System Design

“Every system is perfectly designed to get the results it gets.”
- Paul Batalden, MD

This is one of NICHQ’s guiding principles, a simple yet complex idea that undesirable outcomes are the product of poorly designed systems. If we want a different result, we need to improve the system.

A system is a group of interacting, interrelated, or interdependent elements forming a complex whole. Systems thinking is the perspective that enables us to see how individual components within the system influence each another. If we don’t improve at the system level, we run the risk of making changes that ultimately do not result in an improvement – because a positive change in one area of the system may lead to a negative change in another part.

Most people have difficulty thinking at the systems level because they cannot “see” the system. It’s like the fish that fails to notice the water in which it swims. But systems, big and small, are a constant force in our daily work processes and interactions.

A deep understanding of the system and how it functions can enable smarter decisions about high leverage changes to improve system performance. Only by thinking at a systems level can we fully understand the root cause of an undesirable outcome, determine how the parts relate to the whole, and effectively address the problem through disciplined redesign.

The ability to think at a systems level is a key area of NICHQ’s expertise.

A child’s health is the product of many complex and interdependent systems. Understanding how these systems and the elements within these systems interact to create both positive and undesirable outcomes is the key to improving quality.

Read a blog post on “Viewing Health as a System” by NICHQ CEO Charlie Homer, MD, MPH.

Recent NICHQ Projects Involving Systems Thinking

Collaborate for Healthy Weight
A national effort to address obesity through local coalitions of stakeholders representing systems that typically function independently – primary care, public health and community-based organizations – creating a larger system of shared goals and agendas.

Improving Systems of Care
An initiative to improve the health and wellbeing of Children and Youth with Special Health Care Needs and their families through building the capacity of state Title V programs to create and sustain effective community based systems of care for these populations.

Medical Home
NICHQ has led several national and local efforts to transform pediatric practices at the system level through implementation of a medical home – a model of patient and family-centered, community-based care that provides continuity of care from childhood through adolescence and facilitates a smooth transition to adult services.