Systems-Based Practice 20 Years On: Navigating the System for Better Care.

Area of Science:

• Medical Education
• Health Systems Science
• Quality Improvement

Background:

• Systems-based practice (SBP) was established as a core competency in 1999 for healthcare quality and safety.
• Despite its importance, medical educators and trainees still face challenges in understanding and implementing SBP.
• Previous milestone development led to heterogeneity, prompting a need for a unified approach.

Purpose of the Study:

• To explore the history and challenges of implementing Systems-based practice (SBP) in medical education.
• To introduce the Harmonized Milestones 2.0 and supplemental guides designed to standardize SBP competency.
• To provide suggestions for leveraging new resources to improve SBP education and practice.

Main Methods:

• Review of the evolution of Systems-based practice (SBP) competency and its milestones.
• Analysis of the development of Harmonized Milestones 2.0 to create a shared language for SBP.
• Discussion of challenges and proposed strategies for SBP implementation using new educational tools.

Main Results:

• The Harmonized Milestones 2.0 define SBP through three subcompetencies: patient safety/quality improvement, systems navigation, and the physician's role in healthcare systems.
• New supplemental guides offer practical examples for applying SBP in complex healthcare settings.
• Despite available resources, significant work is still needed for effective SBP implementation.

Conclusions:

• The Harmonized Milestones 2.0 and supplemental guides represent a significant step toward standardizing Systems-based practice (SBP) education.
• Addressing implementation challenges requires collaborative effort from the academic medicine community.
• Advancing SBP is crucial for professional development and ensuring high-quality, safe patient care.