ABSTRACT
Overview: Hospitals as Complex Systems ....................................................................................346 Keywords ....................................................................................................................................... 347 Abstract .......................................................................................................................................... 347 Glossary .........................................................................................................................................348 Case 1: Therac/Panama Case ......................................................................................................... 349
Case Study Elements ................................................................................................................. 350 Background ............................................................................................................................... 350 Complex Systems ...................................................................................................................... 351 Challenges ................................................................................................................................. 352 Development ............................................................................................................................. 352 Timeline of the Therac and Panamanian Cases ......................................................................... 353 Analysis ..................................................................................................................................... 354 Results ....................................................................................................................................... 356 Conclusion................................................................................................................................. 357
Case 2: Surgical Safety Checklist .................................................................................................. 357 Case Study Elements ................................................................................................................. 357 Background ............................................................................................................................... 357 Complex System ....................................................................................................................... 358 Development ............................................................................................................................. 358 Results .......................................................................................................................................360 Analysis .....................................................................................................................................360 Conclusion................................................................................................................................. 363
Case 3: Requirements Engineering in the Design and Management of Health-Care Information Systems-Implications for Complex Systems Engineering ...................................... 363
Case Study Elements ................................................................................................................. 363 Background ...............................................................................................................................364 Purpose ...................................................................................................................................... 365 Development ............................................................................................................................. 365
Requirements Elicitation and Analysis ..........................................................................................366 Requirements Speci£cation ........................................................................................................... 367
A hospital is a collection of systems with many subsystems. However, many of the systems are effectivelycomplexduetotheiroperationalindependenceandrelativeautonomy.Theprimeexampleistheroleofmedicalpractitioners;however,nursesandotherhospitalstaffoperatewithsome degreesofautonomyandindependence.Certainlythewholehospital-basedcaresystemdoesnot operateasasinglesystem.Coordination,synchronization,andintegrationofsystemsofpersonnel, information, and other systems occur in order to deliver health care safely. In health-care settings, thechallengesentailasetofentities(patients,nurses,physicians,otherhospitalstaff,electronic equipment,tonamesome)executingasetoffunctionswhoseinteractionscompriseaglobalsystem behavior(Kopach-Konradetal.2007).Therearemanysystemsinhospitalsemployinganddependingoninformationtechnologyincludingacomputerizedphysician’sorderentrysystem,intensive care unit (ICU) monitoring systems, nursing stations, and various life-sign monitoring systems, just tonameafew.Furthermore,newcomplicatedsoftwareandprotocolsforoperationarefrequently introducedtooperativeswhoareunderpressuresofintensiveworkloadsand,tosomeextent,operateonthebordersofexperimentation,inordertodeliverpossiblecuresforlife-threateningconditions.Forthisreason,thehealth-caresystemcanbethoughtofasanintegratedandadaptivesetof people, processes, and products-consequently, we have a system of systems with the objective of enhancing ef£ciency and effectiveness (improved health).
