The Approach to System-Based Healthcare

The scientific approach to medical care delivery is one of inquiry: get all the data on the patient; sort the data into usable information; establish a hypothesis; and then attempt to destroy the hypothesis. The minute a patient walks into a physician's office or a hospital emergency room the goal is to use the scientific approach to presenting evidence, historic patient evidence and medical care delivery information that may be relevant to the case prior to making medical decisions and determining clinical course of action.

The approach to System-Based Healthcare is also one of inquiry. The planners, designers and decision-makers will utilize the technologies and methodologies of an "inquiring system."[1]

The process of designing System-Based Healthcare begins by establishing the "System's Rules", after which the scientific approach can commence.

"It Takes a Whole Team"

Jeff Hardy, President
Healthcare Enterprise
Development Services

The following System-Based Healthcare Rules relate to the development of the Healthcare System that exists one patient enters the system. The rules have been developed by Jeff Hardy, who utilized as a template C. West Churchman's nine tenets in his "Design of Inquiring Systems."[1]

1. The Healthcare System is teleological (goal-seeking) whose primary goal is to provide expeditious access and high-quality clinical delivery services at the lowest cost to the providers

2. The Healthcare System has measures of performance which include fail-safe clinical delivery, client-patient satisfaction, customer-user satisfaction and cost to providers

3. There exist multiple clients which include patients, physicians, staff, visitors, surveillance entities, payers, among others, whose interests (values) are served by the system in such a manner that the higher the measure of performance, the better the interests are served, and more generally, the patient is the standard of the measure of performance

4. The Healthcare System has a client and customer hierarchy that establishes priority of service delivery, the patient as its primary client, followed by its customer-physician, -clinical and care delivery team, -patient's family, -visitors and system users

5. The Healthcare System has teleological sub-systems which include testing, treatment, catering and support services, and physical and technological components which co-produce the measure of performance of the system

6. The Healthcare System has a horizontally- and vertically-integrated environment (defined either teleologically or ateleologically), which also co-produces the measure of performance of the system that includes hospitals, medical centers, physician offices, remote surgical units, ambulances, fire department EMT vehicles (horizontal integration) among others, and sewage treatment plants, vector control, community education programs, safety laws (vertical integration), among others

7. There exists Healthcare System planners who organize and facilitate the overall process of developing the Healthcare System healthcare system, integrated sub-systems, components and technologies, among others

8. There exists Healthcare System designers who conceptualize the nature of the Healthcare System in such a manner that the designers' concepts potentially produce actions in medical, clinical and administrative decision makers, and hence change the measure of performance of the Healthcare System

9. There exists Healthcare System decision-makers which include healthcare service, information, facility, management architects, as well as physicians, clinical specialists, administrators, among others, who - via their resources - can produce changes in the performance of the Healthcare System's components and hence changes in the measure of performance of the system

10. There exists Healthcare System contractors whose tasks are defined by the Healthcare System designers and proscribed by the decision-makers

11. The Healthcare System contractors' intentions are to implement the plan as directed by the decision-makers

12. The Healthcare System is "stable" with respect to the designer, in the sense that there is a built-in guarantee that the designer's intention is ultimately realizable

[1] Churchman, C. West, "The Design of Inquiring Systems", Basic Books Inc., 1971