Learning Objectives
By the end of this section, you will be able to:
- Define systems-based practice
- Evaluate the role of the nurse in the delivery of systems-based practice
- Discuss the role of interdisciplinary teams in health-care delivery
A system can be defined as “a collection of interdependent elements that interact to achieve a common purpose” (Nolan, 1998). In systems-based practice (SBP), a clinician considers the multiple systems that are involved in a patient’s condition and uses evidence about their interactions to develop a treatment plan that incorporates the intricacies involved in the patient’s care. It takes time to acquire knowledge about all the relevant systems and to acclimate to systems-based thinking. The clinician who achieves this can use the skill to determine the interventions most likely to address all the patient’s issues. (Johnson et al., 2008; Marshfield Clinic, n.d.; HealthStream, 2021)
What Is Systems-Based Practice?
SBP focuses on the broader context of patient care, including the recognition that multiple layers make up the health-care system. These layers include
- consumers of care (patients and their families)
- delivery systems (hospitals, physician networks, drug and technology companies, community resources)
- insurers of care (private companies, Medicare, Medicaid)
- providers of care (physicians, nurses, health-care teams that provide direct care)
- purchasers of care (individuals, employers, governments)
Recognition of establishments such as the structures, systems, rules and regulations, payor sources, as well as the impacts of each to patient care provides a comprehensive understanding of how these entities need to work together as a whole and why their collaboration is important. Examples of SBP in health care include
- approaching identified problems with the goal of solving them versus relying on a workaround
- developing insight into the legal, political, regulatory, and economic factors that influence the delivery of health care
- having an understanding of cost containment, resource allocation, patient advocacy, and interdisciplinary collaboration in the delivery of quality care
- recognizing the outcome of individual and group actions on quality care and patient safety
- understanding how each different care setting works together for patients
- working in interdisciplinary teams to improve patient outcomes
SBP assumes that each patient exists in a context of interconnecting, interdependent systems. These systems may be large or small, complex or relatively simple, The ability to recognize each system and understand how they work together and fit into the overall structure is essential to promoting the quality of patient care while also reducing errors.
Microsystems
Although health-care providers work within a complex system, the area in which they conduct their daily work is considered a microsystem. Microsystems coexist with other microsystems that are typically embedded within a larger health system or organization. For a small-scale example, consider a surgical team, a cardiology unit, and a dialysis/renal unit: these are all microsystems housed inside a larger macro-organization: the hospital. Each microsystem has a common core of elements, including a focused type of care, a defined patient population, skilled staff trained to provide the care processes, and the needed information and technology to support these processes. Effective microsystems evolve over time and can foster collaboration.
Macrosystems
A macrosystem is the culture or society that surrounds smaller systems and gives them structure. Its components include laws, rules and regulations, government agencies, political systems, social policies, and educational resources, all of which have a direct impact on health care, public health, health equity, and the systems in which health care is delivered. SBP incorporates the multiple layers (microsystems) that make up health care (a macrosystem) into the context of quality patient care, patient safety, and health outcomes (Sawatzky et al., 2021).
Role of the Nurse in SBP
Nurses are a key component of an effective SBP strategy. Effective nurses recognize how they function within their respective microsystem as well as how their actions affect each aspect of the macrosystem in which they work. They are responsive to the complexities of these systems and able to call on all the other resources available to them. They can determine the cost of care, analyze risks and benefits, advocate for quality patient care, work within an interdisciplinary team, identify system errors, and develop and implement system solutions.
It is also important to note that systems can be improved upon. As frontline care providers, nurses can effect change because they observe firsthand the impacts of various systems on delivering patient care. These observations can be used to bring about changes to improve patient safety and quality care, which are the goals of SBP.
Role of the Interdisciplinary Team
SBP applies to all areas of health care. Mastering SBP enables a clinician to have a thorough understanding of every direction to which care can lead as well as what is optimal for each patient.
SBP also encourages providers to pay attention to health equity and work together to improve the delivery of care. Effective teamwork is essential to developing competence in SBP. Bringing together team members with specialized skills and training from a variety of disciplines improves both the delivery of care and outcomes for each patient. By implementing interdisciplinary patient rounds, team members can brainstorm solutions to identified problems and coordinate their implementation.
For example, consider the newer routine of having grand rounds on a unit each day at a specific time. Several members of the interdisciplinary team come together to review the needs of the patient and the health plan. The team often consists of the patient’s nurse, charge nurse, house supervisor, physician, pharmacist, social worker, physical therapist, and dietitian. By working together, the team begins to see how each team member contributes a valuable perspective to the care for each patient, enabling the team to develop holistic approaches that enhance the delivery of PCC. Communication among all team members involved in the patient’s care also enables the team to have a better understanding of the patient’s needs and expectations.