an
incorrect approach to the patient's treatments. The errors of care given to the patients are mostly
due to the contraindicated medication given during the times of crowded wards in emergency
departments.

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The delays of receiving medication have also reported to high crowd and failure of services
required to the patients. The exposure to an error in patients care is directly related to the
intended consequence that is associated with an increased rate of the correlated degree of the
crowd in emergency departments (Tsasis, Agrawal & Guriel, 2019).
Conclusion
There is a national emergency stated due to the poor performance of emergency departments in
the public hospitals of Australia. The hospitals should rectify thee poor performance and must
work on giving the patients with best care in case of emergency too. In the assignment, The
approach and strategies have been introduced that can reduce the time period of stay in the
emergency ward of patients and delayed care of them can improve the performance of the
organization and public hospitals. As there is high exploitation of improvement opportunities in
the health care system, the above recommendations can be used to identify and to rectify the
present problems in emergency departments.
Recommendations
Here are the few recommendations for the health care units in Australia to consider placing in
their strategies to improve the patient experience and their emergency departments.
Implement the best customer experience with interactions
As the world is increasing with patients, the emergency departments are one of the most difficult
sectors that have to be treated efficiently. As most of the patients arrive in emergency
departments due to the high medical crises, so there is an important need to implement better
customer service in emergency departments.

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The emergency departments are evaluated in every turns whether it’s on their actions, providing
care to the patients and the impact of reputation to provide a health care system to the patients. If
put another way, the healthcare service can also be recognized as the traits of staff and workplace
that gives the best satisfaction to patients (Thomas (2019).
To win hearts and minds by giving the best approach
A holistic and integrated approach must be taken by the public hospital in their emergency
departments to improve and optimize their patient's experience to get the necessary results of
improvements. As in the healthcare industry, everything is connected to each other, the
emergency departments are no expectation in such a case. Any hospital or healthcare
organization cannot run their business without giving a great patient experience and without
improving their patient satisfaction throughout. Similarly, the hospitals in Australia cannot get
grasp great patience experience if they do not give a certain level of services to their patients. If
the healthcare departments and emergency department in public hospitals start to improve and
tackle the complexity and challenges to improve the patient exercise, they can largely impact a
positive change in their working and in beyond. Apart from this, a focused strategy can also be
implemented that can include purposeful programs and structures to build long-lasting
relationships with the patients (Buck et al. 2019).
Referencing
Tsasis, P., Agrawal, N., & Guriel, N. (2019). An Embedded Systems Perspective in Conceptualizing
Canada’s Healthcare Sustainability. Sustainability, 11(2), 531.

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Aven, T. (2018). How the integration of System 1-System 2 thinking and recent risk perspectives
can improve risk assessment and management. Reliability Engineering & System
Safety, 180, 237-244.
Buck, H. G., Hupcey, J., Juárez-Vela, R., Vellone, E., & Riegel, B. (2019). Heart failure care
dyadic typology: initial conceptualization, advances in thinking, and future directions of a
clinically relevant classification system. Journal of Cardiovascular Nursing, 34(2), 159-
165.
Gonzalo, J. D., Haidet, P., Papp, K. K., Wolpaw, D. R., Moser, E., Wittenstein, R. D., & Wolpaw, T.
(2017). Educating for the 21st-century health care system: an interdependent framework of basic,
clinical, and systems sciences. Academic Medicine, 92(1), 35-39.
Thomas, P. (2017). Integrating Primary Healthcare: leading, managing, facilitating. CRC Press.
Mjema, E. A. M. (2018). A SYSTEM THINKING APPROACHING MAINTENANCE,
PRODUCTION AND QUALITY. Tanzania Journal of Engineering and
Technology, 26(2).
Mupepi, M. G., Mupepi, S. C., & Motwani, J. (2019). Amplifying the Significance of systems
thinking in organization. In Advanced Methodologies and Technologies in Business
Operations and Management (pp. 132-144). IGI Global.
Perkins, D. N., Lochhead, J., & Bishop, J. C. (Eds.). (2020). Thinking: The second international
conference. Routledge.
Rehman, J., Sohaib, O., Asif, M., & Pradhan, B. (2019). Applying systems thinking to flood
disaster management for a sustainable development. International Journal of Disaster
Risk Reduction, 101101.
Sedarati, P., Santos, S., & Pintassilgo, P. (2019). System dynamics in tourism planning and
development. Tourism Planning & Development, 16(3), 256-280.

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Turnheim, B., & Geels, F. W. (2019). Incumbent actors, guided search paths, and landmark
projects in infra-system transitions: Re-thinking Strategic Niche Management with a case
study of French tramway diffusion (1971–2016). Research Policy.
Wang, Y., Li, B., & Niu, Y. (2019, April). Thinking About Improving the Time Use Efficiency
of Growing Cadre Students from the Perspective of System Theory. In 3rd International
Conference on Culture, Education and Economic Development of Modern Society
(ICCESE 2019). Atlantis Press.
Yang, M. (2018, May). Signal and System: Thinking and Practice of the Teaching Reform.
In 8th International Conference on Social Network, Communication and Education
(SNCE 2018). Atlantis Press.
Zhang, W., Zhang, X., Luo, X., & Zhao, T. (2019). Reliability model and critical factors
identification of construction safety management based on system thinking. Journal of
Civil Engineering and Management, 25(4), 362-379.
Zhang, Y., Ge, X., Yang, W., & Guo, J. (2018, March). Analysing Railway Safety with Systems
Thinking. ASCE.
Appendices
To deliver the high care delivery in emergency units in general hospitals of Australia which are
made for common people it is recommended that ED must treat their patients well even in the
stress and chaotic environment in their emergency departments. The public hospitals in Australia

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can also intervene the holistic approach in their units by adding more staff members and doctors
on Sunday’s and in nights as it is seen that the period is much crowded during this time.
As, many ED's experiences and navigates the injuries, life-threatening diseases in patients
approximately on a daily basis. Adding to the tense environment, the ED must grow their regular
pressure by improving the efficiency, increasing the throughput and by reducing the cost and last
but not the least by providing the best care experience to the patients. There are short term
solutions that can be implemented to reduce the problems in the hospital, by increasing the
flexibility to deal up with a various length of a patient which may stay in a hospital. In the
assignment, the flexibility issues that are experienced in the hospital will be conceptualized by
resolving the problems. Therefore the modelling theories will play a key role in identity the
solutions and to ease the pressure of emergency department in the general wards of hospitals.