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Table 3 Illustrative examples of how SSM has been applied in healthcare

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

Type of problem situation Setting Data collection and no. of stakeholder groups consulted Featured SSM tools Solution Outcome
Reducing tensions in the patient discharge process [30, 35] Hospital, UK Interviews, workshop
17 stakeholder groups
Rich picture, CATWOE, Root definition, PAM, comparison of PAM and the ‘real-world’ situation Three approaches for improving the process were recommended. Implementation of the three improvements reduced total length of stay by 67% from 55.8 days to 18.6 days for the patients studied.
Policy -implementation of diabetes National
Service Framework (NSF) [32]
National Health Services (NHS), UK Interviews
2 stakeholder groups
Rich picture, CATWOE, Root definition, PAM, comparison of PAM and the ‘real-world’ situation Issues relating to human communication, information provision and resource allocation were identified and desirable and feasible changes to achieve a more effective NSF implementation were proposed. N/A
Development of context-appropriate informatics tools [27] Ambulatory care, USA Interviews, observations
7 stakeholder groups
Rich picture A framework of ten guidelines for the design and implementation of health information technology solutions for chronic disease care were developed. N/A
Complex care pathway [29] Multiple sectors, UK Interviews, systematic review, online discussion forum, national care audit datasets
12 stakeholder groups
Rich picture, CATWOE, Root definition, PAM Evidence-informed recommendations for service improvement for congenital heart disease services were developed. A coherent set of targeted recommendations for service improvement fed into national decisions about service provision and commissioning.
Asthma emergency care [26] Emergency department at a hospital, UK Interviews, focus groups
3 stakeholder groups
CATWOE, Root definition An asthma patient passport aimed to increase patient’s confidence in their ability to communicate their needs while in severe distress was developed. N/A
Child and adolescent mental health policy development [31] Mental health policy, Belgium 5 stakeholder events (in-depth interviews, workshops and discussion tables), narrative review, a content analysis of policies in 3 other countries/regions
At least 7 stakeholder groups
Rich picture, Root definition, PAM Ten strategic recommendations for how to lay down the contours of a more effective system were proposed N/A
Evaluation of a telehealth intervention for children with neurogenic bladder [33] Hospital, telehealth intervention, UK Interviews, observations, survey
3 stakeholder groups
CATWOE, Root definition SSM was used as part of the evaluation of a telehealth intervention for urinalysis monitoring for children with neurogenic bladder. No solution was proposed. N/A