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The power of systems thinking in medicine

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The convergence of seemingly small events accruing over time can have severe consequences. This is a central message of many aircraft accident investigations. For instance, an attempt to streamline maintenance procedures for an engine mount created the conditions for the United States’ deadliest aeroplane crash in 1979 (http://www.airdisaster.com/reports/ntsb/AAR79-17.pdf). The investigation found a constellation of interacting factors — design deficiencies, faulty maintenance practice, failures of regulatory oversight and flawed aviation industry economics. As noted in relation to a later aeroplane crash (http://www.theatlantic.com/magazine/archive/1998/03/the-lessons-of-valujet-592/306534), it was a “system accident”. The complexity of aviation systems creates conditions for small changes to interact with other system elements across technical, organisational and cultural domains to produce significant outcomes that are hard to predict and control.

All clinicians recognise the complexity of health care delivery. The system accident idea has been adopted enthusiastically by some exponents of ways to…