Systems theory looks at the world as a system composed of smaller subsystems” (Hayajineh, 2007, para. 2). Within a closed-system, healthcare professions neither engage in interactions with nor receive feedback from other departments. Without information and new energy injected into the systems, they lack critical information for evaluating and improving processes, instituting change, and are at risk for stagnation (Schroeder, Wierman & Harchol-Baler, 2006). Conversely, an open-system and its subsystems regularly exchange information with its surrounding and interdependent environments, changing and adapting in response to external feedback, and producing outcomes (Meyer & O’Brien-Pallas, 2010).
Before admission to my inpatient behavioral health unit for patients 55 years of age and older, the majority of patients visit the emergency department where a provider screens them for medical clearance. Unfortunately, medical clearance is often difficult to define in this population. The unit has developed policies and protocol for managing medical conditions and utilizing such interventions as oxygen and intravenous (IV) therapies. However, there are often opportunities for making exceptions based on a given patient’s individual psychiatric and medical needs. Also, there are different physicians evaluating and treating these patients. Emergency department providers make the medical clearance determination, while hospitalists treat medical conditions after patients admit to behavioral health services. Unfortunately, the providers may not view the medical conditions, in the same way, resulting in ED providers medically clearing patients who the hospitalists are not comfortable treating within the constraints of the behavioral health unit.
As described, the process is currently closed-system. The providers function independently of input from each other, the psychiatrist, or the admissions team. This can lead to inappropriate admissions and rapid discharges or transfers to medical care, creating delays in treatment and unnecessary work, in particular for nursing staff.
In open-systems, inputs include materials and resources, personal efforts, and physical materials and provide an influx of new energy and information which can renew and revitalize the system. Throughput refers to the system’s energies created by the reorganization of various inputs. Output refers to the products and results created by the system and cycles of events are the processes of energy transfer working to renew the system. Finally, negative feedback serves to provide feedback for the system’s processes and drive necessary adjustments (Meyer & O’Brien-Pallas, 2010).
From an open-system perspective, this process could become more patient-centered. Directive provider-to-provider communication before a medical clearance determination is an example of input, allowing new information and perspective to infuse the current system. This would create throughput, revitalizing the process of evaluating medical stability and ensuring output in terms of the most appropriate disposition and fewer transfers for each patient. Negative feedback includes tracking of medical transfers within 24 and 72 hours of admission to acute behavioral health care. Changing to an open-system for this process would potentially improve these rates in addition to improving patient satisfaction.
Hayajneh, Y. (2007). Management for health care professionals series: Systems & systems theory. Retrieved from https://pdfs.semanticscholar.org/8e3b/585cdcf178e2…
Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management in nursing: Theory and application (9th ed.). Philadelphia, PA: Lippincott, Williams & Wilkins.
Meyer, R. M., & O’Brien-Pallas, L. L. (2010). Nursing services delivery theory: An open system approach. Journal of Advanced Nursing, 66(12), 2828–2838. Retrieved from https://onlinelibrary-wiley-com.ezp.waldenulibrary…
Schroeder, B., Wierman, A., & Harchol-Balter, M. (2006). Opened verses closed: A cautionary tale. NSDI ’06: 3rd Symposium of Networked Systems Design & Implementation. [PDF file]. Retrieved from http://static.usenix.org/event/nsdi06/tech/full_pa…
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