Hospital systems are complex organizations and involve numerous levels of staffing from unpaid volunteers to environmental services to nurses to management to administration and many other stages in between. Every employee of the hospital is liable for patient safety. However, quality and safety deficits ensue on a daily basis and accidents happen. The responsibility of the quality or safety infraction is placed on the area in which it occurred. For example, a weak patient falls while ambulating to the bathroom. To view that fall from a closed-system perspective results in placing blame on the nursing staff. The closed system approach would not look outside the level of the nursing area in which the fall happened. The nurse may have been inundated with tasks given to her by another department such as venipuncture or providing a breathing treatment to another patient; completing medication rounds; working on required continuing education; reviewing orders; or any of the plethora of tasks that nurses ensue on a daily basis. In actuality, the fall is not the nursing staffsâ€™fault per se but a design flaw of the overall system which results in a lack of proper staffing.
Meyer & O-Brien-Pallas (2010) discuss an open system perspective as a social system of sorts in which each level of the organization is made up of its own parts and requires input from the organization as a whole and its subsystem to ensure sustainability. An open system perspective of the patient safety issue would result in communication and interactions beyond the nursing area in which it occurred. The open system evolves as a result of continuous input and output between each level of the organization. According to Marquis & Houston (2017), a system that exchanges matter, energy, or information with its environment is considered an open system.
â€œDespite the best intentions of health care providers, misunderstanding about how the system in which one operates can break down or succeed can interfere with the delivery of health careâ€ (Johnson, Miller, & Horowitz, 2008, p. 8). An open system perspective would help improve outcomes because it increases communication between departments. No boundaries exist between the levels of staff and collaboration is welcomed. Staff can provide honest feedback on patient safety issues that are occurring, and the success of the hospital system is driven by the staff.
Johnson, J. K., Miller, S. H., & Horowitz, S. D. (2008). Systems-based practice: Improving the safety and quality of patient care by recognizing and improving the systems in which we work. Retrieved from https://www.ahrq.gov/downloads/pub/advances2/vol2/…
Marquis, B. L., & Houston, C. J. (2017). Leadership roles and management functions in nursing (9th ed.). Philadelphia, PA: Wolters Kluwer.
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. doi:10.1111/j.1365-2648.2010.05549.x
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