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Table 3 Illustrative examples of how SSM has been applied in healthcare

From: Re-energising the way we manage change in healthcare: the case for soft systems methodology and its application to evidence-based practice

Type of problem situation

Setting

Data collection and no. of stakeholder groups consulted

Featured SSM tools

Solution

Outcome

Reducing tensions in the patient discharge process [30, 35]

Hospital, UK

Interviews, workshop

17 stakeholder groups

Rich picture, CATWOE, Root definition, PAM, comparison of PAM and the ‘real-world’ situation

Three approaches for improving the process were recommended.

Implementation of the three improvements reduced total length of stay by 67% from 55.8 days to 18.6 days for the patients studied.

Policy -implementation of diabetes National

Service Framework (NSF) [32]

National Health Services (NHS), UK

Interviews

2 stakeholder groups

Rich picture, CATWOE, Root definition, PAM, comparison of PAM and the ‘real-world’ situation

Issues relating to human communication, information provision and resource allocation were identified and desirable and feasible changes to achieve a more effective NSF implementation were proposed.

N/A

Development of context-appropriate informatics tools [27]

Ambulatory care, USA

Interviews, observations

7 stakeholder groups

Rich picture

A framework of ten guidelines for the design and implementation of health information technology solutions for chronic disease care were developed.

N/A

Complex care pathway [29]

Multiple sectors, UK

Interviews, systematic review, online discussion forum, national care audit datasets

12 stakeholder groups

Rich picture, CATWOE, Root definition, PAM

Evidence-informed recommendations for service improvement for congenital heart disease services were developed.

A coherent set of targeted recommendations for service improvement fed into national decisions about service provision and commissioning.

Asthma emergency care [26]

Emergency department at a hospital, UK

Interviews, focus groups

3 stakeholder groups

CATWOE, Root definition

An asthma patient passport aimed to increase patient’s confidence in their ability to communicate their needs while in severe distress was developed.

N/A

Child and adolescent mental health policy development [31]

Mental health policy, Belgium

5 stakeholder events (in-depth interviews, workshops and discussion tables), narrative review, a content analysis of policies in 3 other countries/regions

At least 7 stakeholder groups

Rich picture, Root definition, PAM

Ten strategic recommendations for how to lay down the contours of a more effective system were proposed

N/A

Evaluation of a telehealth intervention for children with neurogenic bladder [33]

Hospital, telehealth intervention, UK

Interviews, observations, survey

3 stakeholder groups

CATWOE, Root definition

SSM was used as part of the evaluation of a telehealth intervention for urinalysis monitoring for children with neurogenic bladder. No solution was proposed.

N/A