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December 19, 2012

Prevention of Patient Harm

Author Affiliations

Letters Section Editor: Jody W. Zylke, MD, Senior Editor.

Author Affiliations: Organizational Dynamics Graduate Studies, University of Pennsylvania, Philadelphia (Drs Starr and Braslow) (lstarr@sas.upenn.edu); and Department of Anesthesiology, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Bircher).

JAMA. 2012;308(23):2458-2459. doi:10.1001/jama.2012.68799

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.

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