MGT603 Systems Thinking: Optimizing Emergency Room Processes

This report aims to enhance emergency department efficiency by reducing patient wait times through the application of systems thinking principles and value stream mapping. It identifies and analyzes system archetypes affecting hospital performance, focusing on improving patient turnaround time. The report includes a current state value stream map of the emergency room, highlighting inefficiencies, and proposes a new state value stream map to streamline processes. Recommendations are made to prioritize patients based on need and to integrate registration and initial diagnosis. The report also considers the intended and unintended consequences of implementing the new value stream map, such as increased customer satisfaction and potential drawbacks like system errors. The ultimate goal is to improve the efficiency of the emergency room and enhance the patient experience.

Running head: SYSTEMS THINKING
SYSTEMS THINKING
Name of the Student
Name of the University
Author Note

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Executive summary:
The report aim is to develop an approach that will help in reducing the wait times. As a
responsible team member it is the responsibility of the managing team to organize the
emergency department in way that it will be beneficial for the patients. The report will
develop a value stream map that will help figure out the patient’s turnaround time by
reducing the current time to half. In order to proceed with the task it is essential to identify
the various system archetypes that will bring positive changes within emergency department
of the hospital. The value stream map will be developed after analyzing all the requirements
and functions. The report will identify and analyses the system archetypes that will affect the
performance of the hospital.

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Table of Contents
Introduction................................................................................................................................3
System Archetypes.................................................................................................................3
Application of system archetypes..............................................................................................5
Value stream map – emergency room........................................................................................5
Recommendation for new state value stream map.....................................................................7
Intended and unintended consequences of new state value stream map................................8
Recommendation........................................................................................................................8
Conclusion..................................................................................................................................9
References................................................................................................................................10

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Introduction
The aim of report is to implement a system archetype that will help to minimize the
time while waiting for the emergency department. The report will describe the system
archetypes that will affect the performance of the hospital (Mutale et al., 2016). System
archetypes are basically referred to combination of strengthening and corresponding reaction.
These contain two or more loops. The report will analyze the state value stream map of
emergency department based on system archetypes that is currently used. The current state
value stream that is developed for the department includes a lot of time and this leads to the
increase in patient turnaround time (Iqbal et al., 2015). Thus it is important to reduce their
turnaround time. There are all total eight types of system archetypes, this includes limiting
the success, instable the burden, fixing the fail, drifting the goals, underinvestment and
growth, success to the successful, catastrophe of the commons and escalation. The report will
address the existing system archetype used in hospitals emergency department. New
recommendation for the state value stream map will be implemented in order to reduce the
time.
System Archetypes
System archetypes are referred to the behavior of a system. Systems that are
represented with the use of circles of causality have same structure. One of the fundamental
property possessed by the system archetypes is that nothing can affect the past. From the
concept of system thinking it ca be stated that every action has some reaction in response. In
the context of system dynamics this reaction is referred to as the feedback. Basically these
feedbacks are divided into two parts- balancing feedback and reinforcing feedback. However,
the feedback offered by the system is not immediate every time, sometimes the feedback gets
delayed. Thus, it becomes easy to draw any diagram set up with the help of circles of

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causality that includes feedbacks, actions and delays. Reinforcing feedback is also known as
amplifying feedback and these is used to accelerate the given process. Whereas balancing
feedback is also known as stabilizing feedback and works at if there is any objective state
exists. The balancing process anticipates to decrease the gap between the existing state and
the chosen state. There are total 8 types of system archetypes, this are as follows:
Fixes the fail: In order to address the problem, faced by the system, a solution gets generated
rapidly and addresses the urgent problem (Abdullah & Shaikh, 2015). This also includes
fixing up the set of unintentional consequences that are not understood at first but ends up
adding one more symptom to the system.
Burden shift: whenever a problem is determined it is being addressed based on sort term and
on a fundamental solution. There is a side effect that is produced on fundamental solutions in
case of short term solution. As the system encounters these problem, the attention gets shifted
to short term solution or to their possible side effects.
Limits to success: whenever s system primarily gives effort it generate a positive
performance. Moreover, with time it is observed that the determination reaches to a limit that
slows down and with that the overall performance also gets affected irrespective of the
energy applied (Hansen, 2018).
Drifting goals: while developing the system it is observed that a gap gets generated between
the goal and the actual performance. The aim is to lower to goal and will affect the
performance of the system.
Growth and underinvestment: there is a limit to invest on a particular system. Growth is
accepted to reach a limit that is avoidable with investments. However, in respect to the
investment a decision is made that stops the system to further invest on. These sometimes
leads to performance degradation (Frank & Kordova, 2015).

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Success to successful: more than two efforts are used to compete for the same finite
resources. With the increase in effort, the larger allocation of the resources gets detriment.
Escalation: the parties and the stakeholders associated with the system takes mutual
threatening actions that escalates the relation.
Tragedy faced by the commons: there are several parties enjoying the benefits of the
resources made common and does not bothers about the effects they are creating on common
resources. As a result this resources gets drained consequential in the system closure and all
the activities of each party gets closed.
Application of system archetypes
System archetypes are used for the purpose of understanding the dynamics and
analyze a specific set of behaviors (Spicar, 2014). This are used as a diagnostic tool. The
objective behind developing a system archetype is that in situation of undesirable results or
horizontal effects can be plotted in the form of mutual behavior model. The information of
system archetypes provides a guidelines for determining the archetype type and after it is
identified an approach intervention is included. However, for proactive perspective system
archetypes the planning part becomes important. There are several strategies that are tested
with the use of archetypes to analyze the potential drawbacks and addresses them in the time
of planning new stages and areas where they can be easily tackled. Apart from these system
archetypes provides a language that helps to communicate among the members of a particular
organization. However, there are some unintended consequences in system archetypes and
these can be translated to the realized consequences (Spricar, 2014).
Value stream map – emergency room
The value stream map of emergency room is described below:

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In the value stream map there are several entities, this includes patient hospital
records, attending nurse, attending physician and the insurance company. This are the main
stakeholders associated with the hospital’s emergency room. In the scenario it is observed
that the patient has to wait for a long time period to get the treatment done. First the
registration is done for every patient who comes for a treatment in the emergency room
(Bures & Racz, 2016). After the registration the history of the patients is transferred to
attending physician by the nurse. These helps the physician to provide proper medicine to the
patients. Once the patient gets registered and gets enrolled with a number they are sent to the
waiting room and after that from their attending nurse takes the charge and shifts the patient
to ER room. Patients are transferred to ER room only after the nurse checks for the available
room. After that the patient is being examined by nurse and a physician (Pejic Zoroja &
Merkac-Skok, 2014). After the patient is being examined by the nurse he is taken to the

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doctor. Once the doctor completes his examination process, the nurse bring the required
medical supplies. The physician supplies the medical requirements to the doctor, the doctor
starts the treatment. Doctor treats the patients accordingly and with that prescribed medicines
and reports are prepared for the patients. After all these procedures the patients can leave the
hospital. However, in each step there are several sub steps that gets executed simultaneously.
Before leaving the hospital, the patient needs to submit a copy of the report to the hospital
records department. The record contains treatment information related to each patient and
also the diagnosis prescribed too each patient. These is a very long procedures and involves a
long time of the patient. As shown in the picture in each step the patient needs to wait. Thus,
this becomes very much difficult to follow the queue. Thus it becomes essential to develop a
new system archetype that will help in reducing the time (Jarvie, 2014).
Recommendation for new state value stream map
In order to reduce the time in getting the treatment it becomes necessary to shorten the
procedures each steps. However while developing the system it becomes necessary to keep in
mind that minimizing the time should not sacrifice with the service provided to the patients.

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The patients should get registered at time of entry and at that time there should be an
attending nurse who will diagnosis the patient on an initial level and will transfer the records
to the physicians. After that once the room gets clear the nurse should assist the patient to the
ER room without wasting time (Tyagi et al., 2015). The nurse should understand the
problems and should schedule the patients accordingly. Emergency rooms are basically for
the purpose to provide instant service to the needful. After these the patients needed to be
diagnosed by the doctor for further treatment. Once the doctor diagnoses the patient, the
information is sent to the physician and according to the information medicines are being
prepared and supplied to the patients. Once the patient gets prescribed with the medicine and
the database gets stored in the system, the patient can leave the hospital premises. The
records of the patients can be sent while the papers are sent to the physicians for medicine
(Nallusamy, 2016). This will save the patient’s time and also will decrease the effort and time
needed to implement the task in two different phase. With the implementation of these state
value stream map the time will be saved and can be done effectively. Moreover the patient
will also get satisfied with the service provided by the hospital.
Intended and unintended consequences of new state value stream map
Unintended consequences are referred to the outcomes that are not predicted and are
brought intentionally. However, there are three types of unintended consequences this
includes unexpected benefits unexpected drawbacks and perverse result (Lacerda, Xambre &
Alvelos, 2016). With the implementation of new state value stream map the unintended
consequences that are likely to be faced by the hospital includes the unexpected benefits, like
the increase in customer satisfaction or with the implementation of these new map the efforts
made by the people associated with the organization can be reduced. After these, it comes to
the unexpected drawbacks (Venkatram, et al., 2014). This includes occurrence of an activity
that was not desired. That is apart from the expected drawbacks there will be a sudden

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occurrence of an activity. With the implementation of new map if suddenly the whole system
gets messed up or the physician prescribes wrong medicine to the wrong person it will cause
an adverse effect. Intended consequences are referred to the cases where someone
intentionally tries to harm an organization or a particular human being (Martin & Osterling,
2014). The intender consequence of the new developed map is in case anyone leaks the
private data of the patients or the data gets transferred or shared with other institutions
intentionally.
Recommendation
The developed new State Value Stream Map of the emergency room will help the
hospital to manage the patients well. Moreover it is recommended to the hospital to set the
patients based on the priorities. The new value stream map will improve the efficiency of
each staff associated with the emergency room as their responsibility increases (Roshani &
Zaharee, 2015). The developed system will also reduce the time. This will reduce turnaround
time and will help organization to manage every patients well. Moreover with the help of
implementing an emergency number will help the organization to manage the system well.
Moreover the physician is advised to be efficient and effective so that they can manage the
work properly.
Conclusion
From the above report it can be concluded that it is important to implement new value
stream map for reducing turnaround time. The system archetypes and their behaviour are
described in the report. System archetypes are used to determine the behaviour of the system.
The report has determined the application of system archetypes. Apart from these the report
has addressed the already existing value stream map and a new system is developed for better

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service towards the patients. With the newly developed system the patients will get better
facility.

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References
Abdullah, M. A., & Shaikh, B. T. (2015). Review of HIV response in Pakistan using a system
thinking framework. Global health action, 8(1), 25820.
Bureš, V., & Racz, F. (2016). Application of system archetypes in practice: an underutilised
pathway to better managerial performance. Journal of Business Economics and
Management, 17(6), 1081-1096.
Frank, M., & Kordova, S. K. (2015). Four Layers Approach for Developing System Thinking
Assessment Tool for Industrial and Systems Engineers. Ind Eng Manage, 4(178),
2169-0316.
Hansen, P. K. (2018). Do Norwegian Textbooks for Compulsory Education Promote
Geological System Thinking?.
Iqbal, A. M., Khan, A. S., Bashir, F., & Senin, A. A. (2015). Evaluating national innovation
system of malaysia based on university-industry research collaboration: A system
thinking approach. Asian Social Science, 11(13), 45.
Lacerda, A. P., Xambre, A. R., & Alvelos, H. M. (2016). Applying Value Stream Mapping to
eliminate waste: a case study of an original equipment manufacturer for the
automotive industry. International Journal of Production Research, 54(6), 1708-1720.
Martin, K., & Osterling, M. (2014). Value stream mapping: how to visualize work and align
leadership for organizational transformation. New York, NY: McGraw-Hill.
Mutale, W., Balabanova, D., Chintu, N., Mwanamwenge, M. T., & Ayles, H. (2016).
Application of system thinking concepts in health system strengthening in low‐
income settings: a proposed conceptual framework for the evaluation of a complex