Evaluation of patient-focused health care from a systems perspective

The purpose of this paper is to outline a hierarchic systems theory approac h as a framework for patient-focused evaluation in nursing and other health care areas. Such a framework allows for complex features of processes in h ealth care to appear by simultaneous analyses of relationships on different levels and with different methods. In nursing and caring research mostly a 'one-level' design has been employed. There is an awareness, however, that the outcome of the nursing process needs to be evaluated in a more differe ntiated manner. A systemic model is offered according to systems thinking w here both system levels and system dynamics in the 'downward' as well as 'u pward' direction are recognized as crucial in the analysis. Copyright (C) 2 000 John Wiley & Sons, Ltd.