NAM Perspectives

Although the U.S. health system excels in several areas, its overall performance remains uneven in terms of safety, quality, value, and the health outcomes achieved. One important lever to address these performance gaps is the use of structured, evidence-based systems-engineering approaches, which have been used successfully by many other industries. When these approaches have been applied to health and health care, they have often brought about significant improvements in care quality, value, patient safety, patient experience, and overall health outcomes. Yet, such approaches remain generally underutilized in the health system, and their potential for improvement remains largely untapped. A systems approach improves health by considering the multiple elements involved in caring for patients and the multiple factors influencing health. By understanding how these elements operate independently, as well as how they depend on one another, a systems approach can help with the design and integration of people, processes, policies, and organizations to promote better health at lower cost. These approaches can be useful for all levels of the health system—patient-clinician interaction, health care unit, organization, community, and nation—with different tools available for the needs at different levels and across levels. These tools include production system methods and other management systems to help organizations continuously improve their operations and identify problems; queuing theory and operations management to ensure that resources are available when patients need them; and human-factors engineering to spot safety, quality, and reliability challenges by understanding how humans interact with technologies and processes. Spreading these systems principles more broadly will require specific technological supports, such as more advanced data systems and interoperable devices; supportive culture and leadership; engagement of patients, families, clinicians, and the broader public in these methods; and new incentive structures.