Despite their diversity, all systems have some characteristics in common. As a result, systems concepts have been applied in many of the fundamental fields of science and most branches of engineering and management. However, until recently the traditional approach to healthcare improvement has been based on specialized and isolated segments. Our approach aims to rectify this situation by adopting:

Furthermore, we summarize the requirements of systems thinking in Healthcare Systems Engineering into the three key principles as shown below:

• From a teaching perspective , the framework will help establish the key functional areas of HSE through the lifecycle of a healthcare system, and then combine these to provide the basis of an integrated curriculum.
• From a research and application perspective , the framework will help the to develop a coherent view of the subject area, and better understand how the multitude of individual concepts and techniques fits into the overall picture - what functions and analytical techniques are involved, where they belong and how they should be applied in a practical situation.

Systems Perspective of Healthcare ? The Reference Model.

When viewed from a systems perspective, any healthcare process/system will have three principal components that must be addressed as a whole: the physical (facility/processes, such as the medical equipment, patient care equipment, transportation and storage equipment, and any other facilities required to support the treatment and services provided), the human and organizational (the personnel and organizational structures involving the doctors, nurses, administrators, and the others within the system), and the information architecture (data and information in all its formats throughout the system). Proper interaction among these is crucial if the system in question is to operate properly and efficiently. Without being properly incorporated into the system structure, any particular entities on their own will not guarantee system efficiency, regardless of how sophisticated they may happen to be. This is particularly important for the assurance of healthcare quality and patient safety. Therefore, for system improvement purposes, a reference model of necessary system structure will provide a logical basis of crosschecking system completeness and integrity. Based on this model, teaching materials can be provided to show how different parts of the system are to be interrelated to guarantee system integrity, and how they should function cooperatively when put into practice. This systems perspective of a healthcare process is generic in the sense that it can be applied at any level within the system hierarchy of a healthcare organization: such as a medical unit, a department, a particular hospital, or the entire healthcare system within a state. Only the details vary (contents, parameters, nature of entities) - the overall system structure, the interrelations, and the prerequisites for efficient system operation remain. As such, it can be used as the reference base to teach about system design/system improvement cycle.

Cycle of Continuous Improvement ? The Process Model.

Based upon a set of necessary conditions for the effective structuring, operation and control of hospital organizations, Figure 1 shows the key analytical functions that should be logically incorporated into the cycle of improvement, necessary for the design, regulation and optimization of a healthcare system/operation. These are: healthcare strategy analysis (HSA), healthcare systems design (HSD), and healthcare system operations management (HSO). Generally speaking, within the domain of the proposed framework, the nature of strategic analysis can be summarized as a method of helping a hospital analyze its patients, service, and performance to identify areas of concern, and then setting objectives for improvement. However, the implementation of strategic initiatives will need to rely on the management of change through systems design/improvement projects. The general aim of a system design project can therefore be defined as the determination of the best structure of a hospital system in order to provide the capability needed to support the strategic objectives. This must be achieved with respect to available resources and other constraints. In addition, the complete cycle should also include the operational aspects to plan, monitor, and control the system once it is implemented. In close relationship to the strategic analysis, a core area involving performance measurement should also be specified. Its role is to provide a coherent means of establishing healthcare goals and objectives, and evaluating the output from various functions in a way that is consistent with the overall strategic aims. The overlap between these main areas identifies three additional functions: Strategy/HSD interfacing, hospital system implementation and hospital system status monitoring. The function of the status monitoring is to assess the system’s current performance against the original healthcare strategic goals, as well as against the best current practice, to identify its current status and to hence trigger appropriate HSA/HSD projects when necessary.

Within each of these areas, teaching materials can be identified (concepts, relevant techniques, parameters and relationship relationships, etc.) and then detailed in a modularized manner.