ArticleBMJ open quality2020
Development and application of 'systems thinking' principles for quality improvement.
Article in BMJ open quality, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 41 papers.
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Who cites it
41 citing papers in PubMed.
- Extracting homogenous data from heterogenous diseases: RaraSwed, the Swedish national rare disease quality registry.BMC global and public health · 2026Review
- The effectiveness of intravenous (IV) to oral (PO) antibiotic switch (IVOS) interventions in managing community- and hospital-acquired pneumonia-a systematic review.JAC-antimicrobial resistance · 2026Review
- Current strategies and future directions to enhance recovery following critical illness.Thorax · 2026Review
- Transitions of care following acute kidney injury: a systems-based analysis.BMC nephrology · 2026Article
- Embedding Systems Engineering Leadership in Learning Health Systems: The Case for a Chief Systems Engineer in Every Hospital.Learning health systems · 2026Article
- The Relationship and Predictive Power of Systemic Thinking With the Attitude, Knowledge and Skills of Nursing Students in the Field of Patient Safety.Nursing open · 2025Article
- Developing a Co-Produced Practice Framework to Support Personalised Safety Planning for Adults Experiencing Suicidality.Health expectations : an international journal of public participation in health care and health policy · 2025Article
- The impact of nurses' perceptions of systems thinking on patient safety competencies: a cross-sectional study.BMC health services research · 2025Article
- Parental involvement in paediatric patient safety incidents in general practice: a cross-sectional study.The British journal of general practice : the journal of the Royal College of General Practitioners · 2025Article
- Delphi analysis of how the practice team should organise event analysis in primary care.BMJ open quality · 2025Article
- Navigating complexity: a conceptual framework for simulation interventions.Advances in simulation (London, England) · 2025Article
- Applications of human factors approaches and methods to the development of teleconsultations in primary care: a systematic scoping review.BMJ open quality · 2025Article
- Understanding the self-management experiences of people with heart failure with preserved ejection fraction (HFpEF), their caregivers and the health care professionals who support them: Systematic review and qualitative meta-study.British journal of cardiac nursing · 2025Article
- The green ICU: how to interpret green? A multiple perspective approach.Critical care (London, England) · 2025Review
- Patient safety is our business! Staff perspectives on implementing hospital falls prevention education.Health promotion international · 2025Article
- Decades of failure to prevent harm to patients-where are we going wrong? A mixed methods study of the perspectives of health services staff across Australia and internationally.Frontiers in health services · 2025Article
- Article
- Organizational Rigidity and Demands: A Qualitative Study on Nursing Work in Complex Organizations.Nursing reports (Pavia, Italy) · 2024Article
- Systems thinking in, and for, public health: a call for a broader path.Health promotion international · 2024Article
- Preliminary adaptation of the systems thinking for everyday work cue card set in a US healthcare system: a pragmatic and participatory co-design approach.BMJ open quality · 2024Article
Corrections and comments
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Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introduction'Systems thinking' is often recommended in healthcare to support quality and safety activities but a shared understanding of this concept and purposeful guidance on its application are limited. Healthcare systems have been described as complex where human adaptation to localised circumstances is often necessary to achieve success. Principles for managing and improving system safety developed by the European Organisation for the Safety of Air Navigation (EUROCONTROL; a European intergovernmental air navigation organisation) incorporate a 'Safety-II systems approach' to promote understanding of how safety may be achieved in complex work systems. We aimed to adapt and contextualise the core principles of this systems approach and demonstrate the application in a healthcare setting.
methodsThe original EUROCONTROL principles were adapted using consensus-building methods with front-line staff and national safety leaders.
resultsSix interrelated principles for healthcare were agreed. The foundation concept acknowledges that 'most healthcare problems and solutions belong to the system'. Principle 1 outlines the need to seek multiple perspectives to understand system safety. Principle 2 prompts us to consider the influence of prevailing work conditions-demand, capacity, resources and constraints. Principle 3 stresses the importance of analysing interactions and work flow within the system. Principle 4 encourages us to attempt to understand why professional decisions made sense at the time and principle 5 prompts us to explore everyday work including the adjustments made to achieve success in changing system conditions.A case study is used to demonstrate the application in an analysis of a system and in the subsequent improvement intervention design.
conclusionsApplication of the adapted principles underpins, and is characteristic of, a holistic systems approach and may aid care team and organisational system understanding and improvement.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.