System Thinking Report: Improving Emergency Department Efficiency

This report applies system thinking to analyze the inefficiencies within a hospital's emergency department, focusing on the problem of prolonged patient waiting times. The analysis begins with an executive summary and table of contents, followed by an introduction to system thinking and its application to healthcare. The background section highlights the challenges of managing patient flow in emergency departments. The discussion delves into the analysis of existing system archetypes, including growth limitations, eroding goals, and escalation, to understand the root causes of the issues. It provides an examination of the existing value stream map, identifying bottlenecks and areas for improvement. The core of the report proposes a new value stream map incorporating an Electronic Health Record (EHR) system to automate processes and improve efficiency. The report concludes with the consequences of the new value stream map, recommendations, and references, providing a comprehensive overview of how system thinking can be used to improve healthcare operations and patient outcomes, specifically addressing the challenge of long patient wait times.

Running head: SYSTEM THINKING
System Thinking
[Name of the Student]
[Name of the University]
[Author note]

1SYSTEM THINKING
Executive Summary
System thinking is the approach related to the integration which is entirely dependent upon
the belief that the systems components part would eb acting in an entirely different way when
they are isolated for the environment of the system or from the other parts of the system. The
main problem that is going to be discussed over here is associated with including the longer
waiting time of the patients in an emergency department of a hospital. The emergency
department of a hospital which has been taken into account for preparing this report is seen to
be receiving feedbacks related to longer waiting time of the patients before they finally
receive the treatment. With an aim of solving the problems faced by the emergency
department a new value stream map would be created which would be helping in elimination
of the existing issues so as to make the emergency department become much efficient in
providing treatment and this new value stream map would be consisting of an addition
element known as the EHR or the Electronic health record system which would be helping in
automating some of the major processes.

2SYSTEM THINKING
Table of Contents
Introduction:...............................................................................................................................3
Background:...............................................................................................................................3
Discussion:.................................................................................................................................4
Analysis of the Existing Archetypes:.....................................................................................4
Growth Limitations:...........................................................................................................4
Eroding Goals:...................................................................................................................5
Escalation:..........................................................................................................................6
Analysis of the Existing Value Stream Map:.........................................................................6
Suggested New Value Stream Map:......................................................................................7
New Value Stream Map consequences:.................................................................................9
Conclusion:................................................................................................................................9
Recommendations:.....................................................................................................................9
References:...............................................................................................................................11

3SYSTEM THINKING
Introduction:
System thinking is the approach related to the integration which is entirely dependent
upon the belief that the systems components part would eb acting in an entirely different way
when they are isolated for the environment of the system or from the other parts of the
system. System thinking is associated with setting out a view in a holistic manner (Ribesse et
al., 2017). Being consistent with the system philosophy the system thinking concerns an
understanding of an entire system by means of examining the linkages and the interactions
existing between the elements which are associated with comprising the entire system. The
practice of system thinking is associated with encouraging the users in exploring the inter-
relationships, perspectives and the boundaries as well (Kreitzer et al., 2019). System thinking
is the technique which is seen to be very useful in addressing the various complex situations
or any kind of wicked problem situations. The main problem that is going to be discussed
over here is associated with including the longer waiting time of the patients in an emergency
department of a hospital.
Background:
The emergency departments of the hospital are having a huge responsibility of serving
their patients with outmost efficiency and in a fast manner. Any kind of delays in serving the
patients with emergency condition would lead to severe devastating effects even leading to
death of a patient. The emergency department of a hospital which has been taken into account
for preparing this report is seen to be receiving feedbacks related to longer waiting time of the
patients before they finally receive the treatment. The existing value stream map which has
been presented is associated with depicting the fact that there exist numerous issues in the
entire process which needs to be looked after so as to eliminate the waiting time of the

4SYSTEM THINKING
patients. One of the major issues is the mismanagement and the lengthy process which the
patient needs to go through so as to receive the treatment. With an aim of solving the
problems faced by the emergency department a new value stream map would be created
which would be helping in elimination of the existing issues so as to make the emergency
department become much efficient in providing treatment and this new value stream map
would be consisting of an addition element known as the EHR or the Electronic health
record system which would be helping in automating some of the major processes.
Discussion:
Analysis of the Existing Archetypes:
The system Archetype is generally considered to be a highly effective tool helping in
the process of gaining an insight of the patterns of the behavior which in turn is associated
with making themselves reflective of the underlying structure of the system which is to be
studied. It is possible to apply system archetype in two ways one is the diagnostically and the
other is prospectively (Vopser et al., 2018). The archetypes are very helpful in understanding
the nature of the problem. The system archetype is used for identification of the problem of
the hospital’s emergency department due to which the waiting patients is seen to be very
high.
Growth Limitations:
The application of the system thinking for analyzing the existing system of the
emergency department helped in identification of the one of the major system archetypes
which is responsible for the problems and this includes the limitations existing in the process
of growth. This archetype is generally seen to be referring to the scrutiny existing in the roles
which are in turn associated with leading to the degradation of the services of the loss of
resources. The mismanagement and the existing of different kind of unnecessary processes is

5SYSTEM THINKING
seen to be responsible for making the entire process of providing treatment a lengthy as well
as time consuming (Swanson et al., 2015). Dynamic theory is the theory which is seen to be
utilized by this system archetype with an aim of managing the various kind of operations that
are conducted by the organization. This is mainly done for the purpose of maintaining a state
of balance between the different operations which are essentially needed for the purpose of
helping the organization in growing. There exist seven steps in the dynamic theory amongst
which the most important is associated with the proper diagnosis of the different kind of
problems, which in turn would be responsible for doubling the performance speed when
problems are identified and mitigated. Additionally, this particular system archetype is
associated with providing assistance in the process of identifying the successful maintenance
measure and the potential balances which are required (Brown et al., 2018). The changes
which are to be made in the new system would be entirely aimed at having a good
understanding of the entire system which would be helping in increasing the efficiency of the
emergency department by decreasing the longer waiting times.
Eroding Goals:
Another important system archetype present in the hospital emergency department
service is the eroding goals and this particular archetype is seen to be existing arounds
various functions of the emergency department and this is seen to be mainly having a relation
with the different kind of shifting that are happening in the environments having dynamic
tension and are seen to be existing in between the symptoms. This particular system
archetype is also seen to associate itself in the process of focusing upon the systems dynamic
nature which are mainly associated with putting forward of the future view of the goals in a
proper way and these goals are generally pre-determined (Domegan et al., 2016). This acts as
one of the moist important as well as critical element which exists in the system of the
emergency department mainly in the starting processes which includes the registration and

6SYSTEM THINKING
other time-consuming processes than generally are responsible for the eroding goals. This
archetype is seen to be related to the obstructions and re generally seen to eb endured
throughout the process of the emergency department.
Escalation:
Escalation is another system archetype which is seen to be existing in the system of
the emergency department and this particular archetype is associated with helping in the
testing of the various kind of functions of the emergency department by the higher
authorities. These tests are conducted so as to identify any kind of problem or issue that are
existing in the system and the major thing which is seen to have been identified is the longer
waiting time of the patients. This system archetype is associated with working as one of the
major aspects of the system that is having the responsibility of providing assistance in the
processes related to the increasing of the entire value of the firm to the clients (Hwang &
Park, 2017). A better understanding of the dynamic theory is put forward by means of the
escalation and this includes the dealing with a single party which are in turn associated with
the perception that the other parties are having. This in turn is associated with acting as one of
the major reasons which is seen to be responsible for the linking of the threats with the entire
process of the hypothesis that are needed for the purpose of maintaining the balance and also
for forming the reinforcements.
Analysis of the Existing Value Stream Map:
The system thinking is associated with helping in the process of analyzing the existing
value stream amp of the hospital’s emergency department so as identify the major reason that
are responsible for the creation of problems related to the longer waiting time of the patients
(Roberts et al., 2016). From the analysis it has been identified that there exists lot of
processes which are entirely responsible for making the receiving of treatment by the patients
get delayed and this in turn is associated with making the claims of the patients entirely

7SYSTEM THINKING
justified. The unnecessary processes are entirely responsible for the creation of the problems
initially making the patients complain about the entire system (Shrubsole, 2018). The major
reason which is considered to eb responsible for the problem is the length and the manual
process of managing the different operations of the emergency department.
Some of the major activities which are responsible for the creation of the problems is
associated with including the filling up of the insurance form, followed by the registration,
preparation of the emergency room, assigning of the nurses and more are initially responsible
for delaying the entire process of treatment initially being responsible for the longer waiting
time of the patients before they receive the initial treatment (Brimble & Jones, 2017). Once
all this are done a doctor would be assigned for the respective patient and the doctor would be
responsible for going through the entire medical history of the patient one after another and
have to conduct several tests so as to have an details of the patient’s condition and this is
initially responsible for taking up of a much longer time. Followed by the detailed analysis of
the patient the treatment would be provided and the doctor would be prescribing the nurse
with the required things for treating the patient and once the treatment of the patient is
completed an entirely new medical record would be created (Eugene Fibuch & Robertson,
2018). This medical record would be later be forwarded to eth insurance companies along
with being stored in the hospitals database by means of hardcopies of the documents. All
these medical records are prepared manually which is initially responsible for taking up of a
longer time and are initially responsible for delaying the discharge of the patient from the
hospital even after the treatment is completed.
Suggested New Value Stream Map:
System thinking used for the identification of the reasons lying behind the problems is
also associated with helping in understanding the new requirements of the system. From the
analysis of the existing system archetypes and the value stream map it has been identified that

8SYSTEM THINKING
there is a need of adding another system archetype which would be helping in the elimination
of the problem (Lobo & Lins, 2017). In addition to this the addition of this system archetype
is also going to make the emergency much more efficient and effective in the process of
providing treatment to the patients. This new System Archetype which is to be included in the
new Value Stream Map is the shifting of the burdens and the burden of extra work would be
shifted to a new entity which would be included in the new system. The new entity that is to
be included is the Electronic Health Record system or the EHR (Flounders et al., 2018). The
EHR implementation would not only be associated with helping in elimination of the
problem but would also be responsible for making the emergency department become much
more efficient by means of automation of numerous processes such as recording of the
medical health to the database directly, providing of overview of the patients medical history
to the doctor and many more. The new value stream map has been depicted below and it is
also to be noted that the EHR implementation would be responsible for speeding up the entire
process to double helping the patients in receiving treatment at a faster rate (Niskanen,
Louhelainen & Hirvonen, 2016). EHR is also going to provide some additional offers to the
emergency department by means of eliminating the various kind of complexities or issues
which might arise at the hospital.

9SYSTEM THINKING
New Value Stream Map consequences:
Along with numerous benefits the new value stream map would also be having
negative impact upon the hospital’s emergency department. The implementation of the EHR
is going to provide the organization with numerous benefits however the major drawback of
this is that the organization have to endure a huge amount of cost so as to implement the new
system and make it work with the other operations of the organization (Phillips et al., 2019).
However, the benefits provided by the EHR is seen to be having a higher count that the
negative impacts. So, it is always suggested to have the new value stream even if the cost is
high.
Conclusion:
From the above provided report it can be concluded that the complains made the
patients side is entirely justified. For this reason, the system thinking concept has been used
for identification of the major reasons lying behind the problem and for the purpose of
analyzing the entire problem scenario. Different kind of system archetypes have been
identified which are generally responsible for the problem. The existing value stream map is
also analyzed which helped in identifying the fact that there are numerous processes which
are unnecessary and are responsible for the problem. Besides this there are also various
process which are done manually and requires automation. So, considering this problem and
needs the new value stream map has been created which includes a new system archetype
that is shifting of the burden. The burden of extra work load is shifted wo an entirely new
automated EHR system which is introduced in the system. This implementation is having
negative as well as positive effects upon the emergency department and this has also been
discussed in the report.

10SYSTEM THINKING
Recommendations:
 Providing of training to the employees so as to use the system efficiently.
 Including of different security features for securing the data in the EHR.
 Improving the interface design in order to support the ways in which people thinks
 Special focus is to be imposed upon the needs of the cognitive support design

11SYSTEM THINKING
References:
Brimble, M., & Jones, A. (2017). Using systems thinking in patient safety: a case study on
medicines management. Nursing Management, 24(4).
Brown, G., Reeders, D., Cogle, A., Madden, A., Kim, J., & O'Donnell, D. (2018). A systems
thinking approach to understanding and demonstrating the role of peer-led programs
and leadership in the response to HIV and hepatitis C: Findings from the W3
project. Frontiers in public health, 6.
Domegan, C., McHugh, P., Devaney, M., Duane, S., Hogan, M., Broome, B. J., ... &
Piwowarczyk, J. (2016). Systems-thinking social marketing: conceptual extensions
and empirical investigations. Journal of Marketing Management, 32(11-12), 1123-
1144.
Eugene Fibuch, M. D., & Robertson, J. J. (2018). BRINGING VALUE: KEY THINKING
TO HELP GET WITH THE SYSTEM. Physician Leadership Journal, 5(1), 58-61.
Flounders, M. B. A., Gates, M. B. A., Heffner, M. B. A., Lawler, B. S., Pardini, M. B. A.,
DePrince, R. N., & Rosenwasser, M. D. (2018). A Systems Thinking Approach to
Redesigning the Patient Experience to Reduce 30 Day Hospital Readmission. JHN
Journal, 13(2), 1.
Hwang, J. I., & Park, H. A. (2017). Nurses’ systems thinking competency, medical error
reporting, and the occurrence of adverse events: a cross-sectional
study. Contemporary nurse, 53(6), 622-632.
Kreitzer, M. J., Carter, K., Coffey, D. S., Goldblatt, E., Grus, C. L., Keskinocak, P., ... &
Valachovic, R. W. (2019). Utilizing a Systems and Design Thinking Approach for