System Engineering and Productivity

System Engineering and Productivity

Analysis and Improvement of Hospital Emergency Service Management Using the Soft Systems Methodology (Case Study: Emergency Services of Kosar Hospital, Semnan)

Articles in Press

Document Type : Research Paper

Authors
Azim Zarei 1
Mehdi Ebrahimi 2
1 Corresponding author: Professor, Faculty of Economics, Management and Administrative Sciences, University of Semnan, Semnan, Iran
2 Ph.D. Student, Faculty of Economics, Management and Administrative Sciences, University of Semnan, Semnan, Iran
10.22034/sep.2025.2067375.1368
Abstract
In complex, high-pressure, and multi-layered environments such as hospital emergency departments, system inefficiency is not simply due to a lack of resources, but rather the result of the uncoordinated interaction of human, structural, communication, and information components. The present study, with the aim of analyzing the problematic situation in the emergency department and designing the desired change, has used the soft systems methodology as an interpretive, participatory, and human-centered approach. In this study, the seven stages of SSM were fully implemented, from recognizing the current situation and drawing a rich picture, to defining the root system, designing a conceptual model, analyzing gaps, and identifying desirable and feasible changes. The research findings showed that the main functional nodes of the emergency department include: lack of a platform for dialogue and reflection of experiences, opaque structure and unclear division of duties, lengthy decision-making process and administrative bureaucracy, distrust of recorded information and rework, lack of a transparent channel for organizational learning, lack of a performance-based reward system, and lack of meaningfulness of data for stakeholders. In response to these challenges, seven intervention proposals were presented, including: designing the meeting structure, redesigning the admissions process, clearly defining roles and responsibilities, designing training packages, reviewing and modifying electronic documentation forms, setting up rapid feedback stations, and designing and deploying local performance indicators. This model is not only theoretical and generalizable, but also derived from a real organizational context and can be implemented in the field. Overall, the results show that traditional problem-solving approaches, without considering human understanding and systemic interactions, have failed in health-oriented organizations; and only through participation, dialogue, and joint redefinition of the problem can sustainable and effective changes be achieved.

Highlights

  • Learning-in-action process based on soft systems methodology
  • Participatory understanding and definition of the problem
  • Designing an ideal system model for emergency services management with relative agreement in Kowsar Hospital, Semnan

Keywords
Emergency
System Analysis
Soft Systems Methodology
Soft Operations Research
Human participation
Subjects

Copyright © Azim Zarei, Mehdi Ebrahimi

 

License

This article is released under the Creative Commons Attribution (CC BY 4.0) license. Anyone is free to copy, share, translate, and adapt this article for any purpose, whether commercial or non-commercial, as long as proper citation is given to the authors and original publication.

Ajami, S., Ketabi, S., & MahmoodAbadi, H. B. (2013). Reducing waiting time in emergency department at Ayatollah-Kashani Hospital using simulation (In Persian).
Aliyari, A., Seyed Mahmoudi, M., Rajaee, R., Ghorbani, A., & Najafi, M. (2018). Evaluating the average waiting time for an emergency medicine specialist visit in an emergency department: a case study. Management Strategies in Health System, 2(4), 260-266 (In Persian). https://dor.isc.ac/dor/20.1001.1.24766879.1396.2.4.2.8
Asgharian, M. R., & Firoozi Jah, F. (2024). A simulation model for optimizing patient flow and length of stay (Case study: Emergency department of a selected specialized hospital in Zahedan). Payavard Salamat, 18(4), 364-374 (In Persian). 
Augustsson, H., Churruca, K., & Braithwaite, J. (2019a). Mapping the use of soft systems methodology for change management in healthcare: A scoping review protocol. BMJ Open, 9(4), e026028.  https://doi.org/10.1136/bmjopen-2018-026028
Augustsson, H., Churruca, K., & Braithwaite, J. (2019b). Re-energising the way we manage change in healthcare: The case for soft systems methodology and its application to evidence-based practice. BMC Health Services Research, 19(1), 666.  https://doi.org/10.1186/s12913-019-4508-0
Augustsson, H., Churruca, K., & Braithwaite, J. (2020). Change and improvement 50 years in the making: A scoping review of the use of soft systems methodology in healthcare. BMC Health Services Research, 20(1), 1063.  https://doi.org/10.1186/s12913-020-05929-5
Checkland, P. B. (1978). The origins and nature of ‘hard’systems thinking. Journal of applied systems analysis, 5(2), 99-110.
Checkland, P., & Poulter, J. (2007). Learning for action: a short definitive account of soft systems methodology, and its use for practitioners, teachers and students. John Wiley & Sons.
Dinmohammadi, M. R., Abbasi, M., & Jalali, A. (2021). Performance indicators of emergency departments in educational hospitals of Zanjan University of Medical Sciences. Journal of Inflammatory Diseases, 25(3), 167–174  (In Persian).
Emes, M., Smith, S., Ward, S., Smith, A., & Ming, T. (2017). Care and flow: Using soft systems methodology to understand tensions in the patient discharge process. Health Systems, 6(3), 260–278.  https://doi.org/10.1057/s41306-017-0027-6
Fattahi, H., Vaziri, S. M., Soori, M., & Askaria, M. H. (2023). Examining Patient Waiting Time with a Simulation Approach (Case study: Emergency department of Qaem Hospital, Mashhad). Hospital Journal, 22(2), 53–70 (In Persian).
Feili, H. R., Alineghian, M., Tabari, M., Rahiminejad, A., Akbari, M., & Abnaki, M. (2010). Reducing patient waiting time in emergency department using simulation optimization technique: A case study. Journal of Health Administration, 13(40), 67–76 (In Persian).
Gharahi, A., Kheirkhah, A. H., Bagheri, A., & Ahmadi, M. (2014). Improving patient flow management process in emergency department using simulation and PROMETHEE method. Journal of Health Administration, 17(57), 11–25 (In Persian).
Heidari, K., Ahmadi, M. R., Forouzanfar, M. M., Hashemi, B., & Safari, S. (2022). Optimizing service delivery process in emergency department using value stream mapping and simulation: A qualitative study. Iranian Journal of Emergency Medicine, 9(1), e10 (In Persian).
Keshtkar, L., & Moradi, M. (2014). Improving emergency department performance using simulation. Journal of Hospital, 13(3), 9-15 (In Persian).
Lehaney, B., & Paul, R. J. (1996). The use of soft systems methodology in the development of a simulation of out-patient services at Watford General Hospital. Journal of the Operational Research Society, 47(7), 864–870.  https://doi.org/10.1057/jors.1996.112
Mayelafshar, M., Noohi, F., Riahi, L., & Nikravan, A. (2020). Investigating the Time Indicators of the Emergency Department and Design a Management Dashboard for it. Journal of Safety Promotion and Injury Prevention, 8(2), 86-96. https://doi.org/10.22037/meipm.v8i2.30539
Moghadam, M., & Mantagi, N. (2013). Improving the quality of medical services in hospitals by using QFD and Cardinal. Quantitative studies in management, 14(4), 154-164 (In Persian).
Nazari-Shirkouhi, S., Yaghoubi, A., & Taghizadeh Yazdi, M. R. (2019). Discrete event simulation and data envelopment analysis to improve the performance of hospital emergency department. Industrial Management Journal, 11(1), 63-82 (In Persian).  https://doi.org/10.22059/imj.2019.264549.1007479
Newell, K., Corrigan, C., Punshon, G., & Leary, A. (2017). Severe asthma: Emergency care patient-driven solutions. International Journal of Health Care Quality Assurance, 30(7), 628–637.  https://doi.org/10.1108/IJHCQA-09-2016-0127
Pourreza, A., Mosadeghrad, A. M., Zelikan, M., & Parsa, M. (2017). The impact of accreditation on emergency department performance. Journal of Health-Oriented Research, 3(3), 277–295 (In Persian).
Rahmani, H., Arab, M., Akbari, F., & Zeraati, H. (2007). Structure, processes, and activities of emergency departments in educational hospitals of Tehran University of Medical Sciences. Scientific Journal of School of Public Health and Institute of Public Health Research, 4(4), 13–22. (In Persian)
Rosmulder, R., Krabbendam, K., Kerkhoff, T., & Luitse, J. (2009). Action research and soft systems methodology for studying problems in emergency care delivery. International journal of healthcare technology and management, 10(4-5), 289-302. https://doi.org/10.1504/IJHTM.2009.030452
Saidi-Mehrabad, M., Ghousi, R., & Emami, S. G. (2018). Evaluation of the performance of hospital rapid emergency department based on the lean principles. Health Information Management, 15(4), 162–167 (In Persian).  https://doi.org/10.22122/him.v15i4.3554
Sarani, M., Bastan, M., & Salimi, B. (2022). Performance Evaluation of the Hospital's Emergency Department: An Integrated Approach based on Resilience Engineering and Lean Management. Journal of Industrial Management Perspective, 12(3), 9-37 (In Persian).  https://doi.org/10.52547/jimp.12.3.9
Shafaghsorkh, O., & Ayough, A. (2022). Application of soft operations research methods in healthcare: A systematic review. Journal of Industrial Engineering and Management Studies, 9(1), 136–147. 
Shafaghsorkh, O., Ayough, A., & Alem Tabriz, A. (2024). Identifying the problems facing the development of patient telemonitoring systems and providing solutions from users’ perspectives: Application of soft systems methodology. Journal of Industrial Management Perspective, 14(2), 9–33 (In Persian).  https://doi.org/10.48308/jimp.14.2.9
Soltani, A., Heyrani, A., Fakhr-Movahedi, A., & Khajavi, A. (2021). Soft systems methodology for implementing clinical practice guidelines in a general hospital: a study protocol.  https://doi.org/10.21203/rs.3.rs-290681/v1
Taghavi Fard, M. T., Oftadeh, R., & Aghaei, M. (2017). Improving hospital treatment processes using simulation and queuing theory (Case study: Emergency department of Hasheminejad Hospital). Journal of Industrial Management Studies, 15(45), 103–126 (In Persian).
Tavakoli, N., & Bagherian, H. (2023). Prioritizing the Challenges of Implementation of the Electronic Medical Record in the Emergency Department of Hospitals. Health Information Management, 20(2), 79–85 (In Persian). https://doi.org/10.48305/him.2023.41826.1122
Torlak, N. G., & Müceldili, B. (2014). Soft systems methodology in action: The example of a private hospital. Systemic Practice and Action Research, 27(4), 325–361.  https://doi.org/10.1007/s11213-013-9290-z
Yousefi Nejad Atari, M., Neyshabouri Jami, E., & Sattari, A. (2020). Optimizing the service provision time in the emergency department using mathematical modeling and simulation (case study: Imam Reza Hospital). Engineering Management and Soft Computing, 6(1), 63-89 (In Persian).  https://doi.org/10.22091/jemsc.2018.2964.1066
Zarei, A., Marraji, M., Mazlom, R., Yousefi, S., & Fazaeli, R. (2023). The effectiveness of feedback methods in improving documentation of nurses in the emergency department of Imam Reza Hospital, Mashhad. Journal of Medical Informatics Systems, 9(2), 168–179 (In Persian).
Zarei, E., & Shamsaddini, L. A. (2017). Service Quality in Emergency Departments of the Public and Private Hospitals from the Patient's Perspective. Journal of Safety Promotion & Injury Prevention, 5(1) (In Persian).  https://doi.org/10.22037/meipm.v5i1.17615
System Engineering and Productivity

Articles in Press, Accepted Manuscript
Available Online from 25 August 2025

  • Receive Date 29 July 2025
  • Revise Date 20 August 2025
  • Accept Date 25 August 2025
  • First Publish Date 25 August 2025
  • Publish Date 25 August 2025