System Design: AHRQ Resources

The health care system in the United States has been the subject of much debate as experts try to determine the best way to deliver high-quality care. In Crossing the Quality Chasm,1 the Institute of Medicine (IOM) called for the redesign of health care delivery systems and their external environments to promote care that is safe, effective, patient-centered, timely, efficient, and equitable. Below are examples of research, resources, and tools on system design developed with support from AHRQ. System Design: AHRQ Resources Contents Introduction Research    Efficiency and Value    Organizational Transformation and Quality Improvement    Organization and Delivery of Care    Organizational Culture, Work Force, and Working Environment    External Catalysts for System Design and Performance: Regulation, Payment, and Reporting Tools and Guidance    Efficiency and Value    Systemwide Transformation    Innovation and Performance Improvement    Process Redesign    Enhancing Minority Health, Cultural Competency, and Health Literacy    Implementing Information Technology and Other Health Technologies    Useful Links For More Information References Introduction Health care delivery systems are complex sociotechnical systems, characterized by dynamic interchanges with their environments (e.g., markets, payers, regulators, and consumers) and interactions among internal system components. These components include people, physical settings, technologies, care processes, and organization (e.g., rules, structure, information systems, communication, rewards, work flow, culture).2 Systems design research examines interactions among system components and their possible impact on quality and cost. Systems design resources and tools provide guides to changes in system design (also known as redesign) that can improve care value and its safety, effectiveness, patient-centeredness, timeliness, efficiency, and equity of care. Care value may be enhanced by improving quality while reducing or maintaining cost. Value is also increased when systems reduce waste and inefficiency while maintaining or improving quality. To foster sustainable value improvements, design initiatives often bundle changes in several mutually reinforcing system components (e.g., information technology, process redesign, and training programs).3 Below are examples of research, resources, and tools on system design developed with support from AHRQ. AHRQ's research and tools on system design complement and build on many other AHRQ programs. Many of the items listed below were funded under AHRQ's Patient Safety and Health Information Technology (IT) portfolios. Below is just a small sampling of recent and valuable studies and tools. Special attention is given to contributions by AHRQ staff and to helpful redesign resources and tools.