scholarly journals Complex adaptive systems approaches in health care—A slow but real emergence?

2018 ◽  
Vol 24 (1) ◽  
pp. 266-268 ◽  
Author(s):  
Carmel M. Martin
Keyword(s):  
Health Care ◽  
Complex Adaptive Systems ◽  
Adaptive Systems ◽  
Systems Approaches ◽  
Complex Adaptive

Information as Change Agent or Barrier in Health Care Reform?

2013 ◽  
pp. 1-17
Author(s):  
Alan C. Gillies ◽  
John Howard
Keyword(s):  
Health Care ◽  
Complex Adaptive Systems ◽  
Adaptive Systems ◽  
Process Models ◽  
Value Systems ◽  
Care Services ◽  
Primary Care Services ◽  
Complex Adaptive ◽  
Care Systems

Health care systems across the world are in a state of flux. If the experience of the early 1990s can be used as a model, the recent global economic downturn will lead to very significant pressures to reduce spending and achieve better value. Systems have provided a range of approaches to modeling and evaluating these more complex organizations, from simple process models to complex adaptive systems. This paper considers the pros and cons of such approaches and proposes a new modeling approach that combines the best elements of other techniques. This paper also describes a case study, where the approach has been deployed by the authors. The case study comes from health care services in Ontario, Canada, who are shifting from the traditionally hospital-based system to one that recognizes a greater role for community and primary care services.

Patient Journey Record Systems (PaJR)

2011 ◽  
pp. 75-92 ◽  
Author(s):  
Carmel M. Martin ◽  
Rakesh Biswas ◽  
Ankur Joshi ◽  
Joachim P. Sturmberg
Keyword(s):  
Health Care ◽  
Complex Adaptive Systems ◽  
Adaptive Systems ◽  
Explicit Knowledge ◽  
Care Delivery ◽  
Allied Health Professionals ◽  
Patient Journey ◽  
Complex Adaptive ◽  
Care Systems ◽  
The Individual

This chapter argues the need for a paradigm shift to focus health care from a top down fragmented process driven activity to a user-driven journey of the individual whose health is at stake. Currently many person/patients express needs that are often overlooked or not understood in the health system, and the frontline care workers express frustration in relation to care systems that prevent them from optimizing their care delivery. We argue that complex adaptive systems and social constructionist theories provide a link for knowledge translation that ultimately will lead to improved health care and better personal health outcomes/experiences. We propose the Patient Journey Record System (PaJR) as a conceptual framework to transform health care so that it supports and improves the experience of patients and improves the quality of care through adaptable and interconnected provider information and care systems. Information technology, social networking and digital democracy is proposed as a major solution to the need to put the patient and their journey at the centre of health and health care with real time shaping of care to this end. Placing PaJR at the centre of care would enable patients, caregivers, physicians, nurses, allied health professionals and students to contribute to improving care. PaJR should become a ‘discovery tool’ of new knowledge arising from different types of experiences ranging from the implicit knowledge in narratives through to the explicit knowledge that is formalized in the published peer reviewed literature and translated into clinical knowledge.

scholarly journals Using Complexity Assessment to Inform the Development and Deployment of a Digital Dashboard for Schizophrenia Care: Case Study (Preprint)

2019 ◽  
Author(s):  
Andreas Gremyr ◽  
Boel Andersson Gäre ◽  
Trisha Greenhalgh ◽  
Ulf Malm ◽  
Johan Thor ◽  
...  
Keyword(s):  
Health Care ◽  
Complex Adaptive Systems ◽  
Adaptive Systems ◽  
Point Of Care ◽  
Scale Up ◽  
Mental Illnesses ◽  
Complex Adaptive ◽  
Complexity Assessment ◽  
Practical Implications

BACKGROUND Health care is becoming more complex. For an increasing number of individuals, interacting with health care means addressing more than just one illness or disorder, engaging in more than one treatment, and interacting with more than one care provider. Individuals with severe mental illnesses such as schizophrenia are disproportionately affected by this complexity. Characteristic symptoms can make it harder to establish and maintain relationships. Treatment failure is common even where there is access to effective treatments, increasing suicide risk. Knowledge of complex adaptive systems has been increasingly recognized as useful in understanding and developing health care. A complex adaptive system is a collection of interconnected agents with the freedom to act based on their own internalized rules, affecting each other. In a complex health care system, relevant feedback is crucial in enabling continuous learning and improvement on all levels. New technology has potential, but the failure rate of technology projects in health care is high, arguably due to complexity. The Nonadoption, Abandonment, and challenges to Scale-up, Spread, and Sustainability (NASSS) framework and complexity assessment tool (NASSS-CAT) have been developed specifically to help identify and manage complexity in technology-related development projects in health care. OBJECTIVE This study aimed to use a pilot version of the NASSS-CAT instrument to inform the development and deployment of a point-of-care dashboard supporting schizophrenia care in west Sweden. Specifically, we report on the complexity profile of the project, stakeholders’ experiences with using NASSS-CAT, and practical implications. METHODS We used complexity assessment to structure data collection and feedback sessions with stakeholders, thereby informing an emergent approach to the development and deployment of the point-of-care dashboard. We also performed a thematic analysis, drawing on observations and documents related to stakeholders' use of the NASSS-CAT to describe their views on its usefulness. RESULTS Application of the NASSS framework revealed different types of complexity across multiple domains, including the condition, technology, value proposition, organizational tasks and pathways, and wider system. Stakeholders perceived the NASSS-CAT tool as useful in gaining perspective and new insights, covering areas that might otherwise have been neglected. Practical implications derived from feedback sessions with managers and developers are described. CONCLUSIONS This case study shows how stakeholders can identify and plan to address complexities during the introduction of a technological solution. Our findings suggest that NASSS-CAT can bring participants a greater understanding of complexities in digitalization projects in general.

scholarly journals Using Complexity Assessment to Inform the Development and Deployment of a Digital Dashboard for Schizophrenia Care: Case Study

10.2196/15521 ◽  
2020 ◽  
Vol 22 (4) ◽  
pp. e15521
Author(s):  
Andreas Gremyr ◽  
Boel Andersson Gäre ◽  
Trisha Greenhalgh ◽  
Ulf Malm ◽  
Johan Thor ◽  
...  
Keyword(s):  
Health Care ◽  
Complex Adaptive Systems ◽  
Adaptive Systems ◽  
Point Of Care ◽  
Scale Up ◽  
Mental Illnesses ◽  
Complex Adaptive ◽  
Complexity Assessment ◽  
Practical Implications

Background Health care is becoming more complex. For an increasing number of individuals, interacting with health care means addressing more than just one illness or disorder, engaging in more than one treatment, and interacting with more than one care provider. Individuals with severe mental illnesses such as schizophrenia are disproportionately affected by this complexity. Characteristic symptoms can make it harder to establish and maintain relationships. Treatment failure is common even where there is access to effective treatments, increasing suicide risk. Knowledge of complex adaptive systems has been increasingly recognized as useful in understanding and developing health care. A complex adaptive system is a collection of interconnected agents with the freedom to act based on their own internalized rules, affecting each other. In a complex health care system, relevant feedback is crucial in enabling continuous learning and improvement on all levels. New technology has potential, but the failure rate of technology projects in health care is high, arguably due to complexity. The Nonadoption, Abandonment, and challenges to Scale-up, Spread, and Sustainability (NASSS) framework and complexity assessment tool (NASSS-CAT) have been developed specifically to help identify and manage complexity in technology-related development projects in health care. Objective This study aimed to use a pilot version of the NASSS-CAT instrument to inform the development and deployment of a point-of-care dashboard supporting schizophrenia care in west Sweden. Specifically, we report on the complexity profile of the project, stakeholders’ experiences with using NASSS-CAT, and practical implications. Methods We used complexity assessment to structure data collection and feedback sessions with stakeholders, thereby informing an emergent approach to the development and deployment of the point-of-care dashboard. We also performed a thematic analysis, drawing on observations and documents related to stakeholders' use of the NASSS-CAT to describe their views on its usefulness. Results Application of the NASSS framework revealed different types of complexity across multiple domains, including the condition, technology, value proposition, organizational tasks and pathways, and wider system. Stakeholders perceived the NASSS-CAT tool as useful in gaining perspective and new insights, covering areas that might otherwise have been neglected. Practical implications derived from feedback sessions with managers and developers are described. Conclusions This case study shows how stakeholders can identify and plan to address complexities during the introduction of a technological solution. Our findings suggest that NASSS-CAT can bring participants a greater understanding of complexities in digitalization projects in general.

scholarly journals Better and fulfilling healthcare at lower costs: The need to manage health systems as complex adaptive systems

F1000Research ◽  
2019 ◽  
Vol 8 ◽  
pp. 789 ◽  
Author(s):  
Joachim P. Sturmberg ◽  
Johannes Bircher
Keyword(s):  
Health Care ◽  
Complex Adaptive Systems ◽  
Adaptive Systems ◽  
Complex Adaptive System ◽  
Healthcare Delivery ◽  
Healthcare Systems ◽  
Best Interests ◽  
Top Down ◽  
Behavioral Norms ◽  
Complex Adaptive

Rising healthcare costs are major concerns in most high-income countries. Yet, political measures to reduce costs have so far remained futile and have damaged the best interests of patients and citizen. We therefore explored the possibilities to analyze healthcare systems as a socially constructed complex adaptive system (CAS) and found that by their very nature such CAS tend not to respond as expected to top-down interventions. As CAS have emergent behaviors, the focus on their drivers – purpose, economy and behavioral norms – requires particular attention. First, the importance of understanding the purpose of health care as improvement of health and its experience has been emphasized by two recent complementary re-definitions of health and disease. The economic models underpinning today’s healthcare – profit maximization – have shifted the focus away from its main purpose. Second, although economic considerations are important, they must serve and not dominate the provision of healthcare delivery. Third, expected health professionals’ behavioral norms – to first consider the health and wellbeing of patients – have been codified in the universally accepted Declaration of Geneva 2017. Considering these three aspects it becomes clear that complex adaptive healthcare systems need mindful top-down/bottom-up leadership that supports the nature of innovation for health care driven by local needs. The systemic focus on improving people’s health will then result in significant cost reductions.

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