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Health Administration Press

Applying Quality Management in Healthcare: A Systems Approach
4th edition

Chapter 4

Understanding System Behavior

Health Administration Press

Learning Objectives

After completing this chapter, you should be able to

explain systemic structure from the perspective of the iceberg metaphor;
describe how an understanding of systemic structure guides managerial questions about performance problems;
identify the influence of mental models on managerial behaviors, decisions, and effectiveness; and
apply learning strategies to better understand how systemic structures affect performance.

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A Systems Metaphor for Organizations

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Lessons for Healthcare Managers

Below the water line: The systemic structure involves the interrelationships among key elements in the system and the influence of these interrelationships on the system’s behavior over time.

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Systemic Structure

Systemic structure influences behavior.

Systemic structure is not readily visible.

Information is essential to identifying systemic structure.

Successful change requires going below the waterline.

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Going Below the Waterline

Strategies managers may use:

Understanding history

Being aware of mental models

Integrating double-loop learning into management philosophy and approach

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Single and Double-Loop Learning