System Analysis

The study of an activity or procedure to determine the desired

end and the most efficient method of obtaining this end.

Systems analysis is defined as looking at a process with an eye

towards understanding and improvement.

This requires interviewing users and management to gather insight

of the process and discern how it fits into the organization's mission
and operational needs.

After this comes re-engineering and change.

And all the while customers want to be involved with alternatives

and decisions.
A systems analysis approach acts as a bridge between the clinical,
economic, patient-centered and organizational domains to incorporate
the clinical pathway with the organization and delivery of care.

Additionally, it acts as a mechanism to integrate interests and

information from multiple levels of the healthcare system
(Figure 1): micro (evidence based clinical practice), meso (institutional
rules), and macro (government policies).

In the evaluation of healthcare provision, emphasis is placed

on the clinical (e.g. effectiveness and safety), economic (e.g.
costs and resource utilization) and patient-centered (e.g.
quality of life and patient preferences) domains while the
organization of services is often left to administration.
Roles and responsibilities: Analysis of the roles of health care professionals, their activity
profiles, their responsibilities, and the organizational hierarchies and decision structures.
Weaknesses that may be found during systems analysis include unclear responsibilities, or
conflicting roles.

Information processing and information processing tools: Representation of the information

processing functions, such as registering, storing and archiving information, as well as the
used information processing tools (paper or computer-based). Weaknesses that may be found
include redundant documentation, insufficient number of information processing tools, or
violation of data integration.

Communication between health care professionals: Representation of the communication

processes taking place between the various roles, both indirect and direct information
exchange, including meetings, briefings, postings, etc. Weaknesses that may be found include
redundant communication or communication breaches.

Business processes: Representation of the logical and temporal sequences of activities.

Weaknesses that may be found include redundant work routines, unclear process definitions,
waiting times, or missing feedback of process results.

Team structure and cooperation within the teams: Representation of the structures of the
multi-professional health care team, description of the cooperation between team members,
and teams.Weaknesses that may be found include a high effort for cooperation, insufficient
definition of team aims, and an unclear team structure for a particular patient.
In general, a system analysis yields an understanding of how a system
works and how different elements in a system interact.
This facilitates system design and system redesign, and aims to
improve the interface between components of a system in order to
enhance the functioning of each individual component in the overall
system.
System analysis has much to contribute to patient safety, specifically
through its study of organizational and work systems.

Adopting a systems approach to error reduction requires a shift from

blaming individuals for errors to analyzing systems to uncover
design flaws, thus moving from addressing problems reactively (i.e.,
after problems occur) to proactively preventing accidents through
system analysis and design.

The basic reliability concept is defined as the probability that the

system will perform its intended function during a period of running
time without any failure. A fault is an erroneous state of the system.

Although the definitions of fault are different for different systems and
in different situations, a fault is always an existing part in the system
and it can be removed by correcting the erroneous part of the
system.
System analysis can help manage and reduce risks by identifying
hazards so they can be controlled through good design. That is, in
order to improve safety, quality, performance, and comfort, a good
place to start is by analyzing the involved systems so they can be
improved.

The key to improving safety and reducing risk is through good system
design, which can only be achieved though a complete understanding
of the system.

To understand the system, it is essential to know how to analyze it.

Industrial and human factors engineering work system analysis

methods provide a set of tools that can be used to analyze health
care systems.

Chapanis states that human factors engineering “discovers and

applies information about human behavior, abilities, limitations,
and other characteristics to the design of tools, machines,
systems, tasks, jobs, and environments for productive, safe,
comfortable, and effective human use.”
 Overall Organizational Staff
Level View Role Task
Organization Unit Member

Role dan
Responsibilities

Information
processing and tools

Communication

Bussiness processes

Team structure and

cooperation
Key systems terms

System element:

A system element is anything that is part of a particular

system. Elements can include people, technologies, policies,
lighting, furniture, and jobs.

System attribute:

System attributes are the perceived characteristics of the

system.

System boundary:

System boundaries are zones between one system and

another. These zones can be in time, space, process, or
hierarchy
Temporal boundary:

A temporal boundary separates systems in time.

Spatial boundary:

A spatial boundary separates systems in space

Process boundary:

A process boundary separates systems into adjacent

component processes, also known as subprocesses

Hierarchical boundary:

A hierarchical boundary separates systems by their

location in a hierarchy of systems
System input:

A system input is anything necessary to energize the

system.

Transformation:

Transformations are processes that turn inputs into outputs;

they are actions in the system.

Outputs:

Outputs are the results of transformations.

Unit operation:

A unit operation is a simple input-transformation output

process that does not contain any other input-
transformation output processes.
System analysis methodologies include :

• the macro ergonomic analysis and design (MEAD),

• fault tree analysis,

• root cause analysis,

• failure modes and effects analysis (FMEA),

• health care failure modes and effects analysis (HFMEA),and

• probabilistic risk assessment (PRA).

 Guidance Stage in RCA Investigation Process Tools Templates

Being Open Framework RCA Investigation Process Maps *RCA Report Writing Templates
Three Levels of RCA Getting Started Triggers for RCA Investigation
HC Risk Assessment Made Easy RCA Investigation Glossary

Aggregate & Multi-incident RCAs *Detection Factors List *Tabular Timeline

Investigative Interview Guidance Gathering and Mapping Information Time Person Grid

*Incident Decision Tree Change Analysis Lessons Learned Log

Identifying Care & Service Delivery Problems
Nominal Group Technique

Contributory Factors Contributory Factors grid

Classification
Identifying Contributory Factors & Root Causes *Fish Bone Diagram
Five Whys

Barrier Analysis
Generating Solutions and Recommendations
*Types of Preventative Actions

Option Appraisal & Impact

Implementing Solutions Analysis *Action Plan

*Investigation Report Writing *RCA Report Writing Templates

Guide Report Writing
Example Concise RCAs Cause and Effect Charting
There can be a quick and effective questioning tool applied in several
environments --specifically in an information system process.

THE PROBLEM

Why? Why do we need this application/process/procedure?

Why do we need this method?

Why is this a problem?

What? What need does this application/step satisfy?

Where? Where is this application utilized?

Who? Who uses this application?

When? When is it done? When does it have to be done?

How? How is it accomplished?

ELIMINATE, COMBINE, CHANGE AND SIMPLIFY

Eliminate Can this node, process or need be eliminated?

Change Can this node, process or need be changed?

Combine Can this node, process or need be combined

Simplify Can this node, process or need be simplified?

WHAT DO YOU RECOMMEND?

Asking for a recommendation turns out to be a very powerful and insightful

question. Often the answers are in front of us -- just ask those closest to the
process.

For some strange reason systems analysts frequently believe "they" are
expected to solve the problem.

This conception is far from the truth. They are expected to find a solution.
By asking users and those ultimately responsible for the process for their
thoughts and recommendations, we are able to compile a list of alternatives.
They have now been included in the solution process by having their ideas
solicited and considered. Therefore, if the users ideas are accepted, the
user has accountability.
DATA GATHERING TECHNIQUES

Interviews: Interviewing all persons associated with the system and asking the above
questions will assist in seeing the problem or need from a variety of
perspectives. It allows the opportunity to ask, "What do you recommend?"

Observation: Observing a process in the users own environment, or getting a

demonstration of the process or problem, combined with asking the
aforementioned questions, provides insights to define the need or problem.
Visit the user area and experience what the user sees and feels.
"Walk in the Sometimes it is possible for the analyst to perform the function. This will give
users shoes”: a sense of user experiences.

Surveys: Surveys can reveal problems, needs and opportunities not discovered with
other techniques. A person completing a brief survey (less than five
minutes) may disclose problems, issues, processes, or solutions not seen
through other data gathering techniques.
Formal Many times formal reports and user documentation reveal needs or
problems.

Reports: This requires the writer to understand the problem - before they can write
about it.

Professional Articles on subject areas provides others’ positions. Diverse opinions

Journals: Offer new insights.

Peer Groups: Attending professional peer group meetings can provide one-on-one
roundtable dialogue, and perspectives to a problem or need.

Committees: Following a structured meeting process using recorders, leaders, timers

and facilitators can make for effective meetings. Tools such as
brainstorming, nominal group technique, affinity diagrams, Delphi method,
weighed voting, and multivoting can provide committee and team
consensus and priority setting, as well the power of group solutions.
PROMOTE INTERACTION AND DIALOGUE

THE THREE STAGES OF SYSTEMS ANALYSIS QUESTIONS

I. During Interviews 1. II. After Understanding III. With the User and Manager …
ask … 1. ask … ask
1. Why? 1. Eliminate?
2. What? 1. What do You Recommend?
3. Where? 2. Combine?

4. Who?
3. Simplify
5. When?
6. How? 4. Change?
to understand the process to seek alternatives for to have those closest and
solutions accountable take responsibility
(and often solve the problem)
Work System Analysis

Conducting a system analysis

Step 1

Decide what system will be the subject of the analysis. This

determination dictates the direction of the remaining steps.
Step 2

Produce a preliminary work system map. This often-overlooked step

is critical to the success of the entire analysis.

The purpose of this map is to identify inputs and outputs relevant to

the system, which facilitates the identification of people who should
be represented on the analysis team (step 3).

Furthermore, by understanding the inputs and outputs of the system

being studied, the system boundaries can be determined (step 5).
Step 3

Use the preliminary work system map to determine who should be

represented on the team that will carry out the analysis. The
importance of good representation cannot be overestimated. Without
representation from all involved stakeholders, it is likely that the team
will lack the expertise necessary to correctly analyze the system,
identify hazards, and control hazards.

Step 4

The assembled team should conduct an initial scan of the system. An

initial scan has two scanning components. First, the team studies the
preliminary work system map and gauges its accuracy.

Step 5

Put boundaries on the system under study. The team needs to

determine process, hierarchical, temporal, and spatial boundaries
Step 6

Performance expectations for each step in the system should now be

determined. Performance expectations are quantitative or qualitative
statements that describe what outcomes should come from each
unit operation, component process, or overall process studied in the
system
Step 7

The team should begin formal data collection to revise and update
the work system map, gauge the current performance of the system,
and determine baseline measures that will be used to evaluate the
effectiveness of the redesign. Data can be collected through time
studies, administrative databases, maintenance records,
structured observations of the process, and interviews of the
involved stakeholders. Interviews should be used to collect details
about the system elements and attributes, and to reconcile and/or
clarify data collected from observations.
Step 8

The team can begin analyzing the collected data. The purposes of the
analysis are to (a) identify weaknesses, variances, and any series of
events that could cause the system to fail; and (b) prioritize the
identified problems for redesign.

This can be executed qualitatively, quantitatively, or using mixed

methods, depending on the system analysis method used (e.g., failure
modes and effects analysis, sociotechnical system analysis,
probabilistic risk assessment).
 Step 9

Once hazards (i.e., causes of failure modes or variances) have been

identified, control strategies should be developed. These strategies
should be based on the hierarchy of hazard control, which states that
the best hazard controls are those that completely eliminate the
hazard.
Criteria for
Step in the Step in process Who currently Proposed Status of
Cause(s) of the Current control knowing Personnel
Hazard process where hazard first controls the control control
hazard ? activities ? variance is responsible ?
hazards occur ? noticed ? hazard ? activities ? methods ?
controlled ?

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Step 10

The final step in a work system analysis is to conduct a system analysis

on the redesign hazard-control ideas that the team develops.

This should be done before redesigns are implemented so the team is

confident its proposed redesign ideas do not unintentionally reduce the
effectiveness of the system nor create new safety problems.
TERIMA KASIH