Mallorie T Tam, Julia M Wu, Cindy C Zhang, Colleen Pawliuk, Julie M Robillard
A Systematic Review of the Impacts of Media Mental Health Awareness Campaigns on Young People
Health promotion practice
closing loops complete diagnostic referrals remains significant patient safety problem health systems 6573 failure rates significant delays common despite years improvement efforts suggesting new approaches may useful systems engineering se methods increasingly advocated healthcare value studying redesigning complex processes conduct formative se analysis process logic variation reliability failures completing diagnostic referrals originating two primary care practices serving different demographics using dermatology illustrating use case interdisciplinary team clinicians systems engineers quality improvement specialists patient representatives collaborated understand processes initiating completing diagnostic referrals crossfunctional process maps developed iterative group interviews urban communitybased health centre teaching practice within large academic medical centre results used conduct engineering process analysis assess variation within practices identify common failure modes potential solutions processes complete diagnostic referrals involve many substandard design constructs significant workflow variation within practices statistical instability special cause variation completion rates timeliness 21 process activities estimated valueadd failure modes similar two practices process activities relying lowreliability concepts eg reminders workarounds education verificationinspection several opportunities identified incorporate higher reliability process constructs eg simplification consolidation standardisation forcing functions automation optouts systems science perspective diagnostic referral processes perform poorly part fundamental designs fraught lowreliability characteristics mental models including formalised workaround rework activities suggesting need different approaches versus incremental improvement existing processes se perspectives methods offer new ways thinking patient safety problems failures potential solutions