Letters Section Editor: Jody W. Zylke, MD, Senior Editor.
Author Affiliations: Organizational Dynamics Graduate Studies, University of Pennsylvania, Philadelphia (Drs Starr and Braslow) (email@example.com); and Department of Anesthesiology, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Bircher).
To the Editor: The Viewpoint by Drs Pronovost and Bo-Linn1 on reducing patient harm “in the same way that engineers manage dynamic complexity: as a systems problem that requires an interdisciplinary systems solution” made 2 linked arguments. The first is that thinking analytically (ie, treating parts as both separate and independent) is “challenging, if not impossible” when faced with a systems problem. Analysis can usually quantify what is wrong but is frequently not useful to explain why. The better approach to a complex systems problem, including hospital-based medical harms, requires one to think systemically. The second argument is that thinking systemically means using systems-based methods that focus on interactions and integration.
Starr LM, Braslow A, Bircher N. Prevention of Patient Harm. JAMA. 2012;308(23):2458-2459. doi:10.1001/jama.2012.68799