Existing models for the safe, timely and effective delivery of health and social care are challenged by an ageing population. Services and care pathways are often optimised for single-disease management, while many older people are presenting with multiple long-term conditions and frailty. Systems engineering describes a holistic, interdisciplinary approach to change that is focused on people, system understanding, design and risk management. These principles are the basis of many established quality improvement (QI) tools in health and social care, but implementation has often been limited to single services or condition areas. Newer engineering techniques may help reshape more complex systems. Systems thinking is an essential component of this mindset to understand the underlying relationships and characteristics of a working system. It promotes the use of tools that map, measure and interrogate the dynamics of complex systems. In this New Horizons piece, we describe the evolution of systems approaches while noting the challenges of small-scale QI efforts that fail to address whole-system problems. The opportunities for novel soft-systems approaches are described, along with a recent update to the Systems Engineering Initiative for Patient Safety model, which includes human-centred design. Systems modelling and simulation techniques harness routine data to understand the functioning of complex health and social care systems. These tools could support better-informed system change by allowing comparison of simulated approaches before implementation, but better effectiveness evidence is required. Modern systems engineering and systems thinking techniques have potential to inform the redesign of services appropriate for the complex needs of older people.

中文翻译：

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系统工程和思维的新视野，以改善老年人的健康和社会护理


安全、及时和有效地提供卫生和社会护理的现有模式受到人口老龄化的挑战。服务和护理路径通常针对单一疾病管理进行了优化，而许多老年人表现出多种长期疾病和虚弱。系统工程描述了一种全面的、跨学科的变革方法，该方法侧重于人员、系统理解、设计和风险管理。这些原则是卫生和社会保健领域许多既定质量改进 （QI） 工具的基础，但实施往往局限于单一服务或条件领域。更新的工程技术可能有助于重塑更复杂的系统。系统思维是这种思维方式的重要组成部分，用于理解工作系统的潜在关系和特征。它促进了对复杂系统动态进行映射、测量和询问的工具的使用。在这篇 New Horizons 文章中，我们描述了系统方法的演变，同时指出了无法解决整个系统问题的小规模 QI 工作所面临的挑战。描述了新型软系统方法的机会，以及最近对患者安全系统工程倡议模型的更新，其中包括以人为本的设计。系统建模和仿真技术利用常规数据来了解复杂的卫生和社会护理系统的运作。这些工具可以通过允许在实施前比较模拟方法来支持更明智的系统变革，但需要更好的有效性证据。现代系统工程和系统思维技术有可能为重新设计适合老年人复杂需求的服务提供信息。