Complex adaptive systems in healthcare
51 views | +0 today
Follow
Your new post is loading...
Your new post is loading...
Scooped by Alison Turner
Scoop.it!

Edgeware: Insights From Complexity Science For Health Care Leaders: Amazon.co.uk: Brenda Zimmerman, Curt Lindberg, Paul Plsek: Books

Edgeware: Insights From Complexity Science For Health Care Leaders

~ Paul Plsek (author) More about this product
List Price: £24.22
Price: £21.14
You Save: £3.08 (13%)
Edgeware: Insights From Complexity Science For Health Care Leaders: Amazon.co.uk: Brenda Zimmerman, Curt Lindberg, Paul Plsek: Books
more...
No comment yet.
Scooped by Alison Turner
Scoop.it!

Implementation Science | Full text | Organizational interventions employing principles of complexity science have improved outcomes for patients with Type II diabetes

Despite the development of several models of care delivery for patients with chronic illness, consistent improvements in outcomes have not been achieved. These inconsistent results may be less related to the content of the models themselves, but to their underlying conceptualization of clinical settings as linear, predictable systems. The science of complex adaptive systems (CAS), suggests that clinical settings are non-linear, and increasingly has been used as a framework for describing and understanding clinical systems. The purpose of this study is to broaden the conceptualization by examining the relationship between interventions that leverage CAS characteristics in intervention design and implementation, and effectiveness of reported outcomes for patients with Type II diabetes.
more...
No comment yet.
Scooped by Alison Turner
Scoop.it!

Implementing Innovative Models of Dementia Care: The Healthy Aging Brain Center

Implementing Innovative Models of Dementia Care: The Healthy Aging Brain Center | Complex adaptive systems in healthcare | Scoop.it

Click here to edit the content

more...
No comment yet.
Scooped by Alison Turner
Scoop.it!

Using Learning Teams for Reflective Adaptation (ULTRA): Insights From a Team-Based Change Management Strategy in Primary Care

Using Learning Teams for Reflective Adaptation (ULTRA): Insights From a Team-Based Change Management Strategy in Primary Care | Complex adaptive systems in healthcare | Scoop.it
more...
No comment yet.
Scooped by Alison Turner
Scoop.it!

Integrated care in the emergency department: a complex adaptive systems perspective.

Integrated care in the emergency department: a complex adaptive systems perspective. | Complex adaptive systems in healthcare | Scoop.it
Emergency clinicians undertake boundary-work as they facilitate patient trajectories through the Emergency Department (ED). Emergency clinicians must manage the constantly-changing dynamics at the...
more...
No comment yet.
Scooped by Alison Turner
Scoop.it!

The meaning of integrated care: a systems approach | Edgren | International Journal of Integrated Care

The meaning of integrated care: a systems approach | Edgren | International Journal of Integrated Care | Complex adaptive systems in healthcare | Scoop.it
The meaning of integrated care: a systems approach
more...
No comment yet.
Scooped by Alison Turner
Scoop.it!

Outcome mapping for health system integration

Outcome mapping for health system integration | Complex adaptive systems in healthcare | Scoop.it
Peer reviewed article authored by (Tsasis P, Evans JM, Forrest D, Jones RK). Read article or submit your manuscript for publishing.
more...
No comment yet.
Scooped by Alison Turner
Scoop.it!

How Do You Modernize a Health Service? A Realist Evaluation of Whole-Scale Transformation in London

How Do You Modernize a Health Service? A Realist Evaluation of Whole-Scale Transformation in London | Complex adaptive systems in healthcare | Scoop.it

Context: Large-scale, whole-systems interventions in health care require imaginative approaches to evaluation that go beyond assessing progress against predefined goals and milestones. This project evaluated a major change effort in inner London, funded by a charitable donation of approximately $21 million, which spanned four large health care organizations, covered three services (stroke, kidney, and sexual health), and sought to "modernize" these services with a view to making health care more efficient, effective, and patient centered.
Methods: This organizational case study draws on the principles of realist evaluation, a largely qualitative approach that is centrally concerned with testing and refining program theories by exploring the complex and dynamic interaction among context, mechanism, and outcome. This approach used multiple data sources and methods in a pragmatic and reflexive manner to build a picture of the case and follow its fortunes over the three-year study period. The methods included ethnographic observation, semistructured interviews, and scrutiny of documents and other contemporaneous materials. As well as providing ongoing formative feedback to the change teams in specific areas of activity, we undertook a more abstract, interpretive analysis, which explored the context-mechanism-outcome relationship using the guiding question "what works, for whom, under what circumstances ?"
Findings: In this example of large-scale service transformation, numerous projects and subprojects emerged, fed into one another, and evolved over time. Six broad mechanisms appeared to be driving the efforts of change agents: integrating services across providers, finding and using evidence, involving service users in the modernization effort, supporting self-care, developing the workforce, and extending the range of services. Within each of these mechanisms, different teams chose widely differing approaches and met with differing success. The realist analysis of the fortunes of different subprojects identified aspects of context and mechanism that accounted for observed outcomes (both intended and unintended).
Conclusions: This study was one of the first applications of realist evaluation to a large-scale change effort in health care. Even when an ambitious change program shifts from its original goals and meets unforeseen challenges (indeed, precisely because the program morphs and adapts over time), realist evaluation can draw useful lessons about how particular preconditions make particular outcomes more likely, even though it cannot produce predictive guidance or a simple recipe for success. Noting recent calls by others for the greater use of realist evaluation in health care, this article considers some of the challenges and limitations of this method in the light of this experience and suggests that its use will require some fundamental changes in the worldview of some health services researchers.

more...
No comment yet.
Scooped by Alison Turner
Scoop.it!

Complex adaptive strategy to produce capacity-driven financial improvement

Abstract

Managing capacity in hospitals and emergency departments (EDs) is a global problem. This article demonstrates an efficiency model applied to an acute care hospital facing a budget shortfall as a result of capacity constraints that negatively affected admissions and increased ED diversions. Operating on the hypothesis that reducing inpatient length of stay would allow patients access through all service points and would return the admissions growth rate to budget, a turnaround team was quickly assembled and charged by the chief executive officer to fix the primary cause of financial underperformance--the creeping length of stay--within 60 days. This case study is generalizable to all organizations, regardless of size. Deploying an efficiency model based on the complex adaptive systems approach of "swarmware," the hospital's rapid turnaround efforts produced the results necessary to achieve two established goals: (1) length of stay was decreased to 0.1 days below budget in the 60-day time frame, and (2) all admissions and potential admissions were accepted (saying "yes" to patients) through key points of access in the hospital. Transfer Center denials were reduced to 0 in 19 days, and monthly ED diversions decreased from 110 hours to 20 hours in 60 days. By using a swarmware approach, the hospital created additional bed capacity, allowing for community demand to be accommodated, budgeted admissions target to be exceeded, and market share to be stabilized. This article describes this project's processes and outcomes and the lessons learned and applied, which will assist healthcare leaders who are facing capacity issues in their own organization.

more...
No comment yet.
Scooped by Alison Turner
Scoop.it!

How complexity science can inform a reflective process for improvement in primary care practices

more...
No comment yet.
Scooped by Alison Turner
Scoop.it!

Implementation Science | Full text | The importance of organizational characteristics for improving outcomes in patients with chronic disease: a systematic review of congestive heart failure

Despite applications of models of care and organizational or system-level interventions to improve patient outcomes for chronic disease, consistent improvements have not been achieved. This may reflect a mismatch between the interventions and the nature of the settings in which they are attempted. The application of complex adaptive systems (CAS) framework to understand clinical systems and inform efforts to improve them may lead to more successful interventions. We performed a systematic review of interventions to improve outcomes of patients with congestive heart failure (CHF) to examine whether interventions consistent with CAS are more likely to be effective. We then examine differences between interventions that are most effective for improving outcomes for patients with CHF versus previously published data for type 2 diabetes to explore the potential impact of the nature of the disease on the types of interventions that are more likely to be effective.
more...
No comment yet.
Scooped by Alison Turner
Scoop.it!

How complexity science can inform a reflective process for improvement in primary care practices

more...
No comment yet.
Scooped by Alison Turner
Scoop.it!

Understanding the complexity of redesigning care around the clinical microsystem

Understanding the complexity of redesigning care around the clinical microsystem | Complex adaptive systems in healthcare | Scoop.it
more...
No comment yet.
Scooped by Alison Turner
Scoop.it!

Crossing the Quality Chasm: A New Health System for the 21st Century

Crossing the Quality Chasm:  A New Health System for the 21st Century | Complex adaptive systems in healthcare | Scoop.it
Second in a series of publications from the Institute of Medicine's Quality of Health Care in America project Today's health care providers have more research findings and more technology available to them than ever before. Yet recent reports have raised serious doubts about the quality of health care in America. Crossing the Quality Chasm makes an urgent call for fundamental change to close the quality gap. This book recommends a sweeping redesign of the American health care system and provides overarching principles for specific direction for policymakers, health care leaders, clinicians, regulators, purchasers, and others. ...
more...
No comment yet.
Scooped by Alison Turner
Scoop.it!

ingentaconnect Systems thinking for transformational change in health

Incremental approaches to introducing change in Canada’s health systems have not sufficiently improved the quality of services and outcomes. Further progress requires ‘large system transformation’, considered to be the systematic effort to generate coordinated change across organisations sharing a common vision and goal. This essay draws on ongoing dialogue relating to transformation, and examines transformative efforts in the Saskatchewan health system. We aim to build a shared understanding of systems thinking in the context of transformation, and to outline examples of how systems thinking perspectives, with an emphasis on the role of evidence, may inform strategy for complex change initiatives.

more...
No comment yet.
Scooped by Alison Turner
Scoop.it!

Use of complex adaptive systems metaphor to achieve professional and organizational change - Rowe - 2005 - Journal of Advanced Nursing - Wiley Online Library

Use of complex adaptive systems metaphor to achieve professional and organizational change - Rowe - 2005 - Journal of Advanced Nursing - Wiley Online Library | Complex adaptive systems in healthcare | Scoop.it

Aim. This paper uses the experiences of a programme designed to bring about change in performance of public health nurses (health visitors and school nurses) in an inner city primary care trust, to explore the issues of professional and organizational change in health care organizations.

Background. The United Kingdom government has given increasing emphasis to programmes of modernization within the National Health Service. A central facet of this policy shift has been an expectation of behaviour and practice change by health care professionals.

Methods. Change was brought about through use of a Complex Adaptive Systems approach. This enabled change to be seen as an inclusive, evolving and unpredictable process rather one which is linear and mechanistic. The paper examines in detail how the use of concepts and metaphors associated with Complex Adaptive Systems influenced the development of the programme, its implementation and outcomes.

Findings. The programme resulted in extensive change in professional behaviour, service delivery and transformational change in the organizational structures and processes of the employing organization. This gave greater opportunities for experimentation and innovation, leading to new developments in service delivery, but also meant higher levels of uncertainty, responsibility, decision-making and risk management for practitioners.

Conclusion. Using a Complex Adaptive Systems approach was helpful for developing alternative views of change and for understanding why and how some aspects of change were more successful than others. Its use encouraged the confrontation of some long-standing assumptions about change and service delivery patterns in the National Health Service, and the process exposed challenging tensions within the Service. The consequent destabilising of organizational and professional norms resulted in considerable emotional impacts for practitioners, an area which was found to be underplayed within the Complex Adaptive Systems literature. A Complex Adaptive Systems approach can support change, in particular a recognition and understanding of the emergence of unexpected structures, patterns and processes. The approach can support nurses to change their behaviour and innovate, but requires high levels of accountability, individual and professional creativity.

more...
No comment yet.
Scooped by Alison Turner
Scoop.it!

Complexity and whole-system change programmes

Objective: There has been growing interest in applying complexity theory to health care systems, both in policy

and academic research discourses. However, its application often lacks rigour – authors discuss the properties

of complex systems, state that they apply to health care and draw conclusions anchored around the idea of ‘whole

system change’. This paper explores the use of whole systems change in a programme to improve the delivery of

unscheduled health care in Scotland.

Methods: Qualitative case-studies of five health boards in Scotland reflecting different demographics, initial

performance data and progress towards meeting programme targets.

Results: The programme’s collaborative approach was successful in moving to a culture of mutual

understanding and greater awareness of the interdependencies between different functions within the

hospitals. There was whole system working at the acute hospital level, leading to improved patient flows. But

despite recognizing the need for whole system change overall, it proved hard to address relationships with

stakeholders influencing wider out-of-hospital patient flows. This was exacerbated by the structure of the

programme, which was designed much more around acute patient flows.

Conclusions: The programme worked well to improve performance by focusing on interdependencies within a

large part of the acute care subsystem but did not have the same impact at the overall health care system level.

This has important implications for the design of policy and associated programmes which seek to effect

whole system reform, or at least are realistic about the magnitude of change they can achieve.

more...
No comment yet.
Scooped by Alison Turner
Scoop.it!

Complex adaptive chronic care – typologies of patient journey: a case study - Martin - 2011 - Journal of Evaluation in Clinical Practice

Complex adaptive chronic care – typologies of patient journey: a case study - Martin - 2011 - Journal of Evaluation in Clinical Practice | Complex adaptive systems in healthcare | Scoop.it
more...
No comment yet.
Scooped by Alison Turner
Scoop.it!

Using Learning Teams for Reflective Adaptation (ULTRA): Insights From a Team-Based Change Management Strategy in Primary Care

more...
No comment yet.