This research develops and implements a practical model of real-time redesign and problem solving for front line healthcare professionals using systems thinking methodologies. Healthcare quality, safety and service issues have been well-documented and lamented, calling into question the current approaches for addressing these issues. The work environment for healthcare professionals has become overburdened with time pressure, workarounds, waste, and failure to learn from the small events which occur on a frequent basis at the front-line. Desensitization may occur until sentinel events stimulate an organizational reaction. Other industries have developed system engineering methodologies, including the Toyota production system, theory of constraints, six sigma and others, to address manufacturing quality, service and safety issues. Many of these concepts were developed within the context of a linear manufacturing environment, with solutions often derived off-line by external experts. Healthcare reality is considered more complex and requires adaptive approaches, suggesting that modifications based on complex adaptive systems theory may be necessary.
The development of the model evolved based on key systems thinking principles adapted to meet the needs of the healthcare experience and introduced to front-line healthcare workers using on-line problem solving. This research includes real-time understanding of what is working or not working in the current condition as it occurs, the ideas of the staff to improve the patient experience, including asset-based problem-solving and introduction of system thinking and design principles using ideas from various systems engineering methodologies in a healthcare worker friendly way. The research focuses on the deep systems of the organization (or clinical microsystem) and ability of front line teams to redesign processes in real-time using rapid cycle mini-experiments and the results of the redesign.
Using case study and action research design, the research analyzes the experiences of an intact work group of a clinical microsystem to test the implementation of a model, labeled an Excellence Makeover. The researcher acts as a participant-observer of the emergent experience and solutions from the staff. The model will then be analyzed and additional refinements will be suggested for additional research.
| Identifer | oai:union.ndltd.org:PITT/oai:PITTETD:etd-12022008-091139 |
| Date | 28 January 2009 |
| Creators | Frndak, Diane C |
| Contributors | Michael Ken-Kou Lin, PhD, Mervat Abdelhak PhD, RHIA, FAHIMA, Valerie J Watzlaf, PhD, RHIA, FAHIMA, Wesley M Rohrer III, PhD |
| Publisher | University of Pittsburgh |
| Source Sets | University of Pittsburgh |
| Language | English |
| Detected Language | English |
| Type | text |
| Format | application/pdf |
| Source | http://etd.library.pitt.edu/ETD/available/etd-12022008-091139/ |
| Rights | unrestricted, I hereby certify that, if appropriate, I have obtained and attached hereto a written permission statement from the owner(s) of each third party copyrighted matter to be included in my thesis, dissertation, or project report, allowing distribution as specified below. I certify that the version I submitted is the same as that approved by my advisory committee. I hereby grant to University of Pittsburgh or its agents the non-exclusive license to archive and make accessible, under the conditions specified below, my thesis, dissertation, or project report in whole or in part in all forms of media, now or hereafter known. I retain all other ownership rights to the copyright of the thesis, dissertation or project report. I also retain the right to use in future works (such as articles or books) all or part of this thesis, dissertation, or project report. |
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