title: The dichotomy of the application of a systems approach in UK healthcare the challenges and priorities for implementation.
abstract: There is increasing demand for a systems approach within national healthcare guidelines to provide a systematic and sustainable framework for improvements in patient safety. Supported by this is the growing body of evidence within Human Factors/Ergonomics (HFE) healthcare literature for the inclusion of this approach in health service design, provision and evaluation. This paper considers the current interpretation of this within UK healthcare systems and the dichotomy which exists in the challenge to implement a systems approach. Three case studies, from primary and secondary care, present a systems approach, offering a novel perspective of primary care and blood sampling. These provide practical illustrations of how HFE methods have been used in collaboration with healthcare staff to understand the system for the purpose of professional education, design and safety of clinical activities. The paper concludes with the challenge for implementation and proposes five roles for systems HFE to support patient safety. Practitioner Summary: healthcare is classified as a complex and dynamic system within this paper and as such HFE system methods are presented as desirable to understand the system, to develop HFE tools, to deliver education and integrate HFE within healthcare systems.
authors.affiliation: a NIHR CLAHRC South West Peninsula (PenCLAHRC), Medical School , University of Exeter Medical School , Exeter , UK.
authors.forename: Laura
authors.initials: L
authors.lastname: Pickup
authors.affiliation: b NIHR MindTech Healthcare Technology Co-operative, Institute of Mental Health, Division of Psychiatry and Applied Psychology, School of Medicine , University of Nottingham , Nottingham , UK.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Lang
authors.affiliation: c Human Factors Research Group, Faculty of Engineering , University of Nottingham , Nottingham , UK.
authors.forename: Sarah
authors.initials: S
authors.lastname: Atkinson
authors.affiliation: c Human Factors Research Group, Faculty of Engineering , University of Nottingham , Nottingham , UK.
authors.forename: Sarah
authors.identifier: http://orcid.org/0000-0003-0288-915X
authors.initials: S
authors.lastname: Sharples
mesh_terms: D003695:Delivery of Health Care / Q000379:methods / Q000458:organization & administration*; D006804:Ergonomics; D006284:Health Plan Implementation / Q000379:methods* / Q000458:organization & administration; D006801:Humans; D013597:Systems Analysis; D006113:United Kingdom
keywords: Systems; ergonomics; healthcare; human factors; patient safety