Moving from systematic treatment to a systemic approach A path for sustainable U.S. healthcare

In 1999, the Core Competencies, a curriculum for second-year medical residents was published by The Accreditation Council for Graduate Medical Education (ACGME) in response to safety problems, poor performance and a high rate of expenditure in the U.S. healthcare system. Systems-based Practice - the sixth core competency - was designed specifically to bring systems thinking to the practice of specialized medicine with the stated goal of providing optimal healthcare. This paper applies a systemic analysis technique called The Dimensions of Systems Thinking (DST) to Systems-based Practice. Thirteen years after publication, Systems-based Practice has failed to have the desired effect on the healthcare system due to improperly defined objectives & system boundaries, lack of defined metrics & assessment procedures and the systematic nature of the system into which it was introduced. We make recommendations for improvements to the sixth core competency that would be part of a larger effort to achieve sustainability in the U.S. healthcare system.