Systems Thinking in Advanced Nursing Practice

Describe the selected problem from two of the three system levels (micro, meso, macro).

 The healthcare system is a complex and high risk; therefore, the Joint Commission recommends creating high-reliability organizations within every healthcare facility.  Building a high-reliability organization is about creating a culture of high quality, high safety, and patient-focused.  Using my facility as an example, the culture within each of the departments at the hospital is the microsystems level.  This is the location of patient communication and hands-on patient care.  The problem exists in reporting near misses to avoid bigger safety events in the future.  The culture across the Mercy Health St. Rita’s including the hospital, home care/hospice, primary care, and specialty offices would be the mesosystem level.  Here continuity of care is provided across this environment.  Having an environment that promotes communication and reporting is the problem.  The culture among the entire BonSecour Mercy Health healthcare system would be the macrosystems level.  They govern the overall healthcare being provided according to the standards and expectations (Alam, 2020).  The problem would be to establish the expectations around creating a high-reliability organization.

Explain how the outcomes of one system level effect the other levels?

            The culture of one system-level reflects the values and beliefs of team members across all levels.  The expectations from the macrosystem reflection down to the microsystem.  Like with Joint Commission setting an expectation for healthcare systems to become high-reliability organizations, the regulatory team members from the macro to meso to micro enforce these expectations.  The mesosystem level receives most of the attention related to the culture embedded within their organization good or bad.  However, the training and education to create a culture of high safety and quality happen at the microsystem level.  It includes providing an environment where front line team members feel safe to speak about the problems and offer solutions on how to solve them without the fear of repercussion.  The microsystem level needs to know the macrosystem and mesosystem levels will trust and support them (Manley & Jackson, 2019).

How is a systems approach beneficial in improving healthcare quality and safety?

 All workers want to be apart of an organization that promotes high quality and safety no matter the system level they are associated with.  Continuing the focus of creating a culture of high quality and safety, all levels have a different view.  The macrosystem level can see when environments do not promote this culture leading to risk and harm caused to patients.  They see patterns for success and opportunity across various facilities.  Learning from one another can be promoted.  This level is visionary,  big picture.  At the mesosystem level has the view to see the expectations and see the details specific to the facility to create the process around developing the culture.  Middle managers at this level are strategically valuable.  They can effectively influence change through educating and encouraging team members to speak out.  From here they can voice concerns or needs up to the macrosystem level (Gutberg & Berta, 2017).  The microsystem level can implement a culture of high quality and safety.  With training, development, and support, they can carry out the vision set forth by the macrosystem level   (Manley & Jackson, 2019).  All system levels are important for advancing the healthcare system.  Neither level could function independently effectively or efficiently.   

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