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In the period from January 2013 to July 2014, three process change initiatives were undertaken at a major UK hospital to improve the patient discharge process. These initiatives were inspired by the findings of a study of the discharge process using Soft Systems Methodology. The first initiative simplified time-consuming paperwork and the second introduced more regular reviews of patient progress through daily multi-disciplinary "Situation Reports". These two initiatives were undertaken in parallel across the hospital, and for the average patient they jointly led to a 41% reduction between a patient being declared medically stable and their being discharged from the hospital. The third initiative implemented more proactive alerting of Social Care Practitioners to patients with probable social care needs at the front door, and simplified capture of important patient information (using a "SPRING" form). This initiative saw a 20% reduction in total length of stay for 88 patients on three wards where the SPRING form was used, whilst 248 patients on five control wards saw no significant change in total length of stay in the same period. Taken together, these initiatives have reduced total length of stay by 67% from 55.8 days to 18.6 days for the patients studied.

Many hospitals face a daily struggle to manage capacity, especially where wards contain patients with a combination of health and social care needs. In this study, Soft Systems Methodology was used to understand the process of discharging patients from an acute hospital and to answer the question 'Why do patients with complex needs often spend longer on the wards than is necessary?'. Through a series of twenty structured interviews, several problems with the discharge planning process were identified. Problems included ineffective communication, slow processing of paperwork, limited forward planning, no clear ownership of the process and delays in finding care in the community. The persistence of these problems despite longstanding guidance on discharge planning can be understood by recognising the tension between two different philosophies in hospitals -a traditional 'Care' mindset focusing on the immediate needs of patients on the wards, and a planning-focused 'Flow' mentality, where the hospital's responsibility to the wider community dominates. Soft Systems Methodology was found to be an effective approach for discussing discharge planning and highlighting this tension. Based on the insights gained from the interviews, three practical initiatives have now been implemented to reconcile the tension and thereby reduce delays in the hospital.

Construction projects are becoming ever more ambitious in terms of the size of structures, the number of requirements, the number and influence of stakeholders, and the extent to which technology is integrated into buildings. Whilst great buildings may historically have been designed and built by a single guiding mind -'the architect' -modern buildings require teams of specialists to work together to develop ideal solutions. In these circumstances, to ensure that construction projects are delivered to time, to budget and to the requirements specified by the customer, the construction industry could benefit from adopting a systems engineering approach to design. Based on 45 years of spacecraft instrumentation research and development and over ten years' experience teaching Systems Engineering in a range of industries, University College London's Mullard Space Science Laboratory has identified a set of guiding principles that have been found to be critical in delivering successful projects in the most demanding of environments. The five principles are: 'principles govern process', 'seek alternative systems perspectives', 'understand the enterprise context', 'integrate systems engineering and project management', and 'invest in the early stages of projects'. Behind these principles is a will to anticipate and respond to a changing environment with a focus on achieving long--term value for the enterprise. These principles are applied in both space projects and non--space projects (through UCL's Centre for Systems Engineering), and are embedded in UCL's teaching and professional training programme. These principles could contribute to the successful delivery of complex building projects.2

Systems Engineering is not a new discipline; the term has been in use since World War II. Yet, while there has been no shortage of definitions of the term over the years (not all of which are consistent), there is little consensus on the scope of Systems Engineering. This is particularly true in relation to other overlapping disciplines such as System Dynamics, Operations Research, Industrial Engineering, Project Management, Soft Systems Methodology, Specialist Engineering, and Control Theory, which share many of the origins and techniques of Systems Engineering. This paper presents a landscape of disciplines and suggests that INCOSE should “brand” Systems Engineering strategically, defining explicitly its position within this landscape including its points of parity (overlaps) and points of difference with other disciplines. Actively branding Systems Engineering will broaden its appeal and attract more interest from stakeholders outside the current Systems Engineering community. INCOSE's “market share” relative to its biggest systems competitor—Project Management—is falling, so even though INCOSE membership is rising, more needs to be done to promote the profession. © 2005 Wiley Periodicals, Inc. Syst Eng 8: 164–186, 2005