This contribution departs from an existing model, the Design Framework for Systems-of-Systems Resilience, to explore systems resilience issues across the health, environmental, and economic domains. The reported research activities include 1) a rapid review to collect a set of systems indicators and 2) a design workshop employing causal loop diagramming to map expected causal influences between indicators. Through this exercise, we examine key themes in this research domain and outline directions for further enquiry, while involving members of the design research community in an open dialogue.@en

The growing demand for better quality of care, together with an increasing awareness of limited resources, is bringing attention to the need for design in healthcare. In mental health, considered the largest single cause of disability in the UK, the need is great. Existing services often fail to meet current levels of demand and do not consistently deliver good quality care for all service users. The design of better delivery systems has the potential to improve service user experience and care outcomes. This paper reports how through the interactive and participatory method of storytelling, the key components of a mental health delivery system were identified. We explain each of the ten components and discuss their implications for system understanding and service design. A model of a mental health delivery system has also been proposed.

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The concept of Health Systems is ubiquitous in the healthcare literature. However, the question 'what is a Health System' is not easy to answer. The emerging field of Health Systems Design is by nature multi-disciplinary, involving several disciplines with different ontological commitments and diverse perspectives and interpretations of health and system. To avoid confusions in communication and facilitate engagement between the design and health communities, it is important to begin an open exploration of the fundamental concepts of Health Systems. This paper is a first step in that endeavour

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Objectives To systematically review the evidence base for a systems approach to healthcare design, delivery or improvement. Design Systematic review with meta-analyses. Methods Included were studies in any patients, in any healthcare setting where a systems approach was compared with usual care which reported quantitative results for any outcomes for both groups. We searched Medline, Embase, HMIC, Health Business Elite, Web of Science, Scopus, PsycINFO and CINAHL from inception to 28 May 2019 for relevant studies. These were screened, and data extracted independently and in duplicate. Study outcomes were stratified by study design and whether they reported patient and/or service outcomes. Meta-analysis was conducted with Revman software V.5.3 using ORs - heterogeneity was assessed using I 2 statistics. Results Of 11 405 records 35 studies were included, of which 28 (80%) were before-and-after design only, five were both before-and-after and concurrent design, and two were randomised controlled trials (RCTs). There was heterogeneity of interventions and wide variation in reported outcome types. Almost all results showed health improvement where systems approaches were used. Study quality varied widely. Exploratory meta-analysis of these suggested favourable effects on both patient outcomes (n=14, OR=0.52 (95% CI 0.38 to 0.71) I 2 =91%), and service outcomes (n=18, OR=0.40 (95% CI 0.31 to 0.52) I 2 =97%). Conclusions This study suggests that a systems approaches to healthcare design and delivery results in a statistically significant improvement to both patient and service outcomes. However, better quality studies, particularly RCTs are needed. PROSPERO registration number CRD42017065920.

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The healthcare sector is facing significant challenges that require a systems approach, resulting in a rapid growth in the application of systems approaches in healthcare since the beginning of the 21st century. Consequently, healthcare practitioners and policymakers now desire to understand the evidence-base for the approach, but little evidence of the kind desired exists. This paper is a first step in conducting a narrative review of the application of systems approaches in healthcare based on a systematic review of the academic and grey literature. First, the emergence of the approach in healthcare is explored. Second, specific examples of applications of systems approaches in healthcare are examined to identify any missing elements in current practice. Third, fourteen reviews of the approach in healthcare published in the last ten years are analysed. The results suggest that the use of the approach in healthcare will most likely continue to increase, however, significant work remains for the design and systems community to demonstrate the effectiveness of systems approaches, specifically in providing convincing measures of impact on patient and service outcomes.

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Healthcare systems are under strain, this creates a challenge for designers to develop solutions for better health and care delivery. This paper presents a sandbox of illustrative design themes used to improve health systems based on state of the art research projects. These were collated from presentations at The Second International Meeting on Healthcare Systems Design Research, held at DTU-Technical University of Denmark. Attending groups were mapped based on their research keywords, target journals and methodologies in order to gain insight on the communities research landscape.

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Delivering good quality mental health services remains a top priority in the English National Health Service (NHS). An approach to designing better delivery systems that takes into account the complexities of mental health services is highly desirable. This paper follows previous work that have sought to identify the key components of mental health delivery systems and explored the nature of the relationships between them. The paper presents the results of a qualitative thematic analysis of the requirements for diagrams as tools for describing and representing delivery systems in mental health.

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Current healthcare delivery challenges are multi-faceted, requiring multiple perspectives to be addressed using a systems approach. However, a significant amount of healthcare systems design research work is carried out within single disciplines or at best a few disciplines working together. There appears to be little deliberate attempt to draw together a wide range of disciplines committed to working together to overcome differences and tackle some of the complex challenges in healthcare delivery. In this paper, we report on the initial outcomes of such an international initiative that, in the form of a workshop held at the University of Cambridge, brought together researchers and practitioners from a wide range of disciplines to explore the foundations of a community for Healthcare Systems Design Research and Practice.

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A challenging area of healthcare delivery in the UK is mental health. There is a growing need to improve outcomes of care. This research is part of an ongoing study that brings Design and Systems Engineering approaches into mental health service design. The focus is on how to understand and describe the architecture of delivery systems. Results from earlier stages of the work, looking at the identification of system components, have been reported previously. In this paper, we report the findings from empirical work on understanding the nature of the relationships between system components.

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Healthcare services that consistently meet the needs of service users have to be designed. The growing demand for better quality of care, together with an increasing awareness of limited resources, are bringing attention to the need for design in healthcare. In mental health, considered the largest cause of disability in the UK, the need is great. Existing services often fail to meet demands and do not consistently deliver good quality care for all service users. The design of better delivery systems has the potential to improve service user experience and care outcome. But, where do we start? This paper reports the first stage of an ongoing research to co-design a language for designing mental health services. This stage of the research identified, through focus groups and interviews with service users and clinicians, the key components of a mental health service. This paper argues that an appropriate concept of a mental health delivery service as a system, the identification of its key components and an understanding of the association between these components form an essential first step in designing such a system.

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This paper investigates the connection between patient satisfaction, waiting time, staff satisfaction, and service time. It uses a variety of models to enable improvement against experiential and operational health service goals. Patient satisfaction levels are estimated using a model based on waiting (waiting times). Staff satisfaction levels are estimated using a model based on the time spent with patients (service time). An integrated model of patient and staff satisfaction, the effective satisfaction level model, is then proposed (using queuing theory). This links patient satisfaction, waiting time, staff satisfaction, and service time, connecting two important concepts, namely, experience and efficiency in care delivery and leading to a more holistic approach in designing and managing health services. The proposed model will enable healthcare systems analysts to objectively and directly relate elements of service quality to capacity planning. Moreover, as an instrument used jointly by healthcare commissioners and providers, it affords the prospect of better resource allocation.@en

In this paper, we argue that the healthcare systems within which patients are treated are like patients themselves. The systems display symptoms which may give indication of problems in an "organ" of the system. The human system that forms the core of healthcare activities is a complex system and so are healthcare systems. The success of medical diagnosis has been facilitated by a generic concept of the human anatomy and its systems, organs, and corresponding physiology. The lower levels are the building blocks on which the upper levels depend. Disease processes cause failure at the chemical levels and this failure affects organs, systems, and even the whole body. We observe an interesting similarity between the medical diagnosis process and the systems design approach, yet there is no corresponding generic representation of healthcare systems akin to the anatomy and physiology of the human system. Our goal in this paper is not to match the healthcare system to the human system part by part and organ to organ but to discuss how the structured medical diagnosis process can be applicable to healthcare systems if an appropriate conceptual representation of the system can be developed.@en