1.2 System Diagnostics Across the Continuum

High performing organisations use systems thinking and tools, to capture process and performance and identify opportunities at all levels.

Most diagnostics aim to shed light on hidden or underlying issues, and to guide attention and identify opportunities for improvement.

There are a range of tools available. Which you depends on the project and what you are trying to achieve.

Simple Visual Diagnostics:

Process Maps – Useful for visualising the multiple steps of a process, and most powerful when completed as a team looking at the start of any design

Spaghetti Diagrams or travel loops – These make clear the touch points and distances

Value Stream Maps – A lean tool looking at efficiency as a means of stripping out ‘waste’

Affinity Wheels – Helps to understand relationships between multiple teams or roles

Observations Audit – Used to collate data on an area otherwise difficult to assess – don’t underestimate the power of a simple check sheet.

Force Field Analysis – Used as a way to understand driving and restraining forces, both current and potential

Root cause Analysis & Ishikawa Fishbone Diagram – Helps summarise themes and sub-themes when diagnosing a problem

Tracer study – Understand the flow of information
Capacity and Demand – Understand where mismatches and constraints in delivery Simple Data Tools:

Pareto chart – Uses large amounts of data to highlight key categories to focus on

Scatter chart – Establishes correlation between two sets of data

Histogram – Used to understand distribution of continuous data and what opportunities are in reshaping the distribution

Funnel Plot – Identifies outliers using confidence limits as exemplar examples and areas of focus for improvement. Less tangible, qualitative or behavioural diagnostics, often require more careful attention.

Culture Surveys – Where are teams and workforce regarding morale, readiness to change, frustrations
Stakeholder Analysis – Consider the power/passion matrix or synergy/antagonism matrix.

Directives to take forward:

System Learning – Root cause analysis of cases allows learning to be shared with staff at the point of care, and creates evidence of system improvements
Differentials and pareto analysis of major measures occurs providing a granular analysis, prioritisation and identification for improvement.

Timing of processes, movement, interactions of patients, staff or equipment is regularly recorded for improvement purposes.

Process / flow mapping of patient pathways – this happens on most improvement projects and occurs on majority of improvement projects and directly involves the clinical team OR is formed from direct « patient shadowing ».

Value-Added Stream mapping occurs on some improvement projects.

Case Study: Nephrology at Aintree University Hospital

What system diagnostic to run will depend on what you are trying to discover.

Nephrologists at Aintree University Hospital looked at patient deaths from three very different presentations of Acute Kidney Injury (AKI), as a reflective diagnostic to better understand systemic weaknesses.

Patient journeys were mapped out in detail with touchpoints, monitoring and interventions compared against best practice. This learning helped them to understand which key aspects of care required emphasis within a care bundle and education program.

The team also used a pareto chart analysis to rapidly identify the clinical areas where the biggest impact could be achieved; which in turn influenced the scale up and spread of the initiative. These diagnostics help set the team up to achieve a 20% reduction in mortality from AKI.