• Engineers cannot fix healthcare alone, and clinicians cannot carry the burden without systems support. The NWU is bridging this gap.
• Healthcare systems engineering can be seen as an umbrella term where the healthcare habitat is viewed as a complex system that encompasses technical, organisational, human, and policy dimensions.
• “Using techniques such as mathematical and simulation modelling, we can, for example predict how many patients will arrive at an emergency care facility on a particular day, such as a Saturday in flu season, and how to deploy staff shifts and use hospital beds to ensure the shortest possible waiting time,” explains Dr Maria van Zyl.
Healthcare in South Africa is a study in contradictions. It is a system burdened by rising demand, chronic understaffing, inconsistent data use, and widening socio economic pressures. Yet it is also a space of innovation, where new ways of thinking promise real, measurable improvements. At the North West University (NWU), this promise is being shaped by Healthcare Systems Engineering, a transdisciplinary initiative that began as a doctoral pursuit and has since grown into a national strategic asset.
Dr Maria van Zyl traces its origins to a simple observation during her doctoral work: “The focus of my doctoral research was to investigate how operational processes and decision making can be improved in South African healthcare systems by making use of operations research and management science.” What she found was a gap not in will, but in method. “It soon became apparent that the application of these tools in South African healthcare settings is limited and that a transdisciplinary approach where stakeholders are involved is required.”
The conclusion was unavoidable: engineers cannot fix healthcare alone, and clinicians cannot carry the burden without structural support. “This led to the active engagement of experts in nursing science to assist and expand our engineering approach for sustainable improvements,” she says. The result is a uniquely South African model, one that refuses the idea that healthcare is a machine to be repaired by numbers alone.
For Dr van Zyl, healthcare systems engineering is an expansive, integrative discipline. She describes it not as a subset of technology or analytics, but as a way of understanding the full ecosystem of care. “Healthcare systems engineering can be seen as an umbrella term where the healthcare habitat is viewed as a complex system that encompasses technical, organisational, human, and policy dimensions.” The work, she argues, lies in “the improved integration and management of these aspects,” recognising that no single discipline holds the solution to South Africa’s healthcare pressures.
The practical application of this thinking is already reshaping hospital operations. South Africa’s hospitals face a relentless paradox: rising demand and fixed resources. “To best serve patients, scarce resources have to be carefully deployed and managed,” van Zyl explains. Staff, beds, equipment, emergency capacity are all but some om the variables that shifts daily, often hourly. It is here that data driven methods prove indispensable. “By developing models of both demand variability and subsequent resource utilisation through data analytics and tools such as simulation modelling and machine learning, we have a better understanding of how the system responds to varying demand.”
She offers an example that would be familiar to any South African emergency physician: seasonal surges. “Using mathematical and simulation modelling, we can for example predict how many patients will arrive at an emergency care facility on a particular day, such as a Saturday in flu season, and how to deploy staff shifts and use hospital beds to ensure the shortest possible waiting time.” Machine learning extends this beyond patients to staff wellbeing. “Data analytics can assist us to predict what the biggest contributors to nurse burnout will be and to what extent high patient loads will have a negative outcome on their mental health.” In a country where burnout contributes to devastating staff losses, this is not an academic exercise; it is frontline intervention.
Yet the initiative is not only about current systems. It is equally concerned with who will run South Africa’s hospitals tomorrow. NWU’s engineering students are trained not merely as technologists, but as systems thinkers. “We believe that practical engagement with real life problems enables them to develop the necessary skills to creatively solve problems,” she says. Serious games - digital simulations of operational crises - allow students to make decisions with consequences. “In a serious gaming environment, students have the opportunity to decide how to allocate ICU patients and ward patients in a hospital to minimise waiting and fatalities whilst not allocating too many resources,” she explains. Their choices affect budgets, outcomes, and lives, just as in the real world.
Looking ahead, the initiative is positioning NWU as a continental leader in sustainable, data driven healthcare aligned with global goals. “We believe that the unique challenges in South Africa’s healthcare system can only be solved by taking a transdisciplinary approach and leveraging from the unique knowledge and skills of both engineers and clinicians.” The establishment of the NWU medical school and deeper collaboration with the nursing school mark what she calls an inflection point. “A new generation of nurses and doctors can be exposed to engineering thinking and view their practice environment as systems.”
Global partners have taken notice. “Our research footprint extends beyond South Africa and includes international collaborators,” she notes, highlighting engagements with the University of Twente in the Netherlands and a prominent research group at the University of California, Berkeley. Both institutions have expressed interest in translating NWU’s locally developed models into broader international contexts.
The ambition is clear: a system that delivers better care, makes better decisions, improve patient and clinical staff outcomes, and treats healthcare not as a crisis to be managed but as a complex environment to be understood. In van Zyl’s view, this is both a national responsibility and an intellectual opportunity. “We contribute to improving healthcare systems by leveraging expertise across disciplines and getting unique and relevant input to practically solve problems and provide sustainable healthcare to all South Africans.”
South Africa’s healthcare challenges are immense. But at NWU, so is the determination to engineer their solutions.
Dr Maria van Zyl
