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Next Steps: A Practitioner's Guide For Themed Follow-up Visits For Their Patients to Achieve a Healthy Weight
Next Steps: A Practitioner's Guide For Themed Follow-up
Visits For Their Patients to Achieve a Healthy Weight

Systems Thinking in a World of Quality Improvement 

A Message from Rachel Sachs Steele, MEd, 
NICHQ's Chief Operating Officer and Executive Project Director

June 2011

When I first read NICHQ’s mission statement – to improve children’s health by improving the systems responsible for children’s healthcare – the word “systems” really jumped out at me. The focus of NICHQ’s daily work is connecting and improving the key systems that affect children’s health. What does that mean? And how does improving systems improve the health of children and their families?

The idea of a system is a fuzzy concept at best. When we look up the word “system” in the dictionary, we receive a long and fascinating list of definitions. The one most germane to NICHQ’s mission is this: “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 influence one another within the whole.

Without a doubt, healthcare is a “complex whole” composed of many elements. Improving how those elements interact is the key to improving quality. This is perhaps best illustrated through the example of our Collaborate for Healthy Weight program. We know from research and from our own experiences that the issue of obesity cannot be fixed by focusing on one issue, but rather is dependent on addressing the “interacting, interrelated, functionally related, or interdependent elements that form the complex whole” of the obesity epidemic. For instance, ensuring the healthcare system monitors patients’ weight and Body Mass Index and educates them on how to find a healthy balance will not solve this epidemic. People are much more complex, and environments, socioeconomic factors, culture, among other things can both hinder and encourage success. This program’s aim is to get systems that typically function independently (i.e., communities, public health, primary care) to take a more holistic approach and work together to address the complex issue of obesity as one whole system.

Novel idea? We don’t think so.

From the very beginning, NICHQ’s work has focused on bringing together interdependent but often alienated elements of larger systems. Some additional examples include:

  • Improving Systems of Care – an initiative to improve the health and well being 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.
  • Be Our Voice – an integrated effort to mobilize healthcare providers with their communities as advocates as local voices in the fight against childhood obesity.
  • Parent Involvement – an ongoing commitment to actively include parents and families in quality improvement efforts.
  • Medical Home – the organizational setting that integrates preventive services, acute illness management, and chronic condition management

In each of these areas, we have learned that by bringing together often disconnected sectors and populations, unifying around a set of organizing principles, measuring results, and running small tests of change on those results, we can indeed improve health outcomes. And in the process, we can improve the systems themselves.

Is this work easy? No. But is it invigorating, inspiring, worthwhile, exciting, and effective? Yes, yes, yes, yes, and yes! It’s the hard work of quality improvement – attacking the root cause and the underlying systems behind the quality issues we see and feel every day. There are no easy solutions here. This is the NICHQ system, and we invite you and your colleagues to be part of it.



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