Re-energising the way we manage change in healthcare: the case for soft systems methodology and its application to evidence-based practice

Table 2 An illustrative example of the application of SSM tools

Root definition
A system to implement evidence-based guidelines, by using a hospital-level generic process, to provide patients with best available and equitable care, owned and managed by hospital administrators, healthcare professionals and policy makers.
PQR formula – Do P by Q in order to achieve R
P Implement evidence-based guidelines
Q by using a hospital-level generic process
R in order to provide patients with best available and equitable care.
CATWOE
Customers	Patients, healthcare professionals
Actors	Healthcare professionals, administrators
Transformation	Guidelines implemented and adhered to
Worldview	Evidence-based guidelines support best available and equitable care being delivered to patients
Owners	Policy makers, administrators, healthcare professionals
Environmental	Inner and outer context - multiple and interacting factors constraints and enablers
Three E’s – Criteria for assessing the outcomes of the improvement intervention, including:
Efficacy – does the intervention lead to higher adherence to guidelines?
Efficiency – is the improvement being achieved with minimal use of resources?
Effectiveness – does the intervention help achieve higher quality of care for patients?

An illustrative example of a Root definition, a PQR formula, CATWOE and the three E’s applied to the problem of getting evidence into practice using evidence-based guidelines

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